Change in Paradigm: Sharing Healthcare Information Outside the Hospital Walls
From the Hayes Healthcare Leaders Blog Series (@HayesManagement)
According to a survey by Hospital and Health Networks magazine, only 39% of respondents integrate clinical data so it is accessible, searchable, and reportable across the care community. That’s up from 33% in 2014 but far short of the type of connectivity needed to ensure quality patient outcomes.
With 10 hospitals, 6,000 affiliated physicians, and 30,000 employees, MedStar, like most healthcare organizations, has its share of IT priorities like Meaningful Use, electronic health record (EHR) optimization, and establishing a consistent set of platforms across all of our inpatient departments. But some of the most exciting and important work we are doing is focused on initiatives outside our hospital walls – connecting to our patients, connecting our clinicians (visiting nurses and geriatric providers making home visits), connecting our myriad of outpatients sites (clinics, physician offices, rehab facilities, urgent care centers) and connecting with other major health organizations, once viewed as competitors, in the Maryland and Washington, D.C. area¹.
We believe that pulling together fragmented patient information locked within siloes of individual organizations is key to improving overall healthcare quality and value. Leveraging technology to integrate a growing number of players across the continuum of care is essential to providing the best patient outcomes.
The CVS Minute Clinics that were springing up in our region were initially considered competition for our primary care practices. Through joint collaboration, however, we were able to link our EMR’s. As a result, the Minute Clinics have more complete information about our patients when they present themselves for pink eye or school physicals, our primary care practices are notified for either referrals or follow-ups on more significant issues, and the primary care physicians can incorporate the results of the Minute Clinic visits directly into their practice’s EMR.
Although originally viewed as competitors, taking patients away from our urgent care centers or our primary care doctors, we now recognize the need to co-opt and connect with these other providers. The discussion is no longer “my data versus your data,” but more how well can we collaboratively use the data that we collectively share. It’s a new way of thinking and the technology is the piece that ties it all together.
Huge benefits from improved connectivity
Telehealth, patient portals, and social media provide venues to keep patients better connected and better informed. The proliferation of smart phones and pads has created a patient base expecting immediate access to physicians, schedules, general information about health, and specific information about their health. Driving information safely into these applications can meet the patients’ expectations for easy, quick access and lower cost. By using these connectivity tools, we are able to deliver either care or information to the patient in the most productive and cost-effective manner possible. It’s not about driving patients to office or hospital visits when there are now so many other appropriate venues available for efficient and timely healthcare delivery. This flexibility allows clinicians to intervene and act sooner rather than later.
Providing more information gives clinicians the ability to provide better care. Clinicians no longer have to struggle to find a stovepiped collection of information, but instead can review what has happened to a patient in any hospital, at any office visit, at any Minute Clinic, or on a televisit whether at one of our urgent care facilities, ambulatory sites, rehab sites, or at a competitors’ facility. Armed with comprehensive and current data, providers can make better informed clinical decisions.
Healthcare delivery organizations face compensation based on quality results and population health. This is driving the need for better connectivity and more comprehensive information about the patient. If we do right by our patients by allowing them to choose the proper care venue, we benefit because it keeps them healthier. Engaging the appropriate provider makes healthcare less expensive for both the patient and the organization. Reducing the costs of duplicative tests and exams that result from piecemeal information is a win for everyone.
Making the move to better connectivity
There are several things to consider when developing a connectivity initiative in your organization:
Develop the right culture
Driving towards connectivity is not just about the technology. It’s also about creating a supportive mindset and culture. We now describe our organization as a distributed care delivery network, which is very different from the traditional view of most hospitals. It can be difficult to think outside of that framework in terms of how to connect to other provider entities.
To make the change effectively, this new thought process must be an integral part of the fabric of your culture. Investments can be relatively significant – either in terms of money or staff resources – so you need your organization to fully commit to the change.
Develop your strategy
There’s no single, ‘silver bullet’ strategy when it comes to connectivity. Your best approach is to focus on a portfolio of strategies that are appropriate for your organization. One option is to use health information exchanges (HIEs) to connect disparate EHRs. We use an in-house HIE to connect some of our remaining niche EMR’s and connect with our regional HIE (CRISP) to connect with other hospitals and providers in the mid-Atlantic region. Other strategies involve common clinical repositories, traditional interfaces, or participation in national interoperability projects such as CommonWell. These can all be part of your connectivity solution.
Whatever you decide must be agreed upon by the entire organization as a go-forward approach. You can’t solve the connectivity problem differently every time; a structured combination of alternatives provides the best chance of success.
Budget constraints can prevent you from making significant technology investments, but there are less expensive ways to begin your connectivity initiative. There are likely many common groups in your region you can approach that provide a lower investment commitment. You can reach out to existing HIEs and adopt some of the common interoperability standards which is less financially onerous than building an HIE from scratch or maintaining a significant network of interfaces.
Pitfalls to avoid
There are several things to be aware of as you move down the connectivity road. With so many groups inside and outside your organization, you need to determine the high value partners. You don’t want to connect with too many entities and end up with multiple projects that spread your resources too thin. Be selective up front and make sure your executive team supports the partners you choose so you can obtain the funding required to be successful. You can maintain a balanced strategy by selecting a portfolio of two high risk, three moderate risk, and two low risks connections.
Another problem can be resistance from your own organization. It’s important that internal stakeholders understand the importance of your connectivity strategy. People have been operating for years with the concept of protecting data from competitors, so shifting to a collaborative strategy will take some educating. You need to get into a mindset that stresses beating the competition now means managing pooled data better than other organizations. It is no longer about maintaining unique or exclusive information, successful organizations will provide easier access to pooled patient data and tools to use that information for better decision making.
As data becomes more valuable the more people have access to it, security becomes much more significant as well. Data sharing is a cause of great concern for executives responsible for maintaining data privacy.
Before you engage with an organization in a connectivity project, you must perform due diligence to understand how they manage and protect data. Getting your legal and compliance departments engaged early is critical. Potential connectivity organizations don’t have to have the same safeguards as you do, but they should be equivalent and proven to be effective. You should review what kind of penetration testing they do, how they audit, and how they educate their staff on handling data so it’s not susceptible to breaches. You can’t just make a passive assumption that your data is well protected.
Why connectivity is so important
As the healthcare landscape continues to shift, it becomes more evident that patient engagements in the hospital are going to be more limited, focused, and specialized. An increased amount of care delivery is also going to occur in more varied, less expensive venues. Connecting the information that will be generated from these disparate entities will be the key to providing integrated effective care.
Much of the responsibility for driving this fundamental change falls on the healthcare IT group. Forward-thinking hospitals are attempting to get out front and lead the transition to cooperative information sharing for the ultimate good of the patients. The challenge is to find and partner with organizations willing to embrace this collaborative effort, including competitors. As access is extended, it’s critical to deploy technology that improves access while maintaining security to control and provide the appropriate privacy. It’s becoming increasingly clear that healthcare technology teams will be at the forefront of solving the connectivity challenge.
As the largest healthcare provider in Maryland and the Washington, D.C., region, MedStar’s 10 hospitals, the MedStar Health Research Institute, MedStar Medical Group, and other programs and services are recognized regionally and nationally for excellence in medical care. MedStar is also a healthcare technology leader having been named to the Hospital and Health Network magazine Most Wired healthcare organizations in 11 of the past 12 years. MedStar has made great strides in creating robust clinical information systems and leading the implementation of several regional HIE groups.
¹HealthCare’s 2015 Most Wired, Hospital and Health Network, July 2015
This article was originally published on Hayes Management Consulting and is republished here with permission.