Making the Case: An Evolutionary Strategy to Achieve Interoperability
As I’ve observed the efforts of integrated delivery networks to develop more interoperability between patient information systems, it’s striking how much frustration I hear about the difficulties of achieving shared access to uniform patient information across disparate clinical settings.
Irrespective of the approach these organizations take – whether it’s looking to a single vendor or a series of vendors to build a truly interoperational system – they often wind up in the same place; that is, administrators and clinicians are both frustrated by the amount of time, energy and resources they’ve devoted to interoperability without yielding the concrete results of every caregiver in a delivery network having access to the patient data they need – in the form and format they need.
I’m not suggesting that these efforts were ill-advised or ill-conceived. But as I’ve analyzed these initiatives, it has become apparent to me that there may well be a different, strategic approach that can accomplish the interoperability many integrated delivery networks seek and that can bypass many of the innate barriers that have largely stymied these efforts to date. I call this an “evolutionary” or “stepping stone” approach to interoperability.
This approach requires a different way of thinking about interoperability – one that recognizes that new technologies can enable sharing of patient information without direct interfaces between information systems or standard harmonization. In fact, sharing patient data among clinicians and caregivers can occur regardless of the type of information system, where the information resides or what format it is stored in.
The potential impact of this new evolutionary approach to interoperability can be significant. Today many healthcare organizations are struggling to make their information systems “communicate” to each other and use a single set of vocabularies as a precursor to achieving any degree of interoperability. The new reality is that these organizations can accomplish varying degrees of information sharing and exchange in a more costand time-efficient way.
Understanding Barriers to Interoperability
To understand this evolutionary strategy, it’s necessary to first look at the barriers that have made interoperability a largely elusive goal at many integrated delivery networks:
- Broad, ambitious goals – In my discussions with healthcare IT executives, clinicians and administrators, many talk of interoperability synonymously with decision support; that is, their focus is on the end game of having clinicians and caregivers with immediate access to all possible patient information to provide more cost-effective and efficient care and quality outcomes for patients. By definition then, the efforts to achieve interoperability create two large-scale challenges – getting the patient data to move effectively between disparate clinical information systems and then determining how to present the data to fit the needs of individual clinicians and clinical practices. I would assert that the sheer size and scope of this approach makes it, at best, extremely difficult to achieve.
- Structural inefficiencies – It’s certainly no secret that the need for interoperability has arisen from the growth of multiple patient information systems within healthcare organizations. Historically, individual departments have sought to use technology to improve the efficiency and quality of care. In turn, vendors have stepped in to provide individualized solutions. The result is often a matrix of separate, department-focused systems that do not effectively “communicate” with one another. Clinicians and caregivers in different departments (frequently in the same organization) often cannot access the information they might need about a patient because it was generated using a different system in another department. This backdrop creates a dual challenge when organizations start to focus on interoperability: First they must focus on enabling access to patient data from a variety of information systems and, second, they then need to ensure clinicians in different departments can retain the work flows and processes they’ve grown accustomed to using on these individualized systems.
- Few best-in-class examples – As integrated delivery networks work toward interoperability, it’s natural to seek out examples of how it’s been done successfully at other organizations. The reality, however, is that our industry has few shining examples of the best way to achieve interoperability. Some organizations that believe it’s best to invest in a singlevendor solution now speak of difficulties of relying on one vendor to work out the challenge of getting patient data to flow between disparate clinical systems. Other organizations have sought to hire integration specialists only to find that those systems may not fulfill the promise of decision support, which is truly the end game when it comes to improved sharing of patient information in healthcare settings. At the same time, I’ve conferred with some organizations that look to government sources for a solution, i.e., a government-mandated, standardized approach toward interoperability that all healthcare networks would follow.
With the lack of best-practice examples and marketplace confusion about how best to accomplish integration of medical information, it’s no wonder that some healthcare delivery networks and organizations have effectively thrown up their hands and adopted a wait-and-see approach. It is my belief, however, that these organizations do not have to stand still.With the advent of service-oriented architecture and other technologies that enable shared access to patient data and information, healthcare organizations can achieve the goals of true interoperability – without the frustrations many have experienced so far.
A Stepping Stone to Interoperability and Decision Support
The barriers that inhibit the exchange of medical information and integration of patient information systems are not limited to integrated delivery networks. In my work, I’ve assisted regional health information organizations (RHIOs) to overcome the challenges of ensuring that patient information follows individual patients electronically as they move from one care setting to another across geographical regions.
It is this experience, and the development of new health information exchange technology pioneered by dbMotion, that leads me to believe there is an evolutionary or stepping-stone strategy that healthcare organizations can use to accomplish their goals of interoperability – without getting beset by the barriers that often inhibit these efforts.
In its most simple terms, there is new data-integration technology now available that enables individual departments and organizations within an integrated delivery network, or that are participating in an RHIO, to view and share patient information in a more cost-effective and less pitfall-inducing manner than the approaches that many healthcare networks are employing today.
This technology makes interoperability a reality by breaking the strict interdependency between the setting of common standards for how data is created, stored and transferred electronically. Instead the technology enables access to patient data from a variety of information systems based on the degree of standardization the organization has achieved. This facilitates the best possible use of the data for their clinical care decision making.
Using this data-sharing technology has been shown to be a cost-effective and efficient way for healthcare networks in Israel to ensure that the information about a patient’s care and treatment follows a patient through the entire continuum of care – be it acute or community care settings. Clinicians there report improved quality of patient interactions, reductions in duplicate tests and procedures and greater satisfaction as a result of improved, shared access to patient information.
This data-sharing technology is a useful tool that can aid integrated delivery networks on their path toward greater interoperability among their clinical information systems. Its use effectively bypasses the innate hurdles of getting disparate information systems to “communicate” with each other and the perceived prerequisite of achieving universal agreement on the definitions and standards that make up a network’s patient care record.
To be clear, this is not to say that reaching such agreement isn’t fundamental to the efforts of organizations to reach the highest degrees of information exchange and interoperability.We should nevertheless realize that emerging technology can create a platform that enables interoperability no matter what degree of standards harmonization an individual organization has reached.
Even more important, though, is the profound effect this technology has on speeding the progress of using shared, universal access to patient information to support the decision making of clinicians and caregivers. After all, it is this as-yet missing link that can help all of us meet the goal of providing the best possible care to patients in a cost-effective and efficient manner.
