Wednesday, January 20, 2016

Interoperability: Of course, it’s important!

This is the second installment of a series focused on interoperability, a key to continuing the momentum started by the Meaningful Use program, highlighted in “2016 HIT Trends: Consensus Predictions.”
As an in industry, Healthcare IT has succeeded in implementing the first phase of interoperability by solving the problem of internal integration. Despite best intentions, the next phase – integrating across institutions - is off to a slow start. 
Solving the first interoperability challenge focused on getting siloed systems within an individual hospital or facility to talk with one another. Time savings, error reduction and improved workflow provided the motivation to move on this initiative. Fortunately, when a hospital wants to integrate its existing systems: 
  • It owns the software and data network.
  • The employees share a common mission and management structure.
  • Standards like HL7 version 2.x and TCP/IP are equal to the task of integrating systems within a hospital's environment.
 Internal integration is a largely solved problem today as a result of many years of hard work by dedicated teams of integration specialists.
The new interoperability challenge before us is integrating data across different institutions. In addition to the technical difficulties discussed in my last article, integration across institutions involves the difficulties of managing a project across two (or more) different legal entities with their own management, processes, policies and priorities. The complexities of this problem remain unresolved, and that's why it appears on the list of predictions for 2016. 
In addition to communications and project management challenges, the second phase of interoperability is driven by different, more ambitious motivators. Some of these (1-3 below) are discussed at length in the AHA's publication, Why Interoperability Matters.
Top six motivators for integration between institutions 
1. Care Coordination
Care coordination means making sure a patient transitions smoothly among care settings, including their home. A recent Chilmark blog post provides an example of a patient with an injury who starts in an urgent care center, visits an orthopedist, and looks for his record in a patient portal. Patient data, including medication lists, discharge instructions, and progress notes need to flow through the system in tandem with the patient in order to produce the best outcomes and reduce admission risks.
2. Public Health Reporting
 Public health departments in all jurisdictions require clinicians to report on certain conditions when they are detected during a patient visit. Reporting processes are largely manual, which creates extra work for providers and results in untimely reports. Completely solving the public health reporting problem will require considerable effort, but interim progress would prove helpful, even with partial solutions.
3. Patient Engagement
 Patients become disengaged when the clinicians providing their care have poor communication tools. The AHA reports that one third of patients have had problems related to clinician information exchange, such as having to bring their own X-rays to an appointment. Interoperability isn't the only factor that limits patient engagement, but it's an important one to get under control.
4. Population Health
In Healthcare IT News, John Halamka, M.D. defines population health as the capability to "automatically aggregate data from multiple provider, payer and patient sources then create lists of patients with care gaps to be closed". This is only possible when the various sources are connected.
5. Analytics
To build the learning health system envisioned by the ONC's 10 year interoperability roadmap, it is necessary to run analytics on clinical, financial, and other data that comes from multiple data sources within and across institutions. This requires the ability to move data between and among facilities.
6. The Internet of Things (IoT)
Integrating data from medical and personal devices is required to support innovative patterns of healthcare delivery. The new types and formats of data from these devices present a novel challenge to integration tools and practitioners now and into the future. 
Meaningful Use may have intended to be a motivator of integration initiatives, but the real drivers are healthcare system reforms, such as new payment models and an emphasis on high quality and outcomes. Meaningful Use was an important incentive to help realize these changes and build the infrastructure to support them, but it was never a primary driver (and going forward it will be replaced).
My next article will discuss emerging technologies and policies that will impact interoperability in the near future.

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