E-mail and texting. LinkedIn, Facebook and Twitter. Mobile phones. Socially and professionally, we are an electronically well-connected society. Leveraged effectively, these tools lend great value to communications, knowledge gathering and information sharing.
Innovative technology that enables a similar level of exchange and connectivity in healthcare exists today – allowing caregivers to share the “true” meaning of the ever-increasing amount of patient medical information and make meaningful use of it, regardless of the originating format or platform. This type of solution – recognized as “semantic interoperability” – is the most likely candidate to form the technological foundation for the widely dispersed integrated delivery network (IDN), the emerging patient-centered medical home, and eventually the monumental national health information network (NHIN).
Semantic interoperability exhibits the potential to inject efficiency into healthcare delivery and elevate the quality of medical care to its highest level. But it won’t be easy. Healthcare presents unique challenges not seen by other industries that have successfully incorporated interoperable platforms within their business model, such as banking or online travel services. Among the challenges, a disjointed care delivery system and the sensitive nature of medical data are significant obstacles to seamless connectivity and fruitful information exchange. Healthcare organizations and technology developers alike, however, are well aware of the need for genuinely connected healthcare and are striving to uncover effective interoperability solutions now and into the future.
Stressors on the Healthcare System
At no time in recent history has the healthcare system been under pressure to the degree it is today. Multiple external stimuli are driving up costs, impeding care delivery, and prompting unprecedented public and legislative scrutiny. What has contributed to this situation?
For one, patients today are generally sicker than ever before. Consider the aging “Baby Boomer” generation, of which more than 14,000 turn 60 every day. When combined with the fact that individuals are living longer than generations past—an average of 78 years, up nearly three years since 1989, according to the Centers for Disease Control and Prevention (CDC)—it’s easy to comprehend the dramatic increase in patients with more than one chronic condition. As a result, the proportional costs to managing multiple chronic conditions has increased at a faster rate than the number of people with these chronic conditions, lending not only to the healthcare system’s fiscal burden, but also to aging individuals’ mounting out-of-pocket costs for care.
Further, site of service has undergone a seismic shift. “Economics have driven many procedures out of acute care and into an ambulatory setting,” says Joel Diamond, MD, a partner in the Handelsman Family Practice, a family medicine practice in Pittsburgh, PA, and an adjunct associate professor at the Department of Biomedical Informatics at the University of Pittsburgh. When you likewise consider that we are an increasingly transient and mobile society – “snowbirds” with seasonal homes, job changes forcing cross-country moves – it’s easy to understand how healthcare has become the disjointed entity it is today.
And, of course, the industry is facing the specter of healthcare reform and concurrent incentive/penalty programs. While these represent an unknown quantity as of yet, there is little debate that some change in how medical care is paid for, and therefore delivered, will come to fruition. This will potentially affect all aspects of the industry—not the least of which will be the adoption of technologies to capture and manage increasing amounts of diverse patient data.
Within this milieu, it appears the concept of the patient-centered medical home is finally getting legs as a likely solution to many of these challenges. “The industry realizes that in order to offer truly effective preventive and disease management programs, it needs to establish a single hub for each individual’s medical care – a hub which will house current, comprehensive health records and clinical data that can then be made available along the continuum of care,” comments Diamond.
In order to achieve these laudable objectives, however, it is imperative that providers employ technology that reliably captures the appropriate patient data and enables clinicians to leverage the information into improved medical decision making and, ultimately, better outcomes.
Building a Connected Healthcare System
While all this makes theoretical sense, most healthcare leaders struggle with how to transform possibility into practice. There is little question that the answer lies in technology – interoperable systems that exchange data, delivering it in a “universal language” that will permit not only visibility, but usability.
“Healthcare has been on an admittedly slow, but nonetheless persistent, path when it comes to technology,” says Peter A. McClennen, President North America of dbMotion. “Retrospectively, it has become clear that technology is becoming accepted and assimilated in distinct waves.”
Early adopters stuck their toes in the water years ago with transactional systems that collected and distributed select information such as radiology and lab results – as well as demographic, insurance, claims and billing data. It became clear that this level of automation streamlined workflow, increased efficiency, cut costs and reduced administrative errors.
As usage spread, thought leaders began to realize that similar benefits could be achieved if patient records were handled electronically, too. The development and maturation of EHRs represented a giant step towards the aggregation of patient data into a single paperless record. Innovative providers quickly realized EHRs could increase clinical productivity and accuracy, which would ultimately lead to improved patient safety and medical outcomes.
While providers around the country continue to implement EHRs, healthcare has begun to accept a new challenge presented by this evolving technology: achieving connectivity among the many constituents involved the cycle of care—primary physicians, specialists, diagnostic service providers and so on.
But the current of change can’t end there. Connectivity is useless without an effective means of integrating and making use of the “true” meaning of patient data residing in isolated clinical systems – resulting in game-changing information management. It may be difficult to conceptualize, but when providers are afforded this wide-ranging connectivity, as well as the tools to integrate and assimilate this information in a useful manner, the potential for healthcare quality and clinical process improvement is nearly unlimited.
IDNs Serve as Thought Leaders and Change Agents
Integrated delivery networks find themselves in an ideal position to advance healthcare connectivity on any number of levels. By their very nature, IDNs encompass a diverse and expansive network of acute and ambulatory facilities, primary care and specialty physicians, and labs and ancillary services. These constituencies are linked by select shared services, with a supportive organizational framework already in place. In other words, IDNs have access to a “captive audience” and established channels to support deployment of new processes or technology. “In addition, IDNs are typically better able to absorb some of the initial costs and risks associated with establishing connectivity,” notes Diamond, “and often have necessary IT resources in place.”
But while IDNs are admittedly able to spearhead efforts to achieve connectedness, what triggers their willingness to do so? Industry experts point out that IDNs can achieve return on their investment in multiple ways:
Improving care delivered to patients through the network. Access to comprehensive patient information would equip caregivers with additional diagnostic and therapeutic information to drive enhanced medical decision-making, as well as minimize the chance of errors like medication interactions, and reduce unnecessary and expensive redundancies in tests and studies.
Consider the support interoperability gives a small primary care practice treating patients with diabetes. At each visit, the physician would have current lab results, and reports from colleagues who may have conducted retinal or foot exams in the interim. Likewise, the IDN could provide easy access to resources and information such as nutritionists and nurse educators that would otherwise be more difficult to obtain.
Enhancing the sustainability of its economic base. Increasingly, patient care is delivered by more than one provider in a community. A family physician or internist sees a patient and refers that individual to a specialist. It is in the best interest of of the IDN – and, actually, of the provider and the patient – to request consultations and the transfer of care to a colleague within the organization. By offering the assurance of connectivity, IDNs can assure stakeholders that neither the patient nor essential clinical information will be lost in the process.
Indeed, as healthcare grows increasingly competitive, the IDN itself cannot afford to allow revenue-generating services to migrate to other organizations. A PCP in one network, for instance, may evaluate a patient with sleep apnea. The physician could determine the patient needs to be seen at a sleep lab and may have three community facilities from which to choose. A connected network will tip the scale in favor of a referral to an associated facility. Or perhaps an internist believes a patient requires hip replacement. With connectivity, he most likely will request a consultation from an orthopedic surgeon in the network, who ultimately performs the surgery. Post operatively, a physical therapist within the IDN offers aftercare.
Advancing Connectivity with Semantic Interoperability
In order to optimize this level of connectivity, however, IDNs must implement an interoperability platform. Many of the technologies traditionally labeled as providing interoperability, however, fall short. Portals, for instance, allow providers to look at select pieces of information, but are unable to import or integrate the data into proprietary medical record systems. Interfaces allow select information to move between systems (e.g., lab software and an EHR). But the data generated in one system may be incomprehensible to the receiving system, rendering the exchange of minimal value.
Technology currently exists, however, to provide the wide-ranging connectivity required by IDNs – through which hospitals, ambulatory centers, clinics, community practices and labs can have access to the “true” meaning of up-to-date patient data. Known as semantic interoperability, this model effectively utilizes service oriented architecture (SOA), and allows an IDN or other healthcare organization to share and make sense of date being exchanged, even if it is created, stored and used by disparate systems. At the same time, semantic interoperability preserves the original meaning of the data to ensure its integrity in the host system.
For example, laboratories will often use different nomenclature to record test results. Semantic interoperability enables this data to be shared, aggregated and used, essentially by translating the variations in nomenclature to a common language. The advantage this offers clinicians as they strive to improve patient wellbeing is monumental. They will be able to integrate most recent results, even if they were ordered by another physician, into their care plan and generate reports such as trending analyses.
Of course, it would be shortsighted to limit the potential value of semantic interoperability to individual IDNs. The level of connectivity can be expanded to non-affiliated physicians, throughout the community, and beyond to regional, state or national organizations.
Semantic Interoperability in Action
Semantic interoperability isn’t just a pipe dream. Organizations such as UMass Memorial Health Care (UMMHC) are reaping its benefits today.
UMMHC serves central Massachusetts and consists of a Medical Center with three campuses in Worcester, a large primary care and specialty medical group, and four community hospitals. In mid-2007, recognizing the need to update its approach to information technology (IT), leadership initiated a strategic plan to effect necessary changes to the health system’s IT architecture quickly and cost effectively. The campaign was designed to address the needs of both the ambulatory and acute care settings. Plus, UMMHC wanted to preserve existing bright spots that supported the organization's forward-looking approach, such as its ambulatory electronic medical record (EMR).
The organization determined that interoperability needed to be a centerpiece of the new architecture to ensure “system-ness” within and between UMMHC facilities. Given that it would continue to rely upon disparate software applications, leaders were committed to ensuring UMMHC would be able to synthesize healthcare data from multiple and varying systems into a single, consolidated clinical view for each patient.
Ultimately, UMMHC selected health interoperability and intelligence solution vendor dbMotion as its partner to build its platform supporting semantic interoperability, and launched efforts to better leverage enterprise-wide IT capabilities to improve quality and enhance caregiver efficiency. To that end, the organization adopted a three-pronged PUSH-SUBSCRIBE-PULL data exchange model, which would ensure users could access just the right amount of data—not too much or too little—to provide the highest level of care possible.
- Data about patients referred to UMMHC are automatically “pushed” out to providers, in order to meet their need for information quickly and to increase their satisfaction with UMMHC.
- Providers are able to “subscribe” to information like discharge summaries and ED reports, encounters that often may occur without the PCP’s knowledge. Nevertheless, the PCP often delivers follow-up care and having current information in hand is vital.
- The “pull” functionality gives providers on-demand visibility
and access to all available information UMMHC has about a patient, no matter where he or she received care.
Elizabeth F. Willett is a Healthcare IT writer, based in Atlanta, following developments in Healthcare Interoperability and Intelligence.
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