Interoperability Is the Key to a Patient-centric Transformation of the Healthcare System

Healthcare data trapped in non-interoperable clinical systems leads to flawed processes, inefficient workflow, and less-than-optimal care. A truly interoperable, patient-centric system would provide access to the right information at the right time.

Physician offices typically have critical patient data that remain locked in databases and applications throughout their extended healthcare network. Too often they lack the capability to connect disparate data or efficiently digitize their paper-based records. This disconnect is caused by non-interoperable technology that makes it impossible to transform business processes and bring the right information to bear at the point of service. The result is that data is not converted to intelligence (ie, a comprehensive collection of patient and provider data organized and presented in a way that enables clinicians and others to make accurate, effective decisions in a timely fashion).

The lack of actionable patient and provider intelligence sets off a cascade of miscommunication between physicians, patients, clinicians, administrative staff , and other stakeholders. This not only hurts healthcare systems internally, but hinders their relationships with patients and business partners. It introduces unnecessary complexity to clinical information sharing, provider management, claims processing, regulatory compliance, and other strategic initiatives.

Transforming data into intelligence is at the forefront of information technology priorities because of intense pressure from governments, employers, and patients to increase the quality and accountability of care services. To transform the current fragmented system into a true patient-centric model will require healthcare systems to build an agnostic technology foundation that can connect siloed information and processes and share data from legacy systems as well as newly deployed applications with minimal disruption.

Improving data quality and reducing administrative costs is considered the “Holy Grail” of healthcare reform. Poor data becomes exacerbated when it is linked, matched, and shared between healthcare providers, with consequences for patients and physicians:

Threats to patient safety: Jane Smith is administered a medication to which she is allergic at an emergency department (ED), because the clinicians referred to the record of Jane E. Smith, a different person.

Reimbursement problems: Jane E. Smith’s insurance is billed for Jane Smith’s treatment, resulting in a refusal to pay. The healthcare facility’s initial claim submission is denied; resolving the error involves extra administrative costs.

Decreased patient and staff satisfaction: Jane loses confidence when the information she gave the ED is not available at their imaging center and physician office, requiring the creation of a duplicate record, decreasing staff efficiency, and increasing error risk.

Increased administrative costs: When Jane has duplicate records, her clinicians have inaccurate data, which may pose safety issues, causing Jane concern and costing the organization money to find and resolve.

On the other hand, when physicians have effective access to comprehensive and accurate patient data and provider information, the practice benefits because its healthcare systems are able to protect market share and grow business by:

Increasing physician retention: making it simple for physicians to do business with a healthcare system provides incentive to continue to serve patients via that system.

Recruiting physicians and clinical staff: reducing the time to get access to information makes for a powerful recruitment tool.

Improving patient loyalty: patients increasingly “shop” for healthcare services, and organizations that provide the best experience have a distinct market advantage.

Providing “patient-centric services”: offering patients online access to their treatment history, as well as other customized services, increases patient satisfaction.

The data collected across healthcare systems continues to grow exponentially due to the increased use of clinical software, more complex regulatory reporting requirements, and the increased size of health systems, as more facilities—and clinical business lines—are consolidated into single corporate entities. The current push by President Obama and Congress to promote EHR adoption will only add to the data intensification.

To deal with this, the healthcare industry needs to enter an “age of interoperability,” and organizations that do not strategically plan to provide the level of data sharing required will find themselves at a disadvantage.

Lorraine Fernandes is the vice president and ambassador for Initiate Systems, maker of Initiate Patient and Initiate Provider.