HIMSS - Helping to bridge the great divide
Having observed the evolution of healthcare information technology and interoperability within both the acute care and long-term post-acute worlds, I can conclude that life for both provider and HIT vendor is in many ways simpler in the acute care setting. The care setting-level workflow, regulatory, and reimbursement variances and nuances across the sub-segments of long-term and post-acute care naturally add complexity.
However, while acute care has HIMSS and HL-7, the native complexity of LTPAC is compounded by a highly fragmented set of associations and standards bodies attempting to represent and advance the technology agendas and interests of different segments of providers and HIT vendors. Instead of one NASA trying to put a man on the moon, it feels like we have two dozen NASAs all independently trying to build rockets for the long-term care industry.
Given this fragmentation, it is very exciting to see HIMSS take an expanded interest in what we do, especially with interactions with the acute and ambulatory settings. While these efforts have been growing slowly over time, the recent HIMSS 2016 conference had the unmistakable feel of building momentum.
There were very specific LTPAC sessions regarding electronic transitions of care, which were well-attended. In addition, there were focused roundtable and networking sessions that were very well attended by providers, HIEs, the leading LTPAC HIT vendors, and some of the most forward-thinking LTPAC associations. These sessions were engaging and brought together real experts in the inherent differences and common needs of these different worlds.
With healthcare interoperability making headlines for both positive and negative reasons, it was good to hear a consensus emerge from these sessions as to the actual state of affairs with respect to electronic transitions of care.
Using the three core elements of interoperability (payload, transport, transaction) as a frame of reference, there was consensus that we do indeed have effective solutions for two of the three elements. With respect to payload, the HL-7 ordained Continuity of Care Document (CCD) and Consolidated Clinical Document Architecture (C-CDA) definitions serve to provide a relevant, although voluminous, care summary.
On the transport front, various implementations of the DIRECT messaging framework are being used quite effectively to securely transmit care summaries between partners. Assuming timely generation and transmittal of the care summary to the receiving partner, it is the transactional aspect where the summary is “consumed” by the receiving system and presented into a useful clinical workflow that continues to disappoint.
Most current implementations simply attach or otherwise make available the full care summary within the resident's medical record. Per the clinician voices in the HIMSS-coordinated sessions, this is akin to dumping the full haystack on my head when all I need is a handful of needles (e.g. problems, med list, allergies, etc.) to perform my normal workflow. Defining the essential clinical workflows involved in a transition of care and the small subset of truly valuable data points within the care summary is an area needing more focused collaboration between provider clinicians and HIT vendors across all healthcare sectors.
I believe that HIMSS can and will be an effective force in facilitating this cross-segment collaboration and driving adoption of usable workflow solutions for provider clinicians.
While HIMSS' growing involvement in LTPAC can complement and augment the work being done to create effective solutions to key use cases such as electronic transitions of care, we will still have to address one of the more troubling, overarching issues in bridging the acute to post-acute divide. Having transmitted a very large number of care summaries electronically through our platform, the single most disappointing thing I have witnessed over the last three years is an attitude of distrust of the clinical practice and standard of care between “partners.” In reality, nearly all of the value that is created by executing the electronic transition of care is squandered when the receiving side simply disregards the information and “starts from scratch” with the mantra of “we don't trust what they do over there.”
This is not a technology challenge; it is a much bigger challenge that will require cross-organizational care coordination and transparency regarding the quality of care and clinical practice. Hopefully the conversations and collaboration that began at HIMSS 2016 will result in trusting relationships that will help to effectively bridge the great divide.