Moving beyond the interoperability base layer, into clinical collaboration

True interoperability is centered not on just the technical, but on using technology to fuel highly functional clinical workflows.

Our industry is rightfully chasing a utopic vision of interoperability — a single, unified, fully-reconciled patient record seamlessly accessible to the patient and all providers at any time, and one that is fully-structured in form, machine-readable, normalized, and able to be used in population-level analysis to more accurately facilitate pattern recognition and statistically significant data-derived insights. Interoperability is no longer an ideal written into the footnotes of regulatory initiatives like CMS’ “meaningful use” program — it’s a prerequisite of value-based care, the basis of provider coordination, and the juice that fuels a successful Accountable Care Organization (ACO).

As such, we’re seeing a push by organizations like CommonWell Health Alliance, The Sequoia Project, various community health information exchanges, and others to integrate and normalize data between disparate health systems to drive optimal health outcomes.

But interoperability is still largely limited in its primary definition as a conduit that moves data from point A to point B. This definition, which I’ll call “technical interoperability,” doesn’t yet fully tap into interoperability’s true potential to catalyze behavior at the clinical level where data is processed and filtered into workflows that span multiple disparate organizations represented by providers who may never have met one another.

These providers share a common stewardship, perhaps unbeknownst to them, in that they are tied to an individual patient. For this reason, they need more than access to a unified patient record; they require awareness of when to act, proactively, through insights and tools that enable them to communicate — and better, to collaborate — with one another. So, while we’re mastering the sending of data from point A to point B through our HL7-powered networks, we haven’t quite figured out how to move beyond the conduits. Most patient data still sit in silos, which means our efforts also remain siloed.

When we consider the noble intentions of CMS’ EHR Incentive Program, the “meaningful use” initiative — which launched with the ambitious though narrow goal of funneling patient data into repositories with little foresight into the potential of, and need for, actionable information — our lack of progress is understandable but frustrating.

On the bright side, our priorities have shifted. While the original “meaningful use” metrics weren’t built with the idea that proprietary electronic health records (EHRs) would need to support a higher purpose, most of us strive for data sharing and equal access: In August, CMS finalized a rule that will overhaul the meaningful use program with a core emphasis on advancing health data exchange, rebranding it the “Promoting Interoperability” initiative.

Simultaneously, the idea of intentional “data blocking” by healthcare organizations is slowly becoming antiquated. We’re observing a healthcare landscape full of good folks who are trying to do the right thing by going out of their way to make data available for the good of the patient.

But we need to address larger questions in order to move beyond this base layer of basic interoperability and to achieve what I’ll call “clinical interoperability” — the appropriate collaboration between multiple, distinct stakeholders who care for the patient:

How do we prompt and enable informed clinical action in a timely manner?
How do we recognize that every community has multiple distinct stakeholders, each of whom has an essential role to play in the care of the patient?
How do we appropriately sequence the interactions of each those stakeholders in the most efficient and effective way, acknowledging that each uses different EHRs, care management tools, and population health tools?

These questions — which speak to the broader need for behavioral change — are much harder to solve. But these aren’t insurmountable questions, nor is this yet another idealistic vision of what might be.

We can look toward real-world examples at play today in states such as Virginia, which recently sought to improve care coordination through the establishment of an Emergency Department Care Coordination initiative (EDCC). Though the example is admittedly self-serving—the state makes use of our clinical network and supporting applications to connect 130-plus hospitals and health systems, along with its related post-acute operators, providers, ACOs, and health plans—these stakeholders are reaching for a level of collaboration that extends well beyond technical interoperability and into the clinical workflow.

Virginia’s EDCC program is evidence that there is true desire to work together for the good of the community. By leveraging tools that distill signal from the noise and transmit only the most meaningful information to providers, providers are better positioned to engage with the patient in a timely manner. Stakeholders from across the Commonwealth meet regularly to discuss specific archetypes representing vulnerable groups of patients, and then work to design clinical pathways that more effectively meet these individuals’ needs. While there is much yet to be done, Virginia is on path toward true clinical interoperability.

They’re among the early visionaries of the utopic, silo-free existence.

For those seeking to truly move beyond silos, I see three critical takeaways from Virginia’s example:

1. Embrace a collaborative mindset. Instead of thinking of interoperability in limited technical terms, and instead of naturally anchoring on existential self-preservation and gain, we must tap into the reason we all got into healthcare in the first place – to help patients. Viewing competition as second order, we must instead view ourselves as part of a common community whose primary purpose is to operate in concert with others to deliver a unified care experience to the patient — one informed both by a unified patient record (itself enabled by technical interoperability).

2. Adopt tools which help to coordinate across the care continuum and anticipate providers’ needs—especially when the patient isn’t sitting in front of them—and enable each to maintain awareness of the others’ roles and interactions relative to the patient at any given moment. Collaboration requires effort, but the right tools and systems make it easier to align that effort across the system. The result is an informed set of stakeholders who mitigate identified risks more quickly, avoid redundancy of patient work-ups, increase throughput, and apply scarce resources in the most effective manner possible.

3. Engage. Technology helps, but the human element is paramount. Collaboration doesn’t happen unless people dive in. Form multi-stakeholder community collaboration groups to identify specific patient archetypes of vulnerable individuals, reconcile individual systems’ care management efforts, and facilitate clinical pathway design.

Interoperability isn’t going to happen everywhere overnight, but we can make great strides in mending our fragmented institutions by seeking solutions that take interoperability beyond the technical base layer and begin to contemplate true clinical interoperability. We can learn from our missteps in limiting our thinking around data sharing and see interoperability through a three-dimensional lens, beyond data aggregation and technical specifications.

Chris Klomp is CEO of Collective Medical. Collective is building the nation’s largest network for care collaboration.

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