Implementation best practices: Making interoperability work
Interoperability in health IT is tricky, to say the least. It requires complex technologies, robust standards and solid strategies.
The government and the industry are working on interoperability solutions. On the industry front, healthcare organizations are focused on using technology to improve interoperability of existing services and capabilities, according to a new Proskauer survey of 100 C-suite healthcare executives.
Here, three experts in health IT interoperability offer their advice and tips on how best to launch interoperability efforts at healthcare provider organizations.
Identifying clinical use-cases
An important initial step when thinking about interoperability is to first identify clinical use-cases, said Dr. Daniel Nigrin, senior vice president and CIO at Boston Children’s Hospital and an assistant professor of pediatrics at Harvard Medical School.
“What data about your patients do your providers need, and at what times?” Nigrin said. “Will the provider pull data about a patient when needed from another organization? Do they even know what that organization is or if there’s even any data out there?
“Or does data need to be pushed to the patient’s record from the other organization?” he asked. “And if pushed, should the patient’s provider be notified about that new information? Who is the patient’s provider, and how is that defined? And how should they be notified?”
"It’s absolutely important to use established standards when exchanging healthcare data. SNOMED, ICD-10, LOINC, RxNORM, USCDI, FHIR, etc. A veritable alphabet soup of acronyms for sure – but absolutely important."
Dr. Daniel Nigrin, Boston Children’s Hospital
Knowing the answers to these and similar questions will allow an organization to prioritize the technical approaches it takes to exchanging data with other organizations, especially those using a different EHR platform, Nigrin stated. And the answers will help an organization know whether things like CommonWell/CareQuality, direct messaging, provider portals, point-to-point interfaces or regional IHEs offer the best solution, he added.
“Or perhaps even, as we march toward the future, the potential reliance on a patient-centered model, in which the patient themselves maintains and controls the aggregation of their data, and makes it available to their provider as needed,” he said.
Set up an implementation playbook
When implementing interoperability technology, the first best practice is to align all stakeholders around an interoperability implementation playbook, said Julie Mann, chief commercial officer at Holon Solutions, a healthcare data interoperability technology and services vendor.
“The best playbooks start from a template but are modified to meet the provider organizations unique needs and should contain components such as an enterprise implementation methodology, an enterprise project plan, practice project plan, and self-service tools/reference guides to support knowledge transfer,” she said.
Alignment around the playbook should be focused on the anticipated value, process, requirements and time expectations of the implementation, she explained. Obtaining stakeholder engagement in this first step is critical to success, she contended.
“This is because interoperability projects typically stretch across entire networks and include many ‘firsts’ for many stakeholders, such as connecting independent practices, presenting patient-specific analytics into the physician workflow and liberating data that has been isolated – all of which may be brand new to those involved,” Mann said. “Preparing stakeholders for these firsts with a common playbook and a defined plan ensures unity through the project.”
Summarizing and articulating the project
The enterprise implementation methodology summarizes and articulates the components of the project across each phase of the engagement, she said. Key phases include the overall implementation plan, analysis, execution, validation and deployment, she said. This methodology can be shared with all stakeholders to articulate the process and set the foundation for the project, she explained.
“Self-service tools and reference guides assist the various stakeholders and support each phase of the project,” Mann stated. “Access to a shared enterprise implementation plan, standard specifications, and online video demonstrations are some of the most widely used tools for interoperability projects and allow scalability in knowledge-sharing.”
Above all, the interoperability implementation playbook is fueled by communication, she explained.
"Access to a shared enterprise implementation plan, standard specifications, and online video demonstrations are some of the most widely used tools for interoperability projects and allow scalability in knowledge-sharing."
Julie Mann, Holon Solutions
“Each phase of the interoperability project needs to be communicated to share progress by the project team, technical team, clinical teams and executive oversight committee,” she said. “This ensures consistent alignment throughout the project to share wins, review challenges and proactively mitigate risk. A consistent communication plan keeps the team abreast of all variables to minimize disruption.”
Combining tools, communication and alignment around an enterprise methodology serve as a comprehensive playbook for success – and is a proven best practice for interoperability solution implementations, she stated.
How interoperability fails
Interoperability implementations fail not because of technology, but due to misaligned incentives, contended Kevin Mehta, chief technology officer at Payformance Solutions, a value-based care technology vendor that deals with data interoperability issues.
“Stop thinking about interoperability as the use-case or solution for a specific technology,” he advised. “Instead focus/reframe your implementation to focus on the actual use-cases that interoperability can solve for or enable. Incentives drive behavior. Payment transformation – for example, fee-for-service to fee-for-value – is based on this core concept. The same core concept holds true for interoperability initiatives.”
Think about the reasons why organizations share data, Mehta advised. Focus on “what” problems interoperability can solve for your business within your business model, he said, and be prepared to answer “why” interoperability adds value, “why” one needs to share information, and “how” it adds value – between one’s business and one’s competitors, between one’s business and one’s partners, and between one’s business and one’s patients.
What is the return on investment?
Mann said another best practice she recommends for implementing interoperability technology is to clearly define and document the return on investment from the very beginning of the engagement. Often a decision is made to implement a solution by executives, then delegated to a project team, but the ROI goals are lost somewhere in the tactical deployment of the technology, she said. The result can be a lack of buy-in and adoption from end users, she contended.
“From the initial kick-off, it is important to review the success criteria of the project from a value perspective and ask probing questions,” she said. “What does ROI on this engagement look like for the patient, the physicians, the practice, clinical leadership, technical leadership and the administration? What are the baseline metrics? What is the short-term versus long-term value?”
By illuminating ROI as a key item on the planning portion of the project, the foundation for success is clearly understood for all stakeholders involved, she added.
“As the project begins, ROI becomes a critical component to measure, track, monitor and discuss as a team,” Mann advised. “In healthcare technology, the ROI and the strategic goals of provider organizations should be measured and mapped to the operational and clinical quality improvement.
“This should be viewed as a cyclical process during the implementation and after,” she explained. “The cycle begins with outlining the success criteria, defining the metrics, measuring, reviewing the results, and then refining elements in each step before the next round.”
Broadly communicating the results of the ROI during implementation is a strong catalyst to encourage adoption, Mann added.
“For example, it is exciting for a practice to learn that they can expect to save five minutes per patient visit after the new interoperability solution is deployed,” she said. “Sharing this and other positive interoperability solution outcomes builds project momentum and long-term engagement across all stakeholders.”
Where standards fit in
A major key to interoperability is the use of powerful standards. And there are a variety to choose from. Healthcare organization CIOs must be versed in standards when launching an interoperability project.
“It’s absolutely important to use established standards when exchanging healthcare data,” said Dr. Nigrin of Boston Children’s Hospital. “SNOMED, ICD-10, LOINC, RxNORM, USCDI, FHIR, etc. A veritable alphabet soup of acronyms for sure – but absolutely important to take advantage of. Why? So that when information is transmitted from one organization or system to another, that the meaning of that information is correctly conveyed.”
"Stop thinking about interoperability as the use-case or solution for a specific technology. Instead focus/reframe your implementation to focus on the actual use-cases that interoperability can solve for or enable."
Kevin Mehta, Payformance Solutions
Even then, sometimes a perfectly categorized data element can imply different things to different organizations. Still, this is the best the industry has at the moment, Nigrin said, and critical to take advantage of to derive the most clinical value from exchanged data.
“In addition, not relying on out-of-the-box mappings that commercial vendors provide is something that we’ve found to be important,” he said. “Especially where standards are still evolving – for example, FHIR – care needs to be taken to ensure that mappings from local data elements to the industry standard nomenclature is accurate.”
An example Nigrin and his team recently encountered had all data elements for “height” within their EHR repository being mapped to the FHIR resource for “height.”
“Sounds straightforward – until one realizes that, as a pediatric organization, we routinely capture ‘father’s height’ and ‘mother’s height’ as discrete data elements in addition to ‘patient height,’ and that all of those values were being inappropriately mapped to patient height. These kinds of examples will hopefully be addressed as we all gain more experience with some of the newer standards, but for now, double-check everything.”
Data without context is noise: Ensure there is clear communication with regard to data standards for the day-to-day users, said Mehta of Payformance Solutions.
“The key to quick wins with interoperability solutions is getting information that flows quickly through the organization to have accurate information to make the best decision at the right time,” he said. “To do this, you need standardization of data collection and reporting with a clean UI/UX. There is no amount of AI, machine learning, data science, natural language processing, or fuzzy matching logic that can make up for starting with good data.”
The variation of information, volume of data and veracity at which healthcare data travels do not allow for “cleaning it up on the back end,” he added.
“Set up the data structure with growth and external systems in mind,” he advised. “Storage and privacy are important considerations but need to be considered with growth of use-cases in mind. Users will undoubtedly want to link to other systems across the enterprise, so be mindful not only of the structure inside your system but also of those across the enterprise – for example, billing, EHR, lab, practice management, care coordination, etc.”
And ensure alignment of ROI goals with the use-cases; make sure they are measurable, he concluded. Make them bold and aligned with the vendor’s compensation, he suggested.
“Incentives drive behavior,” he said. “Use internal resources to implement the systems versus relying on the vendor, which can lead to an expertise vacuum in your organization when vendor partners move on to their next projects, or worse, they become full-time consultants that cost significantly more than an FTE that places a long-term drag on your hard fought budget.”
Health IT implementation best practices
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