Where tech's role in interoperability ends, clinician engagement begins

Discussions of interoperability are often framed in the context of patient-centered care, of making data available for the patient's benefit. The free flow of information is not simply about enabling data to move from system to system; rather, it's about getting necessary information where the patient wants and needs it. But who is responsible for getting it there?

In a previous interview with Becker's Hospital Review, Ed Park, COO of Watertown, Mass.-based athenahealth, said patient-centered health information exchange is ideal but not reality.

"There's been an unarticulated demand for patient-centered health information exchange, this idea that I as a patient should be able to go to a lab or go to a primary care doctor [or] a hospital and be able to ask them to share my record and have that be true," Mr. Park said. "If you start asking around, you find that's true essentially nowhere."

Mr. Park discussed patients' growing desire to access to their medical records. He suggests vendors aren't adequately addressing that demand.

Doug Dietzman, executive director of health information exchange Great Lakes Health Connect in Michigan, says Mr. Park's analysis of the situation overlooks one key party: the care team. Mr. Dietzman says vendors' focus should be on giving the provider what he or she needs to better serve the patient.

"The relationship with the patient should not be with me as an HIE or a technology provider. The relationship with the patient is with the provider," he says.

What's more, patient demand and provider demand aren't mutually exclusive. In fact, the two go hand-in-hand. He says Mr. Park's presentation of the problem assumes a provider focus on information exchanges is somehow different or unique from a patient-centric image of the exchanges. When vendors properly support providers, providers can properly care for patients. Patient engagement and satisfaction stem from how members of the care team use the technology and how they talk about it with patients.

"It's not for the health IT behind the scenes to reach out and try to establish a relationship with the patient or be more patient-centered," Mr. Dietzman says. "The technology is as patient-centered as the clinician. The clinical setting knows how to engage that patient and bring them into that decision making."

Healthcare professionals often refer to banking as an ideal industry for interoperability. A person can withdraw money by using any ATM regardless of his or her home bank. There might be additional fees for use of an ATM that differs from your branch, but customers learn of the fee and agree to accept the fee before they can proceed.

But within the context of this example is a nuance that Mr. Dietzman says supports his view.

The interoperability of banks and ATMs is dependent upon the ATM network, which includes companies like NYCE, Cirrus and STAR. But debit and credit card holders don't directly engage with these networks — their relationships are with their independent, individual banks. "The bank has the connection with me, not the network moving the data around," Mr. Dietzman says.

Interoperability isn't a goal with an end point, Mr. Dietzman says. Instead, the true goal is to change the nature of patient care, something that technology itself can't do. Technology supports business, and in this case, Mr. Dietzman says it can support healthcare organizations better patient care quality.

"We can serve up all the best technology we want to serve up, and the [patient] experience isn't going to be any different. That has to go hand-in-hand with the interoperability," Mr. Dietzman says. "We're oversimplifying it in some regards to say [interoperability] is a tech problem and interoperability has to be solved, because it's really a myriad of different conversations going on across the community to make sure the right thing is being delivered to the right place."

More articles on interoperability:

15 thoughts on interoperability from healthcare leaders
Why your organization can’t afford to skimp on interoperability anymore
When innovation is stifling: A cautionary tale from athenahealth's Jonathan Bush

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