How to boost the chances that tech can aid care quality
Certain steps can increase the impact of interoperability rules and regulations, boosting the probability that patient care can be improved.
How do we know that interoperability rules and regulations will make patient care safer and better? New is not necessarily better.
This universal principle applies to almost anything, including the design and implementation of new interoperability standards or regulations, whether from the Office of the National Coordinator for Health Information Technology (ONC) in the U.S. or another authority, aimed at standardizing, creating incentives and removing barriers for encouraging the freer flow of information across organizational, regional and national boundaries.
This is a case in point. Imagine a project involving healthcare ecosystem participants impacted by a new initiative of a government-sponsored health information exchange (HIE) that requires participants to adopt the Fast Healthcare Interoperability Resources (FHIR®) standard. The HIE’s technology strategy is to move away from and decommission legacy Health Level Seven (HL7 v2) production interfaces between the local information systems of hospitals in the region and a shared clinical information repository and to migrate to FHIR interfaces. In theory, the FHIR migration would enable a region to improve quality, efficiency and effectiveness of healthcare—the goals of the standard as stated by the non-profit HL7® FHIR® Foundation, which promotes global adoption and implementation of the FHIR® platform standard.
Unfortunately, this change to FHIR will have an unintended consequence if many hospitals in the region don't move forward and maybe even take a step backwards in timely sharing of pertinent clinical information via electronic means, which increases risk to continuity of the highest possible quality of care for patients. The risk of failure to achieve the intended outcomes has nothing to do with the FHIR standard itself but rather decisions made by the health authority regarding the project approach and design and implementation of the standard.
The health authority has a stated goal of improving healthcare for the population but has framed the initiative as an IT infrastructure rather than a clinical transformation project. With the approach being technology-oriented and IT leadership-driven, representatives of hospitals in the ecosystem were not invited to serve as sponsors or consulted effectively at the outset of the initiative. Their voices not heard, the initiative was launched with all good intentions but a poor design and subsequently suboptimal implementation and ultimately lack of acceptance by providers. The FHIR implementation is not fully consistent with the approved industry FHIR standard and incorporates new regional-specific privacy requirements that providers see as burdensome, unnecessary, complex and with poor feasibility technically for implementation. Ultimately, everyone may suffer from the new rules introduced by this technology initiative—especially patients and those that care for them.
There is nothing wrong with IT projects per se; implementation of new and upgraded back-end technology infrastructure often is necessary and critical. It’s just that the most important benefits from this particular project are about better, safer care and improved access to information for providers and patients; technology standardization should not be the only or most important objective.
Pure technology infrastructure projects can and in many cases should have measurable business benefits, e.g. better confidentiality, integrity and availability of information. Some technology projects are more appropriate to be positioned from the get-go as clinical transformation projects, enabled by IT. This distinction may seem subtle and therefore unimportant. But the framing of the approach can have dramatic impacts to so many aspects of the work and hugely affect the extent to which resources are responsibly used, risks effectively mitigated and value to the stakeholders is ultimately achieved.
The good news is government authorities enacting regulations, industry bodies creating standards and healthcare systems themselves can take steps to mitigate risk, responsibly use resources and create value from their efforts, not just for interoperability but for any data and technology initiatives. It’s wise, before formally initiating and investing time, energy and funds in transformational change initiatives, first—and continuously—to engage with key stakeholders that will impact or be impacted by the change, seek their perspectives and cultivate their support, and to decide whether the project will be sponsored and led by the business or by IT.
Winning and sustaining strong stakeholder sponsorship, engagement and support is easier said than done yet is so critical to success. We can learn from numerous examples of successful transformational change journeys across the world, spanning many industries not just healthcare. The lessons of so many others point to the wisdom of working together to think carefully about what you are trying to accomplish; how you will know (and measure) whether the change will result in better outcomes; and how you will sponsor, lead, approach, scope, staff, schedule and fund the project.
Invest plenty of time on the front end to engage stakeholders in setting direction. In determining the approach, don’t be dogmatic: seek outside advice and help, where needed, but avoid getting married to a single cookie-cutter approach espoused by consultants while learning from other organizations’ successes and failures. Be open-minded, flexible, resilient and adaptive in selecting and applying various established and leading-edge frameworks, whether from consultants or vendors, and apply knowledge from other fields including complexity science, systems thinking, project management and change management, to help you work together to turn vision into reality.
Robert Slepin is a project director and advisor that helps leading hospitals and healthcare systems to plan, execute and oversee large-scale Epic health information system (HIS) projects, enabling clinical transformation.