The current state of our healthcare ecosystem is more disconnected than connected.
The National Academy of Medicine (NAM) provided an accurate picture of the current activities that continue to perpetuate our quilt-like approach to interoperable data exchange instead of data liquidity in their special publication Procuring Interoperability: Achieving High-Quality, Connected, and Person-Centered Care.
The report also laid out key health IT milestones dating back to the early 2000s and provided a comprehensive background about what interoperability means at the different levels of our healthcare ecosystem.
Interoperability is a Long-Term Business Strategy
Clearly, our healthcare system has a lot of room for improvement and this report made the sound argument that, “With better procurement practices, supported by the establishment of shared interoperability platform and architecture, healthcare systems can prepare themselves to advance much more rapidly into the person-centric healthcare environment of the future.”
Healthcare technology has long been purchased in a one-off manner and often with uncoordinated approaches. This report highlighted that progress is stunted due to the lack of consistency around standard implementation, inconsistent purchasing strategies and diverging incentives for vendors across the healthcare continuum. For better or for worse, interoperability must be “managed as a component of a long-term business strategy.” It’s imperative that as upgrades occur and purchases are being made, that both vendors and purchasers alike are thinking about what’s best for the patient and not just their respective bottom lines.
Five Action Priorities to Advance a Sound Interoperability Procurement Strategy
The report lays out five action priorities that could move the needle in terms of realizing a truly interoperable healthcare community. In order for this to work, there needs to be a paradigm shift for vendors and purchasers alike.
The report explained, “The goal is for healthcare systems to move away from serial purchases of individual software and hardware with proprietary interfaces, toward purchasing certified technologies that will interoperate with others through a vendor-neutral open platform.”
Below are the five action priorities that the NAM report outlines for each healthcare organization and system leader to consider as they examine interoperability procurement strategies:
- Commit. There must be concentrated effort to ensure interoperability is a top priority for an organization or health system. This includes champions within the organization from the technical (IT), administrative and clinical perspectives. Ensuring that these individuals have the trust and respect of their colleagues is critical and they are members of a broader group or governance structure that has strategic oversight over IT acquisitions.
- Identify. Empower the governance body to prioritize and identify specific measurement criteria, example use cases, and goals that aligns with the broader organizational procurement process.
- Collaborate. Like many activities in healthcare, working across an organization or system is crucial to drive improved patient outcomes, lower costs and healthier populations. Identifying a sector-wide approach to aligning the common inputs for contract specifications will enable a strong foundation for broader interoperable healthcare solutions.
- Specify. Clearly articulating the specification requirements necessary to ensure interoperability is central to all existing and future acquisitions and contracts. Leverage the sector-wide approach and the governance body to ensure this work is translated during this important step of the procurement process.
- Assess. At the core of all continuous improvement efforts, evaluating the progress and ensuring the measurements used are still relevant is essential and something all organizations must do to ensure interoperable health IT is a reality.
Being ‘smarter’ about technical and business infrastructure procurement strategies is critical to the long-term viability for all members of the health IT community and their ability to thrive and navigate this ever-changing healthcare terrain.
Equipping Ourselves with Actionable Checklists
In addition to providing five strategic priorities, the publication also equips the reader with sample language and actionable checklists that could be included and leveraged for future requests for information that encapsulate the procurement priorities and strategies articulated to achieve a fully interoperable system. There is so much noise about how we are going to achieve fully interoperable health IT systems, but these kinds of tools are critical to have in our tool-belts when it comes time for the rubber hitting the road.
The checklists included are crafted for specific members of the healthcare community – healthcare executives and other key stakeholders, such as, payers, federal government, associations and digital health IT vendors. All of these members play a role in protecting patients and their families in the care delivery process and it is even more important that these stakeholders understand how they can play an active role in realizing an interoperable healthcare ecosystem. It is easy to passively wait on the sidelines for the next technology solution to become the ‘new shiny object’ that promises to solve all of our challenges. It is harder to be an active member of creating the broader framework to achieve what this country so sorely needs: patient information to be readily available where and when it is needed.
Interoperability Barriers Have Little to Do With Technology
As many of us have heard before, technology is not at the root of our interoperability challenges – so often it is the cultural and political components that get in our way. Certainly standards need to be implemented correctly, but fortunately efforts like the IHE Connectathon, are making sure this technical variability and adoption is being addressed in a rigorous and structured manner.
As we await a proposed rule from the Office of the National Coordinator for Health Information Technology around the definition of information blocking, impending and undefined policy further highlights the misalignment of incentives amongst healthcare systems, vendors and other key healthcare stakeholders and we may have ultimately created our own chaos.
The report cites that an ideal interoperable healthcare state means that “… health systems would work with payers and device manufacturers to demand and adopt a platform that is standards based, addresses one-to-many communication, allows two-way data exchange in real time, and enables comprehensive integration of devices and systems …”
While this sounds like a utopian state, I believe it will take the proverbial village to nurture and manage these challenges from the technical, cultural and policy perspectives, and hopefully we will shift our thinking before this becomes a full-blown crisis. NAM’s report is an important read because it provides all healthcare stakeholders accessible tools to begin to shift their thinking and turn them into action today for a more interoperable tomorrow.