How care coordination records enable clinical interoperability
By Ted Quinn
There has never been more urgency for healthcare organizations to pursue new models of care and address the unsustainable costs of the US healthcare system.
Team-based care coordination programs are growing in scope and number across the country. What were once underfunded experiments are now thriving, integrated demonstrations, proving the value of coordination across care settings. The goals for these projects are ambitious. For example:
One program in Alaska is setting out to engage 600 physicians in team-based care models.
In New York, another project is engaging 4,000 physicians who care for patients with severe mental illness in a technology-based care coordination program.
At the Children’s Hospital of Orange County in California, 1,450 pediatric care providers are working together to implement and align teams around culturally-sensitive care plans and evidence-based care pathways.
We commend those pursuing new approaches to care delivery. Regardless of your political orientation or position in healthcare we can all agree that the status quo is unsustainable and new approaches need testing, valuation, and scaling. These projects, funded by the recently announced Transforming Clinical Practice Initiative of the US Department of Health and Human Services, together with their 36 peer projects collectively represent one of the largest federal investments in healthcare system transformation ever.
We will be watching and working alongside these efforts, as success is dependent on their ability to engage patients and their caregivers with modern communication and collaboration platforms. As HHS and common sense both suggest, health IT is central to the success of these efforts. In fact, the Initiative mentions technology and data needs at least 60 times in their award announcement. Yet the Federal Health IT Strategic Planannounced by ONC on September 21 – a document more than twice as long as the HHS award announcement – mentioned “coordination of care” just once. This disconnect between delivery model transformation strategy and federal HIT strategy is clearly coming into focus, most recently in a HealthSystemCIO webinar during which John Halamka, MD, CIO of Beth Israel Deaconess Medical Center, applauded most of the Strategic Planexcept it’s notable lack of support for care coordination efforts.
One of the challenges that innovators face is not understanding the operational differences between data interoperability and clinical interoperability. This disconnect was also brought to light by Grahame Grieve, the architect behind FHIR and HL7. At Harvard Medical School last month, Grahame spoke about the difference between data interoperability and clinical interoperability. While FHIR and its cousin SMART represent significant advances in data interoperability – defined as standards-based exchange of clinical information – these tools are simply not equipped to solve the challenge of clinical interoperability. In a literal sense, “clinical interoperability” is the real-time exchange of relevant clinical information within clinical teams and between disparate teams; figuratively, Grahame suggests that this is what we all really want when we broadly talk about interoperability. Josh Mandel, lead architect for the SMART Project and participant in the lecture, suggested that “clinical interoperability” is HIT shorthand for care coordination.
If the data interoperability experts think data interoperability won’t enable true care coordination, then what will?
This is the job of the Care Coordination Record, the tool that I and my team believe is the dominant HIT innovation for the foreseeable future. Designed and purpose-built for healthcare teams, it’s a new layer in the HIT stack that sits on top of and between legacy EMRs. It serves as connective tissue between systems and teams, pulling in data and people to connect all parts of the clinical workflow. Additionally, in our work with payers and providers we’re seeing that improved outcomes and true engagement requires a record that enables community resources, which often surround and support clinical teams, to see and understand the plan and participate in moving care forward. This is an empowering component of the Care Coordination Record – a team-based multi-authorable environment that shows all care activities and the state-of-play within a single record. At the center of the record is the patient, with 24/7 access to their own clinician-led care plan, which we think is the most important document in healthcare.
In an ever growing environment of complexity, healthcare needs simple solutions. Data interoperability is complicated, challenging, and terribly important. EMR and HIE vendors certainly have their work cut out for them to make data interoperability happen in a reasonable timeframe. In the meantime, the job of caring for patients – especiallypatients with complex medical needs – requires support from a Care Coordination Record that enables clinical transformation in ways the EMR can only dream of. It does this by empowering the whole care team to live up to their potential and work together to fundamentally change how healthcare is delivered in this country.
Disclosure: John Halamka, MD is on my company’s Board of Advisors.