The case for clinical practice interoperability

Both executives and clinicians must 'adopt a new brand of polarity thinking'
By Michelle Troseth
10:52 AM

The healthcare system demands enhanced care coordination and collaboration in response to value-based reimbursement, population health, patient engagement, integration and an expanding continuum of care. To accomplish these things, healthcare leaders must invest in interprofessional care, clinical integration and evidence-based practice, and integrate the perspectives and practices of every healthcare professional – physicians, nurses, allied health professionals and non-healthcare providers engaged in prevention and care management.  

Building the pillars of interoperability 
Technology alone can never generate healthcare change and transformation. Instead, executives and clinicians must focus on delivering the right information at the right time to care for consumers and patients with both simple and complex conditions.  

Doing so demands that executives and clinicians integrate the pillars of clinical practice interoperability that "live" with health information systems. Among the strategic priorities for executives and clinicians:

  • Implement evidence-based care planning and documentation.
  • Deliver timely clinical reference content to empower patients, consumers and providers.  
  • Increase engagement via mobile health devices-- before, during and after episodes of care.
  • Develop and share patient stories that connect episodes of care and daily activities.  
  • Rely on evidence-based order sets.

Executives and clinicians must also change the way they describe, interpret, analyze and evaluate care. Specifically, they must extend awareness, knowledge, skill, experience and competence beyond health information systems to interprofessional clinical practice. Instead of taking an either/or approach to technology and clinical practice, they must consider technology and clinical practice simultaneously.  

Moving toward polarity thinking
Doing so requires executives and clinicians to adopt a new brand of polarity thinking. They must evaluate the upsides and downsides of an exclusive focus on information systems technology. On the upside: innovation, standardization, information integration, enhanced efficiency and data retrieval. On the downside: lack of evidence-based information, interference with integration and absence of the human element. As a chief medical informatics officer (CMIO) once said: "We're one of the most wired healthcare systems in the nation, but we're not achieving quality results."

In a second step, executives and clinicians must evaluate the upsides and downsides of an exclusive focus on clinical practice. On the upside: evidence-based, professional practice and workflow, clinical integration across disciplines and a more caring culture. On the downside: limited awareness of technology's benefits, lack of information to enhance quality and declines in information access and retrieval.

But how can executives and clinicians implement polarity thinking and bring about technology and practice interoperability? A first step is to ensure that interdisciplinary care team members understand the design, purpose and functionality of varied technologies. Equally important is offering team members the time and resources to learn and assimilate EBP. This includes embedding technologies with tools and processes that help team members grasp EBP, scope of practice and integrated workflows.  

Toward a cross-continuum platform for practice interoperability
Executives and clinicians must also establish a platform for practice interoperability anchored in the following strategies:   

  • Champion intentional design of automation: Expedite interoperable systems. Prepare and engage clinicians by supporting an EBP framework capable of generating quality outcomes.
  • Support practice interoperability:  Rely on a professional practice framework with tagged data to guide care, facilitate information exchange and deliver interprofessional services across care settings.
  • Endorse content interoperability: Depend on consistent professional data and content exchanged within systems across the continuum of care.
  • Promote EBP: Implement EBP, first defined by David Sackett in 1997 as "the conscientious, explicit and judicious use of current, best evidence in making decisions about the care of individual patients. (It) means integrating individual clinical expertise with the best available external clinical evidence from systematic research."

Make a case for EBP as the interaction between four elements:

  • Best research evidence
  • Clinical expertise
  • Patient values and preferences  
  • Care context

Accelerating national action on EBP
The majority of healthcare organizations have committed to improving quality and safety, according to a 2013 survey of 276 nurse executives conducted by Ohio State University with support from Elsevier. Not surprisingly, implementing EBP tools and resources ranked low on the list of executive priorities.
To accelerate movement on EBP, nurse executive leaders at a 2014 national forum  made several recommendations including  that healthcare organizations seamlessly integrate EBP into the electronic health record (EHR), generating two outcomes: (1) Evidence to guide care decision-making and, (2) Making healthcare professionals competent in EBP and informatics.    

Spearheaded by the TIGER Initiative, a collaborative focused on usability and clinical application design has endorsed early, consistent attention on product users, product evaluations involving users and metrics and iterative design processes with versions matched to users, tasks and environments.   

Clinical application design calls for integration of multiple elements, including EBP, systems thinking, scope of practice, individual and integrated competency and knowledge discovery. Among the issues:

  • Within acute care, how well do technologies and practice tools support the patient experience--from entry through the emergency department to critical care to med-surg to discharge to rehab?  
  • Has the organization created EBP systems that clinicians and executives can easily support, use and update?  
  • Do systems adequately support the scope of practice of each professional discipline?
  • How well do individuals and teams work together in caring for patients?
  • How should healthcare professionals share best practices in clinical practice interoperability, contributing to learning healthcare organizations and a learning healthcare system? 

Forward to the future
Healthcare will soon be dominated by interprofessional teams that operate with individual and integrated scopes of practice. To deliver care across the expanding continuum, professionals will need health information systems that support individual and team based care. By integrating a focus on technology interoperability with a fresh focus on clinical practice interoperability, clinicians and executives can improve quality and outcomes and build a more effective care delivery system.

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