• October 2008 FEATURE ARTICLES •
Interoperability
Tying IT All Together
A chief quality officer makes a compelling case for capitalizing on IT potential with the interoperability platform.
By Tami Merryman
Few would argue that delivering the best
possible care is the overarching goal of virtually every
healthcare facility in this country; and yet, providers have
attained this objective with varying degrees of success. While
striving for quality, they recognize that the current healthcare
delivery system does not always facilitate optimal outcomes for
every patient across the continuum of care.
The emergence of pay-for-performance (P4P)
initiatives has shone a light on the flaws and fissures in
healthcare delivery. The P4P agenda is undeniably founded on a
commitment to improving patient care outcomes. And, because of
the potential impact on the bottom line, the movement has
invigorated discussions about quality at the highest levels of
healthcare organizations.
C-suite executives recognize that improved
outcomes can be achieved only if the right clinician has the
right information — at the right time — to make the right
decision for the right patient. This means re-evaluating how
healthcare organizations manage information. Presently, patient
data often reside in silos, with each independent provider
claiming proprietary access to his or her own records. But to
optimize quality and care, this information must be shared
between primary care providers and specialists, ambulatory
settings and hospitals, as well as long-term and acute care
facilities.
Falling Short of Potential
But therein lies the rub. Healthcare
organizations have invested precious resources, both human and
financial, in information technology (IT) at an aggressive pace
throughout the past 10 years or so. Yet sole-source systems have
not delivered the results leaders anticipated, and have left
them decidedly disillusioned with IT solutions that have
over-promised and under-delivered.
Physicians and clinical staff likewise have
grown frustrated. The conversion from paper to electronic
systems has demanded many different types of investments on
their part; changing entrenched personal work styles, adapting
to dramatic modifications in institutional workflow, and
learning new skill sets associated with computer software and
hardware are a few examples. However, despite their efforts,
clinicians have yet to enjoy the benefits they were assured
would ensue.
In the face of these setbacks and obstacles,
healthcare organizations have nevertheless continued to
implement IT systems for a number of reasons: They recognize, at
some level, the value IT offers — even if this potential has not
yet been achieved. Furthermore, they concede that this is the
"information age" and that all industries are bowing to a
greater reliance on technology. And, they realize that as a
greater proportion of their income derives from P4P, the need to
comply with IT and reporting requirements will only grow.
Accelerating IT Value
To overcome these deficiencies and achieve
the long-anticipated outcomes promised by the IT revolution,
many healthcare organizations are adopting interoperability
platforms to improve performance, quality and outcomes. These
platforms facilitate health information exchange between
disparate technology systems. The most advanced approach in
interoperability, in fact,
allows two systems to not only share information, but also
enables the receiving system to understand and make use of the
incoming data while maintaining the original "meaning" of that
data. Ultimately, an interoperability platform can deliver an
integrated view of a patient’s medical history to any clinician
at the time of care — regardless of where the information
originates within disparate technology systems.
Among the potential gains a healthcare
enterprise can realize through this capability is improved
efficiency. One of the most substantial causes of waste in the
healthcare system is tracking down information and supplies
crucial to the care of patients.
At University of Pittsburgh Medical Center
(UPMC), for instance, quality professionals have observed nurses
preparing patients for surgery. The range of time nurses spent
looking for information was from one to 41 minutes, while the
range of time they waited to receive necessary information was
between five minutes to as much as 20 hours. Despite their
efforts, about 30 percent of patients were not adequately
prepared for their procedure on the day of surgery.
Implementation of an interoperability
platform, on the other hand, enables clinicians of healthcare
organizations to make data immediately accessible, even if it is
generated by or stored in unrelated systems. This functionality
can have a significant and positive impact in a number of areas,
including pre-procedural testing, access to and delivery of old
medical records, diagnostic imaging screening, and completing
accurate admission assessments.
Further Potential
Other gains can be measured to improvements
of clinical outcomes. There can be no question that the quality
agenda is growing at an explosive rate. The
Centers for Medicare & Medicaid Services (CMS) has implemented
27 quality measures already, with plans to expand the number by
43 in 2009 and by more than 100 in 2010. CMS also recently
increased its list of selected hospital-acquired conditions from
eight to 11.
Many healthcare organizations have reached
the conclusion that manual extraction and reporting is virtually
impossible, and that discrete electronic medical record systems
offer only an incremental improvement.
Alternatively, best-of-class interoperability
solutions offer open-source access to data throughout the care
continuum — simplifying reporting, increasing successful
participation in P4P and improving care. Because a longitudinal
patient record is easy to obtain, healthcare organizations can
shift focus from isolated chart review to genuine analysis and
trending. Interoperability permits the organization to
thoughtfully question results and outcomes, and consequently
investigate patient care issues. This microscope can likewise be
focused on the entire enterprise, because leadership can
generate a snapshot of select clinical outcomes within a patient
population and determine if problems exist that require
attention.
A classic example can be found in tracking
surgical site infections — an issue of growing importance at
healthcare organizations throughout our country today, with more
than 30 states mandating infection rate monitoring. Previously
at UPMC, an infection control nurse was tasked with contacting
the surgical team about incidence of infection and how cases
were treated. Data collection was totally dependent on whether
the surgeon responded. Interoperability now allows the nurse to
independently mine data residing in the system, review
information on patients who had surgery and check if they were
subsequently prescribed antibiotics. In addition, through the
use of an interoperability platform, reports detailing the
number of cases, types of infections and methods of treatment
can be generated automatically.
Additional Considerations
The patient-centered nature of the technology
is also an asset. Virtually all care providers recognize the
critical need to ensure medical records and information
management processes are patient-centric. No longer do patients
remain in the same geographic area, being treated by the same
providers from cradle to grave. High mobility has made
continuous healthcare in one location a rare luxury, and has
engendered an environment of waste due to the rework that must
occur when patients move from one provider location to another.
Interoperability offers the opportunity to reduce this waste in
a number of ways, such as making use of emerging functionality
to give patients personal access to their records (e.g., PHRs).
Another is the option of developing encrypted log-in codes so
new or remote providers can have temporary Internet access to
longitudinal records.
This level of access helps eliminate
unnecessary testing and speeds development of treatment plans
because providers have a comprehensive view of the patient’s
status from virtually any location. Perhaps most importantly,
this approach engages patients so they are more invested in
their own care. UPMC is in the process of determining how to
provide this personal access to patients, with the goal of
having it available in early 2009.
Population management and outcomes can be
enhanced as well. Increasingly, providers are directing their
attention to enterprise clinical decision support systems
(ECDSS) that integrate clinical data across the continuum. The
implementation of an interoperability platform provides a
framework that enables continuous monitoring of patient
populations for defined clinical events. Providers are alerted
to changes in the patient’s condition or departures from a
prescribed care plan, and can then intervene to improve health
and outcomes.
Also, consider patients with multiple
co-morbidities and non-healing wounds. It is widely acknowledged
that these individuals consume significant resources,
experiencing frequent re-admissions and failed plans of care.
When ECDSS and interoperability platforms are available, any
provider can view the complete record of all care and treatment
supplied to the patient. Clinical photos of patient wounds can
be embedded and retrieved so that all clinicians can monitor
progress.
Because care is coordinated — and consistent
— wounds heal more quickly (sometimes in half the time) and
overall costs are significantly reduced.
Good Business Sense
Interoperability and better data management
can only improve clinical outcomes, yet a strong business case
can likewise be made for this approach, with potential for gains
in three specific areas: First, cost savings: Healthcare
organizations can eliminate duplicative testing on fixed
reimbursement cases, for instance, and reduce administrative
FTEs by automating previously manual processes. Second, control
investment in IT: The availability of an interoperability
solution may prompt a healthcare organization to revise its
entire IT strategy. Rather than trying to convert to a single
platform, leadership can utilize interoperability to integrate
legacy systems. And third, strengthen the referral base and
revenue source. Likewise, organizations potentially can improve
physician loyalty by providing access to patient data in their
offices via the Internet.
Implementation of an interoperability platform, on the other hand, enables clinicians of healthcare organizations to make data immediately accessible, even if it is generated by or stored in unrelated systems.
Healthcare organizations can accomplish much
if the right data is placed in the right hands at the right
time. Providers are empowered to make better clinical decisions
and institute the most effective care plans when this data is
accessible, while patients receive optimal and timely treatment,
likely resulting in better outcomes.
Healthcare organizations improve workflow
with this technology, cut costs and maximize access to revenue
opportunities. With an interoperability platform in place, they
are much better equipped to accelerate clinician access to the
vital information that will allow the entire organization to
capitalize on these gains and hasten the return on their
technology investments.
Tami Merryman is chief quality officer for
the University of Pittsburgh Medical Center. Contact her at
merrymante@upmc.edu .
