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Expanding Interoperability Across the Care Continuum: Who to Call When There’s No CIO

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Lorren Pettit, MS, MBA

Imagine if you will, you’re the chief information officer of a hospital whose mandate coming out of the most recent board meeting is to advance interoperability across the local care continuum.

This will require you to work with the 20 or so nursing homes in your market, so you pick up the phone and call the first facility on your list. Who do you ask to speak to?

You’re first inkling may be to speak to your chief information officer (CIO) peer. If so, findings from the recent 2019 HIMSS U.S. Leadership and Workforce Survey suggest you would be successful in connecting with a peer in only about three of the 20 organizations called (15 percent of respondents from a long-term care facility report their organization employs a CIO).

But since you’re smart, you know it’s prudent not to limit your contact to CIOs but ask for any senior leader with specific oversight of information and technology (albeit the CIO, vice president of clinical IT, senior information security leader, or similar type role). Congratulations: According to the HIMSS survey you’ve just doubled your chances of successfully connecting with someone.

RELATED: HIMSS Releases 2019 U.S. Leadership & Workforce Survey Results

Provider Organization Contrasts

Contrast these findings to the representation of information and technology executives in hospitals as reflected in the same report. Roughly 90 percent of hospital respondents indicated their organization employed at least one information and technology executive, with two executive groups emerging as the most common type of executives employed in hospital settings; chief information officers (84 percent) and senior clinical IT leaders (68 percent).

That the profile of information and technology executives in nursing homes varies remarkably from hospitals is hardly breaking news. Conventional wisdom (and a number of research studies) hold that nursing homes lag behind hospitals in their use of information technology.

And of course, there are a multiplicity of factors to explain why this chasm exists; information and technology leaders are expensive to employ and nursing homes already run razor thin margins; many nursing homes use remote hosted IT systems, nursing homes are less advanced than hospitals in their adoption of IT, etc. While these are all legitimate issues, the issue remains, who from your facility should the CIO from the local hospital contact to discuss interoperability specifics?

The scenario described here of course is not hard to imagine. In fact, with the Centers for Medicare and Medicaid Services’s recent request for information related to advancing interoperability across care settings, particularly for those in the long-term and post-acute care space (see the Interoperability and Patient Access Proposed Rule), it is very probable these type of conversations will begin to accelerate.

Managing Information and Technology Conversations

In the absence of an in-house information and technology leader, nursing home administrators should have a plan in place regarding how external information and technology conversations are managed. Part of this plan is to designate at least one individual in the facility as the information and technology point person. This may be the director of nursing, the minimum data set (MDS) coordinator or even the administrator. While there is no expectation this individual will be an expert on all things IT, the business is progressing such that there is the need to have someone current on information and technology forces impacting nursing homes (evidence the aforementioned CMS Rule). In consultation with your EMR vendor (assuming you have an EMR) and/or IT consultants, this individual can at least present to local area CIOs that your facility has a person who can champion information and technology initiatives.

The plan nursing home leaders develop should also include efforts to proactively introduce their information and technology point person to area hospital IT teams, instead of sitting back and waiting for a call from area hospital CIOs.

The intent here is not to promote the IT competencies of the point person or even the IT sophistication of the nursing home. Rather, the idea is two-fold. First, to establish an information and technology liaison between your facility and the local hospital. When (not “if”) questions about the facility’s IT capabilities do arise, you want the hospital to have the name and contact information of the individual to whom these questions should be directed.

Second, it reassures area hospitals that your nursing home is at least aware of, and if appropriate, taking proactive steps to manage key information and technology demands.

While a general discussion about interoperability across the local care continuum is certainly one issue your facility may want to broach in these outreach efforts, a related, yet more urgent matter getting the CIO’s attention involves information security. According to the previously cited HIMSS survey, when asked to identify the top information and technology for the coming year, hospital respondents overwhelming selected cybersecurity, privacy and security. By expressing a shared concern about cybersecurity threats in data exchange relationships, hospital CIOs are apt to look favorably on your facility as one who “gets it” and more likely to consider your facility’s candidacy in a preferred network type arrangement.

Most senior healthcare leaders today understand that data is a core business asset. They also understand that information and technology needs to be leveraged in order to realize improved patient outcomes. Healthcare provider organizations, like nursing homes, without an executive at the helm shepherding the organization’s use of information and technology can understandably generate partnership concerns for those organizations with more advanced data management operations.

With pressure mounting on provider organizations to share patient data can across the care continuum, nursing home leaders should expect interoperability conversations to intensify with local hospital CIOs. In absence of an in-house IT executive, nursing home leaders should have a plan on how to manage these conversations before area CIOs come a calling. Because the reality is, these calls will come.

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