Interoperability: Balancing risks and opportunities
Greg Nicholas, Optimize Health
My previous article in this series made the case for interoperability in long-term care and how it has become an essential data communications foundation for so many critical clinical and financial decisions facing owner-operators today. We explored the various reasons why every facility manager should care, how strategic plans and metrics ensure implementation success and why the time to act is upon us.
The long-term care industry finds itself at an information technology crossroads. The urgency and importance of seamlessly exchanging vital business and healthcare data is as complex and multifaceted as any medical condition or issue. So many of you may be waffling – not knowing when or why to start, much less what will happen if you do nothing at all.
Many providers are experts at overseeing day-to-day operations, yet are intimidated by the prospect of leaping from paper to an electronic system.. Many also are quick to foist important information tasks to manual processes and people, yet remain wary of computers and security. Sadly, there are big prices to pay for doing nothing, or worse, doing it poorly.
This is why it's important to go into interoperability initiatives with eyes wide open. A clear understanding of the risks and opportunities is a good place to start.
The consequences of avoiding interoperability initiatives:
- The old problems never go away. Interoperability is something that isn't going away. Neither are the old problems if you decide to ignore its importance. There are countless examples of how interoperability solved problems entire industries didn't even realize they had. Take the banking sector. Imagine if we still had to collect all of our checks at the end of the day or week, drive them over to the bank, write out a deposit slip, stamp each one of them, and take them up to the teller window? And imagine where we would be if credit cards were never invented by Western Union in the early 1920s. Speeding and approving the flow of currency created vast amounts of new wealth, infrastructure, skyscrapers, modern education, explosion and curation of the arts and on and on. Now apply those same questions to the healthcare industry, where speedy decisions based on collaboration and accurate information make people faster and better and even find cures for diseases years before their time.
- Increased costs and lost efficiencies. The problems of the past are still going to plague the future if interoperability continues to be delayed or avoided. Vast efficiencies will never be realized if the mindset in the long-term care industry continues to rely on enlisting people and manual processes to chase down information and other tasks that automation can do in a fraction of the time and for virtually no cost. The hard costs alone are staggering. Then there are the soft costs – including government mandates and loss of business.
- Missing the boat on patient-centered care. It's bad enough lacking the interoperability to share and exchange information, but not having the best available data to talk to patients and residents about the quality of care they're receiving borders on tragic. If the data isn't there, that conversation can't take place, and patient-centered care simply cannot happen.
- Missed partnerships. Understand that competitors who beat you to the punch with fully implemented interoperable capability will likely cost you invaluable partnerships with key providers such as hospitals, doctors and accountable care organizations. These partnerships have to be established, so the movement of data is efficient. And the standards are already in place with HIPAA EDI and HL7, which allow vital health information to flow as effortlessly and secure as currency now does.
- Loss of referral bases. To be direct, those who don't jump on board and get connected to hospitals and provider groups are very much at risk of getting left behind. Absent interoperability, your facility runs the very real risk of becoming irrelevant, falling off the radar screen of referral sources and essentially becoming virtually invisible. It's no longer enough to rely on your good reputation or word of mouth. It's about data. In a previous job I held, a major reputable regional healthcare provider sought more efficient data movement. The system made it very clear to me they were very willing to stop sending me referrals if I did not embark on this initiative. Not doing so would have cost me all referrals in 60% of my facilities.
- Diminished decision making and quality of care. Fully interoperable EMR systems provide powerful clinical decision support capability, and ultimately, demonstrably improved quality of care. Whether it's clinical lab results, or instantly updated continuity of care record information automatically uploaded to your EMR, interoperability obviates scores of inaccurate and costly manual processes and brings decision making elements directly into the providers' hands for improved patient outcomes. Ultimately, that's what we're trying to do – improve lives and patient care.
- Rating declines and penalties. Very real penalties are now in place for hospital EMRs that fall short of meeting meaningful use criteria. Fines can result if ratings drops under Five Star. It's not hard to imagine those kinds of pressures being applied soon in long-term care. This industry is headed for the same environment hospitals find themselves in an environment that rewards and punishes on quality and measurement issues. We're already starting to see owner-operators scramble to put the pieces in place. Some say they're not moving fast enough. The cost of falling behind are going to be the same: lost revenues, declining quality, higher costs, potential mandates and financial penalties.
Maximizing the value from interoperability
Interoperability has quite an enviable return on investment. Once you do implement interoperability, there are a host of immediate and very tangible benefits. There also are a number of ways one can unwittingly leave many not-so-obvious ones on the table. That's why it's important to maximize the value of your investment.
Ironically, one of the most easily ignored benefits is the data itself. In other words, collecting all of that rich data does you very little good unless you know what to do with it.
Here are a few tips:
Start simple. Understand the beauty of scalability.
Many facilities have found success by starting out slowly, usually with a business process with a high chance of success. Direct deposit is one example. Looking more broadly, you can maximize the value of interoperability by targeting a big item that's repetitive in nature. If the solution is designed properly, it can easily be applied multiple times. This is the beauty of interoperability, so many parts of it are scalable. For example, say you want to connect to a hospital and exchange ADT data. If you have a bidirectional connection, you could send the same ADT data back to the hospital if the patient needs to go to the hospital. You could apply essentially the same process with continuity of care records. There are long-term benefits to choosing the right initiative, implementing it correctly and applying it multiple times to different initiatives that are needed in a long-term care facility.
Don't reinvent the wheel.
Looking upstream, acute care has long ago developed and implemented a lot of these technologies that post acute care can easily piggyback on or adopt without incurring the same costs or sweat. It makes no business sense from a time or cost perspective to pursue a customized solution that addresses the same problem. Moreover, many costs involved with interoperability are one-time costs. One of them is connecting to an exchange. You connect to the exchange one time and then exchange multiple pieces of data for different provider organizations over that same exchange. Look to your technology partner to help with architecting and designing the connectivity and interoperability solutions, so that one-time spend can be used over and over again.
Be careful not to think your challenges are that unique.
Too many long-term care providers today are convinced their challenges are unique, and therefore, pursue needlessly costly customized interoperability initiatives. For example, there are already lightweight solutions available for exchanging data. Remember the concept of plug and play? Believe it or not, it still has a viable place in IT infrastructure.
Find an IT partner you can trust.
This is especially true when it comes to outsourced IT expertise. Most people don't just jump into a marriage the same day they meet someone. Choosing the right technology partner is equally important. Not only does that partner have to have an understanding of your business and the long-term care industry, but also needs to be engaged with your leadership team. There's a certain level of trust that's necessary for the relationship to work well, so strive for a true partnership rather than just a technical resource to implement a solution.
Educate yourself and create your roadmap.
Embarking on an interoperability initiative is infinitely more successful if owner-operators educate themselves on the fundamentals. We're not talking “geek-level” knowledge, but the basic concepts behind EMRs and interoperability. You have a huge stake in the interoperability initiative succeeding. Why not do all you can to know as much as possible about it? In addition, visualize how interoperability will help your business evolve, and establish realistic goals you hope to achieve by implementing interoperability, establishing metrics and measuring your success along the way.
Is installing an EMR enough?
Make no mistake: Installing an electronic medical records system is essential for any long-term care owner-operator – sooner rather than later. It is a big part, but not the only part, of building an information technology platform for your business.
Too many long-term care owner-operators think investing in an electronic medical records system and interoperability are one in the same or that an EMR is the golden key to opening all the doors to opportunity.
Installing an EMR gives you the ability to track your patients, assign residents to rooms and beds and maintain and manage quality of care. But its greatest potential is wasted without a fully implemented interoperability strategy. In other words, an EMR system is not something you assign someone to check on periodically to ensure the lights are blinking. The most successful implementations begin with EMR and ends with fully integrated interoperable functionality.
Your EMR needs to connect seamlessly with internal systems like scheduling, charting, claims, billing and payroll. Once your internal systems are connected, you start reaching outside the facility and connect with provider groups, lab companies, hospital systems, marketing systems, etc.
Remember: There's no one system in the world that does everything, and there's no reason to think one EMR or another is going to be the Holy Grail for what you want your long-term care operation to achieve. In larger organizations, dozens of other systems and applications must be able to interact seamlessly with each other to achieve true interoperability, and hence, greater opportunities, greater efficiencies and higher revenues. The real beauty comes in the world outside your four walls, when healthcare entities and players of all kinds exchange, share and use information to improve business processes and more importantly, your residents' lives!
Greg Nicholas is managing partner of OptimizeHealth in Dallas, which works with long-term care customers on IT solutions.