Integration not for the feint of heart
The truly heavy lifting for healthcare organizations regarding their information technology isn’t with deployment and utilization of systems – it is with the coordination and synchronization associated with integrating all the disparate elements across the enterprise. Getting all the moving parts to work together in harmony is a massive project that can overwhelm even the most experienced CIO.
Taking a global view of IT’s role within a healthcare organization and across the continuum is necessary to formulate an effective integration strategy, experts say, but to effectively implement it takes a piecemeal approach that assembles everything one component at a time. It is a process that can be time-consuming and exhausting, but the results will ultimately be rewarding, says Holly Rimmasch, RN, senior vice president and chief clinical officer for Salt Lake City, Utah-based Health Catalyst.
As a vendor that is focused on building and deploying effective integration technology for healthcare organizations, Health Catalyst has a three-tiered procedure for implementation: building the platform for the enterprise data warehouse and integrating data sources into it; building foundational and discovery apps on top of that platform and finally adding advanced apps designed to build best practice models.
“Integration consists of optimizing the horizontal/vertical intersection and workflow,” Rimmasch said. “At the point of horizontal and vertical is the important part because you have to set up an organization that can prioritize goals and resources. You need a physician champion and nurse champion, and depending on the size of the initiative, you may have more disciplines involved. We create visualization sets that we present to the team, who should meet on a weekly basis. You also need a data analyst to help build the tool and to facilitate clinical process improvement. The whole process needs to be broken out into chunks – take it one piece at a time.”
Hopkinton, Mass.-based EMC has identified some key integration issues based on a joint survey it conducted with CHIME on the major challenges CIOs are facing today. John Reeves, chief healthcare solutions architect and Roberta Katz, director of healthcare solutions at EMC, use this data to produce integration solutions they believe will propel organizations forward.
One of the major findings of the survey, Katz says, is that CIOs believe they can save $11 billion collectively over the next three years by incorporating the IT as a Service model. The estimates are based on the goal of saving 9 percent of overall IT costs.
“The EMC-CHIME survey reveals where providers are with IT transformation and IT as a Service model,” Katz said. “We discovered that healthcare organizations are becoming internal service providers to extended networks across the continuum. They are working simultaneously on the transformation of infrastructure, EMRs, meaningful use Stages 1 and 2, forming business models for ACOs, and while they are doing all this they are striving to improve information security. Even though they are challenged with budgets and staffing, they have to move forward on all these initiatives.”
Reeves adds that the Affordable Care Act is another dimension challenging providers.
“As healthcare organizations move to be more efficient with the demands of the changing landscape, it is important to recognize that IT domains cannot exist with ‘business as usual,’” he said. “New formations are taking shape now and as trickle-down compliance issues become more prominent, it is another driving factor for transformation.”
Based on responses, the upshot of the survey is the quandary presented by determining the right priorities in the proper order, Katz said.
“Many are wondering how to move forward, what steps they need to take to drive down IT operating costs and to begin virtualizing processes,” she said.
“They are also trying to figure out how to invest in EMRs, how to improve infrastructure at the same time and move toward consistency and consolidation of that infrastructure in order to meet the requirements of all end users.”
Bridging the ‘gap’
The myriad variables that exist with the machinations of integration also encompass the diverse identities of providers across the healthcare spectrum. For instance, Reston, Va.-based Harmony Information Systems operates in the public sector, dealing with community-based service agencies at the federal, state and local levels. By leveraging its technology offerings, Harmony is working to integrate service agencies, managed care organizations, caregivers and consumers to reduce costs and improve outcomes, says Keith Ewell, founder and vice president of marketing.
“We work at all levels of the healthcare ecosystem, primarily with agencies that offer services to the elderly and people with developmental and intellectual disabilities as well as with caregivers and consumers,” Ewell said. “Over the past 15 years, this environment has evolved from a conglomeration of siloed systems into an integrated system that performs a lot of functions across the strata in the ecosystem to serve multiple levels. Providers and caregivers can now interact without redundancies – the culture has followed the technology.”
Getting public agencies synchronized is no small feat, Ewell says, because they have typically operated with “incredibly complex and arcane structures that were hard to navigate.” Once the gaps between them are bridged and they are operating in conjunction with each other, he predicts the result will be “a significantly better consumer experience.”
It’s the workflow, stupid
Ask the clinicians what they are looking for from integration and the answer is likely to be accessibility to critical information from the field, says Barry Chaiken, MD, CMIO for New York-based Infor. The proliferation of wireless mobile devices has created a situation that is tailor-made for integrated data delivery, he says.
“Software has to be engaging and fit people’s workflow – there is no reason why technology can’t be similar to smart phones and iPads,” he said. “As a result, we are designing software that fits people’s workflows so they can do their jobs better because it fits the way they work and the way they think. It’s not about being pretty, but about providing a positive user experience.”
Workflow is a critical part of the homecare field as well, which is why New York-based AMC Health is committed to improving integration for those who work in that area.
“It is not as much about technology as it is about the data and helping partners thread it into their workflows,” says Jon Shankman, AMC vice president of analytics and product management. “There is a lot of hard data being transmitted from devices – cuffs, glucose monitors, thermometers, scales, sleep telemetry and aids to daily living – all report the patient’s vitals and activities. Our system allows these to coalesce in the cloud to give the care manager the broadest view, corroborating and providing full context. We help them find patterns that the naked eye can’t see. Our next level of challenge is to make this data far more meaningful.”
Integrated audit trail
When it comes to guarding patient privacy, it is imperative to know who is accessing records and for what purpose. That is what Hanover, Md.-based Hexis Cyber Solutions’ security program is designed to do.
While most records breaches are accidental, it is still unacceptable and each one should be identified and traced to the source, says Kim Lennan, director of healthcare markets. By collecting and integrating various applications into a central repository, she says the provider organization can create a data audit trail with forensic capabilities.
“You can see what an individual is doing with an app with regard to the patient health record,” Lennan said. “Privacy is covered by two distinct areas – privacy management and IT security, and historically those two areas did not communicate with each other. Now they are talking and collaborating.”