Guest Columns

A case for interoperability: Electronic lynchpin for long-term success

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Greg Nicholas, Optimize Health
Greg Nicholas, Optimize Health

As an owner-operator, you likely are on information overload when it comes to electronic health record (EHR) systems. You may be surprised to learn that a much larger issue – interoperability – lays the essential data communications foundation for not only EHR, but a whole host of critical business and clinical processes at your facility. This foundation, if properly laid, could reap significant hard-dollar savings and better efficiency down the road.

Let's take a look at the fundamentals of interoperability.

Interoperability in business terms

The Healthcare Information and Management Systems Society defines interoperability as the ability of different information technology systems and software applications to exchange data, and use the information that has been exchanged. The essential part of the process is to avert human intervention on the front end while rendering the data usable on the back end.

Imagine a large puzzle you just spent hours laboring over, breaking it apart and throwing it on another table and watching the piece's land exactly where they were before. Experts can provide any number of reasons why interoperability is so difficult, but the most succinct yet profound reason is this: it's an exact science and there is no room for error. The data in the sending system must be transmitted to the receiving system and land in exactly the right spot, every time.  This alone results in the use of file standards, such as HL7 and data mapping exercises.   

Unfortunately, many providers don't always populate all of the fields in their EMR, which can create critical gaps in key pieces of information when those records are exchanged with another provider system.  In order to fill these gaps, a phone call to the provider must be made to clarify points and get additional pieces of information and this increases costs in labor. Parties in interoperability must agree to populate required fields and not just the ones they think they need internally. Being able to effectively exchange and use data relies on having complete data.

The case for interoperability is that it significantly increases the speed and accuracy data can be exchanged and removes human intervention, which saves money in labor costs.

Consider this example, a large facility may have to employ several people processing and submitting hundreds of claims per day. But if I can programmatically write a process that automates the handling and submitting of those claims, you pay one person one time to write the program to do it, you have increased your cash flow, reduced errors in submissions and reducing the amount of staff previously needed for claims processing or at least freed up their time to do other things.

Once your facility can establish a connection with a hospital or other entity, the hospital can transmit large volumes of data over that connection repeatedly, far exceeding the amount of data that any person can manually key.  And if that connection is used by multiple facilities, the scalability benefits in terms of time and labor savings are exponential.

Why long-term care providers should care

First, there are clinical reasons. Evidence shows that as interoperability becomes the norm, it will lead to fewer medical errors and better clinical decisions. A higher volume of accurate data from various sources will be presented to providers at the point of care, enabling better decisions which should lead to better outcomes.

Second, there are financial reasons.  Without interoperability, your only answer is to add another resource to the task you need done. But if the task is repetitive in nature, and the data is available in one of your other systems, building a connection to the other system in your environment will save you from adding another resource for a simple repetitive task. The risk and reward of interoperability heavily favors early adopters.

Third, there are compelling scalability benefits of time and cost savings from interoperable connections across multiple owned entities. Consider the claims processing scenario I previously mentioned, what would your staffing levels look like if you had to manually submit 3000 or 5000 claims.  Granted, this is only an example, electronic claims submissions have been around a long time but you can understand how cumbersome, error prone and expensive this scale would be without a programmatic means and an interoperability connection to your payer.

The case for an interoperability strategy

No important business initiative can succeed without a strategic plan. And that plan entails several important elements.

First is understanding that each business unit or department has its own unique interoperability needs. For example, your claims department may need to connect to a clearinghouse that will route claims data to a payer, your front office may need to send and receive admit, discharge and transfer data between a nearby hospital, while your accounting department may require a bidirectional data exchange with a bank for direct deposit or accounts payable.

Second, a successful interoperability initiative must be led by the business unit and implemented by the IT staff with detailed requirements. This is one thing I learned to be an essential key to success: An overall strategy from a business department perspective leads to the right initiatives implemented by the IT team.

Third, identify the right people to implement your interoperability plan. The beauty of outsourcing IT expertise is your provider likely has seen what works, and more importantly, what doesn't. An IT professional also plays a key role in helping you shape your overall goals, as well as the myriad of technical and security challenges that make interoperability possible.

Fourth, interoperability must be a major component of your IT strategy and technical architecture. You can invest a lot of money in building an IT infrastructure but if it doesn't communicate seamlessly with other systems outside your four walls, you will not get the benefits from your investment.

Finally, the IT architecture you build must be able to support multiple interoperability initiatives.  This can be difficult to grasp, as an example, if you establish a connection with a hospital partner, you should be able to exchange admit, discharge and transfer records, continuity of care records, lab results, referrals, etc. over this one connection.   

When to start?

If you've waited to embrace interoperability and you're reading this article wondering when to start, you may be surprised when you realize the potential savings that you can achieve from such an initiative. But that should not discourage you. The time to implement an interoperability plan is now.

In fact, you may be surprised to learn like most, your facility already has some form of interoperability in place. If you have time clocks in your building that transmit data into payroll systems, that's one example. Direct deposit processes between your facility and banks is another. Decide which area of your business has the greatest need for it. Likely culprits are payroll or claims processing due to high volumes of repetitive information but exchanging clinical data with other providers and hospitals will also reap great rewards so leave no stone unturned as you build your plan.  

Measuring your success

In conclusion, the long-term viability of important initiatives like interoperability hinge greatly on careful planning and a resolute devotion to executing the plan. That includes identifying up front the benefits you hope to realize – not only the financial fundamentals, but also enhancements in quality and operational efficiency. In this way, you can measure how well your interoperability plan helped you achieve your desired results.

Finally, measuring the results of your interoperability initiative keeps you honest and helps you fine tune future endeavors. A good example is the admission, discharge and transfer (ADT) process. A successful interoperable connection will ensure that a referring hospital will discharge their patient, an ADT and CCR record will be sent to your facility and by the time your new resident arrives, they're already enrolled in your system and can be welcomed at the front door.

In my next article I will discuss how to balance the risks around interoperability.

Greg Nicholas is managing partner of OptimizeHealth in Dallas, which works with long-term care customers on IT solutions. A 20-year healthcare veteran, he also has led technology integrations for the Department of Defense, Empire Blue Cross Blue Shield, WellCare, WalMart Pharmacy, Aetna and Cigna-HealthSpring. 


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Guest columns are written by long-term care industry experts, ranging from academics and thought leaders to administrators and CEOs.