Interoperability, as it was envisioned, should be built on transparency and connectivity, allowing a patient’s critical health information to be easily accessible, regardless of where treatment is being administered. By creating an infrastructure that supports the sharing of patient data along the care continuum, hospitals, skilled nursing facilities (SNF) and long-term post-acute care (LTPAC) facilities can offer the best care possible. As a result, organizations that participate in interoperability best practices are positioned to become preferred providers.
Unfortunately, interoperability is still a work in progress for many organizations. While more than 95 percent of hospitals and 90 percent of office-based physicians are now utilizing electronic health record (EHR) platforms, many struggle with — or have reservations around — sharing information outside of their facility. As such, silos represent a great barrier to realizing a fully implemented state of interoperability.
The current data gap can drastically impact care. For example, a patient experiences a serious medical incident — such as a fall or stroke — and arrives at the hospital where staff may not have access to existing patient data which could inform the best delivery of care. Or perhaps they’re able to access that data, but not right away. Care is now delayed, which can be additionally concerning depending on the time-sensitivity of the patient’s condition.
Taking this example a step further, let’s explore what happens after care at the hospital has concluded. The patient requires rehabilitation, and a continuation of care document (CCD) is issued to a post-acute care facility. From there, the patient’s information is transferred by less-than-foolproof methods such as fax, for example. A glitch as simple as a jammed paper feed could prevent critical information from reaching the appropriate caregiver.
As value-based care and payment-care models are moving toward the forefront, blind handoffs of patient information are no longer viable, as they drastically increase the financial risks hospitals and payer groups are subject to — not to mention the clear detriment the system has on delivery of care.
Closing the gap
The larger question is how does the industry get from Point A to Point B? The easy answer is to liberate the data through a cloud-based infrastructure that supports an efficient, easy-to-access data exchange between all caregivers. An integrated solution would connect stakeholders across the care continuum, providing accurate insights when needed, eliminating data silos between care partners, and enabling more confident decision-making.
These systems would promote:
Optimized transitions: Data needs to travel with the patient — or before movement — discretely across all systems.
Patient visibility: Data should reflect the most current ADT information, identifying and sharing where a patient is and from where they’ve been discharged.
Central view of LTPAC patients: This facility-agnostic feature should offer automated updates of a patient’s functional progress.
Ongoing status and monitoring: Maintaining continued care is facilitated through alerts and notifications to caregivers regarding any change to their status or well-being and meaningful feedback on care pathway progress.
Facility performance: Beyond understanding a patient’s status, it’s also helpful to understand how facilities in and out of their PPN have performed.
The concept of interoperability, in some ways, seems contradictory to traditional best practices. Healthcare organizations are charged with protecting patient data at all costs, and the idea of sharing data in a way that opens access to a wider group of stakeholders could give pause. Regulatory infractions for data loss in the healthcare industry can be steep, and the number of well-publicized data breaches in recent years reinforces how valuable health records are to both the organizations who keep them and those who try to steal them.
So, it should go without saying that an EHR “superhighway” must be developed with security in its DNA, taking stringent regulatory requirements into account. The good news is that the newest breed of information exchange platforms is being built with security roles in mind, drastically reducing the possibility of data loss.
Interoperability between healthcare’s disparate systems seems to be the stickiest of wickets, and a Holy Grail that every soul in the sphere is trying to find. Given the number of conversations about the topic, there’s often little discussed about its actual importance. Perhaps this is an assumed measure or an outcome that should be clearly understood as positive, but every relevant aspect of every story should be covered, not simply assumed. Because far better reporters and publications have done a far better job of describing the interoperability issue and its place in the current healthcare landscape, I decided to ask one question of the community, in an search of a foundational answer to: How is interoperability critical to healthcare innovation?
The prospective provided here, from some of healthcare’s most knowledgeable insiders, offers some interesting insight into a topic that seems more or less overlooked in the larger conversation of achieving interoperability or its capabilities.
Rick Valencia, senior vice president and general manager, Qualcomm Life Interoperability is the future of healthcare innovation, especially as we move toward an era of connected, team-based care. We need to create platforms and devices that enable the seamless, frictionless flow of data to allow doctors, patients, providers and care teams to collaborate efficiently to make critical care decisions. As care moves from the hospital to the home and more patients are remotely monitored, we need solutions that enable continuous care, informed interventions, and better management of at-risk populations. Without interoperability, we can’t innovate. Without innovation, we can’t improve the health of our nation.
Interoperability is critical to innovation in healthcare IT, particularly when it comes to connecting the care delivery ecosystem to provide safer transitions of care between acute and senior care. While some individuals may require short-term rehabilitative care, others may need home-based care, assisted living or long-term and hospice care. As seniors move through these different stages or between acute care and post-acute care, these transitions pose challenges for healthcare providers. Ideally, all the information that clinicians need to treat the individuals will be available when they arrive at their new destination. However, this is not always the case. Healthcare providers must invest in an infrastructure and emerging technologies, such as electronic health records and mobile communications, which support seamless transitions; interoperability plays a vital role. Compared to single-purpose or “best-of-breed” software solutions, comprehensive platforms can optimize many parts of the business, from enabling better-connected resident care and documentation, to delivering high quality data insights for financial management and risk mitigation. In the end, this will allow for better health outcomes, help reduce unnecessary hospital readmissions, ensure organizations are financially sound and keep healthcare costs down.
It is estimated that one-fifth of the U.S. population will be 65 years or older by 2030. According to Florida Atlantic University, out of the 1.6 million Americans currently living in a nursing home, 60 percent of that population is sent to the emergency room, while another 25 percent are admitted to the hospital each year. As a result, the care transition process between senior communities and acute care providers has become critical to ensure the best outcomes for patients.
Traditionally, when a senior care resident is sent to a hospital, the receiving healthcare provider may not have a complete view of the patient’s history. Ideally, documentation and medical records should travel with the resident so that all the information clinicians will need to properly treat the individual will be available upon arrival. Unfortunately, this is often not the case.
The good news is that there is technology to help improve this process in three main ways:
Reducing unnecessary hospital readmissions
Reducing paper and therefore medication errors
Increased focus on person-centered care
Reducing unnecessary readmissions
There is a lot of talk in the industry about how technology is helping to reduce hospital readmissions, but these conversations often lack tangible, measurable results. One thing is certain – providers have benchmarks to meet. On Oct. 1, 2012, The Centers for Medicare & Medicaid Services (CMS) implemented penalties for hospital readmissions at a rate of one percent. By Oct. 1, 2014 this rate increased to three percent. By 2018, CMS is mandating that those same penalties that apply to hospitals will apply to skilled nursing facilities.
CommonWell Health Alliance announces the addition of five new members enhancing the association’s nationwide footprint, share of the EHR marketplace and diversity across the care continuum. MEDITECH, Merge and Kareo join as contributing members while PointClickCare and Surgical Information Systems (SIS) join as general members.
With the addition of these new members, CommonWell membership now represents 70 percent of the acute care EHR market and 20 percent of the ambulatory care EHR market. CommonWell membership also represents market leaders in imaging, perinatal, laboratory, retail pharmacy, oncology, population health, post-acute care and others across the care continuum.
“We know it takes collective experience and dedication to break down barriers to nationwide data exchange, so we are especially pleased to welcome these industry innovators to the CommonWell family,” said Nick Knowlton, Vice President of Business Development at Brightree and CommonWell Membership Committee Chair. “Each organization will contribute to our effort by providing a commitment to action and new perspectives for additional use cases that will help us accelerate our current deployment of real-world interoperability services.”
• MEDITECH is one of CommonWell’s largest members to join since inception. It provides fully integrated technology solutions for hospitals, ambulatory care centers, physicians’ offices, long term care and behavioral health facilities, and home care organizations. MEDITECH’s membership increases CommonWell’s share of the acute care market from 50% to 70%.
• Merge is a leading provider of enterprise imaging, interoperability and clinical systems that seek to advance health care. It offers solutions in radiology, eye care, cardiology, orthopedics and clinical trials—all of which provide the opportunity for CommonWell to develop new use cases across a broader spectrum of the health care continuum. Additionally, Merge has the most complete radiology solution on the market, from small-volume sites up to the largest practices and chains in the country.
“Merge embraces the opportunity to join CommonWell at a critical moment in health care,” said Steve Tolle, Chief Strategy Officer at Merge Healthcare. “Industry leaders must actively come together to make interoperability real, and the Alliance provides an effective platform for meaningful dialogue and collaboration to help chart the future trajectory of the health care industry.”
• Kareo brings more than 30,000 providers and 60,000 users of its cloud-based medical office software suite into CommonWell. As CommonWell continues to deploy services nationwide, Kareo’s ambulatory experience and reach will accelerate universal provider access to critical health care data.
I recently had the opportunity to attend PointClickCare’s annual user summit held in Orlando. Though the senior care market is not one I’ve spent a great deal of time covering, senior and long-term care are deeply interesting to me. There are several reasons for this interest: Seniors are becoming the largest population segment in the US and that has serious ramifications ranging from politics to economics, and because I’m interested in alternative care models. And, in some way, senior care effects all of us.
There are a number of differences between senior care and ambulatory or in patient, but the technology needs are still overwhelming and great. Senior care facilities across the US face tight budgets, extremely high levels of employee turnover and technology challenges, but the care they provide is still important, as is how the information they collect on behalf of their patients is similar to other sectors.
According to Mike Wessinger, CEO and co-founder, “PointClickCare’s goal is to enrich the lives of care providers through technology that will help them better care for their residents in ways that are effective and efficient.”
PointClickCare’s primary reason for being is to deliver electronic health record and practice management solutions, but the company has an eye on mobile delivery, where both Mike and brother David Wessingner, CTO and co-founder, feel the future of health IT lies.
Mobile is king for its ability to deliver health data quickly and where needed, as well as to alleviate stress and confusion of overwhelmed healthcare employees.
Hospitals, too, are overwhelmed. Data flowing in from various systems often goes unnoticed or unpackaged, a particular troubling problem for the senior population. When there’s a patient transferring in from a senior home to a hospital for emergency care, a health record of some kind may accompany them. A fully loaded paper chart may only be shuffled through and details lost.
It should come as little surprise to me that no matter the healthcare sector — long-term care, ambulatory or in patient, for example – most of the worries faced are the same or very similar. Many of the same levels of attention is given to many of the highly complex usual suspects – interoperability, health information exchange, accountable care, HIPAA and even mandates like meaningful use. The murmurs of those working here are often similar and there is a fairly deep collective holding of the breath in regard to advancements or developments in these areas regarding the blowing winds of how these and other issues sway constituents throughout the marketplace.
The general sentiment of individuals, those leading large hospitals and multi-location care facilities, who express their opinions and concerns to organizations like HIMSS, to name one, are the same as the concerns voiced by many of the attendees at PointClickCare’s annual user meeting, to name one, in Orlando Nov. 2-5, 2014. These same sentiments also are expressed at variety of other meetings of the minds throughout the US in similar constituent groups or with vendor and other allegiances.
Educational and work sessions held at these gatherings always have the same look and feel; the same as those expressed at PointClickCare’s Summit 2014. Engagement, connection, care; ACOs, HIEs, and managing their relationships; EHRs, interoperability, and managing this relationship and the flow of information (or doing so when the information does begin to flow); and change management strategies that provide guidance and advice for … managing change.
The information exchanged in venues such as these and the sessions themselves are valuable, of course, and needed to fill an enormous information void. Most importantly, these healthcare education sessions draw together folks seeking guidance and those needing insight, as well as provide a dash of leadership at times when much seems to be lacking. Finally, these educational sessions – quick and concise as many of these sessions may be – alleviate fear during a scary and tumultuous time in healthcare.
Health IT pain points seem to be lingering long despite the never ending promises and hope eternal new technology innovation seems to offer. Every sector has its prickles, no doubt, and much is left to overcome in healthcare, but given the complexity and the copious amount of change and development here, it’s of little surprise that pain is being felt.
What may be surprising, though, is that like patient engagement, there seems to be a different type of pain, and severity of pain, depending on who you ask.
With that, for greater clarity, I decided to ask some of health IT industry insiders what they’re pain points were and why. Their responses follow:
Dr. Trishan Panch, chief medical officer, Wellframe
One of the biggest pain points for hospitals is that we’ve come across a health system’s inability to scale care management resources. They are effective in improving outcomes when patients are engaged, but because of limitations around existing models (i.e. human interaction via phone or in-person) only a small proportion of the patient population can be engaged. That’s why organizations are turning to technology solutions to scale care management resources to reach more people.
One of the biggest pain points for physicians today is the lack of interconnectivity between different IT systems. Participation in the meaningful use program has helped create some common standards for communication but, for a variety of reasons, these have not yet lead to widespread, effective clinical data sharing. Few physicians can operate in the ecosystem of a single electronic medical record, since they often work in systems that are different, from practice, various hospitals and other places of care.
Interoperability is a pain point in healthcare IT, particularly when it comes to transitions in senior care. Connecting the care delivery ecosystem to provide safer transitions of care is critical to long-term care. While some individuals may require short-term rehabilitative care, others may need home-based care, assisted living or long-term and hospice care. As seniors move through these different stages or between acute care and post-acute care, these transitions pose challenges for healthcare providers. Ideally, all the information that clinicians need to treat the individual will be available when he arrives at his new destination. However, this is not always the case. Healthcare providers, both long-term and acute, must invest in an infrastructure that supports seamless transitions of care; interoperability plays a vital role. Connecting healthcare providers across the care continuum will allow for better health outcomes, help reduce unnecessary hospital re-admissions, as well as keep healthcare costs down.
There are various statistics about the negative impact paperwork has upon providing healthcare. The AHA has estimated it adds at least 30 minutes to every hour of patient care provided. A main pain point continues to be the ability for IT to implement efficient EHR systems. At the core of any EHR system are its image capture capabilities. It must be simple to use throughout the workflow process. This includes image capture, editing, saving and sharing. The capture, or scanning, must be speedy. Editing features must be clear in how to use. This minimizes learning curves at the start. It also optimizes the speed of processing documents during the life of its use. Easy saving to local or network locations should also enable simple and secure sharing too. When one, some or all of these areas stall, it can cripple the realization of benefits from digital document management.