Forward-thinking health care enterprises recognize the potential and promise offered by health information exchanges (HIEs). Data sharing within and between these organizations has been identified as a top strategic priority -- one that will improve care, cut costs and enhance productivity.
When undertaking these initiatives, many enterprises invest considerable resources in developing an effective governance model and constructing a viable organizational structure. It is vital, however, that an equal amount of time and effort be devoted to technology considerations.
Here are 10 key factors health care enterprises must consider while developing a technology plan and implementing systems or solutions that will advance their HIE objectives.
1) Define priorities and goals.
Ensure the enterprise clearly defines the specific priorities and goals that the HIE is designed to achieve. This requires leadership to look beyond its overarching vision of improving care delivery in the served community and optimizing the resources available to participants. Among objectives to pursue, for instance, is the creation of a physician portal or the extraction of data for participation in pay-for-performance (P4P) initiatives. These operational goals will allow leadership to zero in on specific functionality that technology will be required to support.
2) Understand relevant technology and terminology.
Gain a working knowledge of relevant technology and the terminology used to describe it. Without this understanding, the enterprise runs the risk of being misled by technology vendors eager to attract customers. For example, the enterprise might require interoperability, which the vendor may propose achieving through Web portals or interface engines -- neither of which represents true interoperability. Leaders must step back and educate themselves to ensure they can match the appropriate technology with the enterprise’s identified needs.
3) Think long term -- and beyond internal needs.
The first application selected and implemented represents the initial stone on a path to more extensive information exchange. The enterprise must be aware that these early steps act as a roadmap for creating a comprehensive infrastructure that serves emerging and future data-sharing opportunities. It is vital that these building blocks provide a solid foundation for subsequent expansion. Leadership must recognize that, while the first stages of HIE development may be accomplished internally, it is probable that the enterprise will participate in a regional health information organization sometime in the future. The architecture and policies that are established must eventually support both internal and external data sharing.
4) Focus on the value of data to be collected.
Avoid the trap of making technology decisions based solely upon which sets of clinical data are most readily available at the onset of the HIE. Instead, the enterprise must find the golden path between reaping immediate benefits with easily accessible information and identifying how to retrieve and use important but hard-to-extract data. Often, an enterprise will initially implement technology to make the most of “low-hanging fruit” -- which is the proper approach. However, these organizations should adopt a strategy that supports all varieties of data so they can access important, but non-standard, data as HIE efforts mature.
5) Become acquainted with SOA.
Acquire a genuine understanding of service oriented architecture (SOA), which holds great promise for effective HIE. SOA represents a standards-based approach to software design that enables the reuse and reconfiguration of components inherent to independent applications and systems. These components are known as services. Simply put, SOA facilitates a mix-and-match approach to system design. Services are pulled together and used to compose new applications, providing specific, self-contained functionality. This construct provides flexibility, efficiency and modularity -- all key to successful HIE. The term SOA is commonly misused, but health information technology vendors can serve as a good resource in helping leadership become educated about its potential and value.
6) Build upon what works.
Understand what works well within the current enterprise. If it’s not broken, don’t fix it. When effective processes and systems are already in place, they should be included in the implementation. For example, physicians may be accustomed to using an inpatient EMR, but lack vital information from the practice medical record. Instead of replacing either the familiar inpatient EMR or practice-based system, the inpatient system can simply be “empowered” with the outpatient data to retain familiar work processes.
7) Achieve operability before interoperability.
Ensure the enterprise has attained “operability” before undertaking “interoperability.” In other words, leadership must ascertain that technology users have learned and are comfortable with the technology on their desktops and at their fingertips, and that they actively use it to deliver patient care. Only then can integrated systems be introduced to attain the goal of interoperability.
8) Assume leadership and take ownership.
Balance consideration of the end-user’s preferences with the overall objectives of the enterprise. The enterprise needs to be inclusive throughout the decision-making process. Ultimately, however, executives must demonstrate leadership and ownership by making difficult and responsible decisions. Their task is to set priorities and direction for interoperability and HIE activities.
9) Simplify workflow transitions.
Do not underestimate the importance of workflow. While physicians and other users are genuinely committed to improving patient care and safety, they will reject changes that are too cumbersome and interfere significantly with productivity. Consider current processes and procedures when adopting technology for HIE, with the goal of supporting familiar workflow patterns. Identify what works and build upon it to drive adoption, and, ultimately, achieve greater return on investment.
10) Solicit buy-in from all stakeholders.
Undertake communication efforts to achieve complete buy-in by all key stakeholders in leadership roles. Too often, the health care enterprise focuses on eliciting support only from those clinicians and administrators who will actually be using the technology after implementation. However, the positive impact of interoperability extends the traditional bricks and mortar venues of patient care. All key stakeholders must be aware of the potential, and committed to maximizing benefit and value.
Dr. Diamond is a partner at Diamond, Fera and Associates, a family medicine practice in Pittsburgh, and CMO, North America, for dbMotion.
This article is also available on-line at ADVANCE for Health Information Executives.