When you think about your own healthcare or “patient” experience, you will most likely remember filling out multiple forms, entering the same demographic information in each form and having to repeat this process at each ancillary service. This hallmark of healthcare is due to lack of interoperability across the organization's various systems. In other words, the technology systems do not “talk” to each other.
However, when you think of your experience with other industries, such as banking, you probably do not remember filling out different forms with the same information for each type of account. System interoperability has been an expected experience in most industries for years. Healthcare is just catching up.
Historically, healthcare organizations have used short-term solutions to deal with interoperability issues, such as building interfaces between systems when needed. In addition, since each facility or department may work with a different vendor, there are multiple vendor relationships. This evolves into managing hundreds of interfaces from separate vendors, which becomes a problem.
The chaos associated with managing multiple interfaces and vendors is the antithesis of interoperability's purpose. The purpose of interoperability is to create a seamless flow of information across the enterprise that is easy to manage, access and use. Interoperability helps improve quality, reduce throughput time, and ultimately saves money through its efficiency. While we in healthcare strive for improved clinical outcomes, the fact is that unless we can connect our systems, continuity and quality of care remains largely dependent on an error-prone paper process and people.
The remedy is to achieve a seamless flow of information across the enterprise — and beyond to other constituents, including community physicians, clinics, suppliers and patients. The interoperability advocate must demonstrate the urgency of the need for the initiative — enough to overcome the barriers inherent in healthcare, including lack of resources, competing priorities, short-term thinking and the endemic “silo” paradigm in which each department plans for its own needs.
To build the business case for interoperability, locate the organization's “pain points” such as patient safety, patient and physician satisfaction, etc. Then, show how interoperability can help improve the problem. It is imperative that the interoperability initiative is aligned with the organization's strategic goals. Therefore, the interoperability advocate must be able to answer these questions, to start:
How does the organization define itself?
What is the organization's mission?
What are the organization's goals?
What are the challenges and pain points it faces?
What does the CEO worry about?
Then, define the mission of the interoperability initiative:
How can interoperability support the organization's strategic goals?
What are some strategies to accomplish these goals?
What are the tactics needed to accomplish each strategy?
What activities are involved in each tactic, and, finally,
How will each tactic, strategy and goal be measured and assessed as successful?
Here is a case in point. Due to mergers and acquisitions, a client healthcare network grew to 50 sites, including two hospitals, physician practices and community clinics — supported by various best-in-breed IT systems. Fortunately, a strategic plan for interoperability was included in the organization's mission. So we bypass the buy-in process and go straight to developing and executing the plan.
This client's answers to the aforementioned organization questions were as follows:
How does the organization define itself? We are a large healthcare network serving both an inpatient and an outpatient population at over 50 sites.
What is its mission? To provide the best healthcare and the best patient experience possible.
What are its goals? To be the best network in the geographic region in which we serve.
It is very easy to get stuck in wanting to be “the best.” But what exactly does that mean? Adjectives need to be clarified, attainable, and measurable. For this organization, “best” meant the best patient experience and the best quality of care.
The next exercise was defining “best patient experience.” For the interoperability initiative, it meant that the patient was “known” by all the departments that were part of the visit(s). It also meant that there were no surprises, delays, misinformation, redundant processes or frustration. It meant that the patient experienced “being taken care of” not only physically, but in regards to logistics such as registration and billing as well.
From a patient's standpoint, an organization with the same name across the enterprise should have the same information system. Having to repeat information at various check-in points is a perceived sign of lower quality.
With that clarified, the mission of interoperability can be defined:
How can interoperability support the organizational goals and mission?
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