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People, processes and technology: Interoperability isn’t just about technology

I stumbled across an amusing headline a few weeks ago: “Interoperability: It’s not just ‘nerd talk’.” My first response was amusement, followed by “Well, of course it’s not.” The context? Kevin Fickenscher, MD, of AMC Health, told the AHIP Institute Data Analytics Forum that interoperability needs to move from “a nerd discussion” to a discussion across the entire health care community.

It’s starting to happen. 

Recently, the ONC released Connecting Health and Care for the Nation: A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure, which describes the ONC’s broad vision and framework for interoperability. It rightfully identifies interoperability as “a core foundational element of better care, at a lower cost and better health for all.” Physicians must be able to receive information about their patients as they transition across care environments, and that information should seamlessly flow into their EHR systems. Moreover, as we all know by now, interoperability is a requirement for Stage 2 Meaningful Use. 

Lack of interoperability has hampered the potential of EHRs to enhance care delivery, particularly as patients move across the care continuum.

And that, my friends, is why Direct is so powerful. Direct provides a secure, standards-based way for participants to send authenticated, encrypted personal health information directly to trusted recipients across the street and across the country–regardless of who has which EHR system. Connecting providers with certified EHR systems nationwide, Direct addresses real-world health care gaps, especially the lack of care coordination across care transitions.

That’s where MedAllies comes in. MedAllies has provided Direct services since the Direct Project’s inception. Today we run a leading national Direct network. Our service suite, MedAllies Direct Solutions™, builds on existing technology to achieve interoperability.

And that gets me back to the “nerd” issue. Interoperability can’t be viewed simply as a technology issue. It involves people. That’s why any effort to advance the direct exchange of information must be clinically relevant. It must enhance–not impair–provider efficiency.

I’ve said this before and I’ll keep saying it: If a clinician believes health IT enhancements will improve care and efficiency, interoperability will advance rapidly. If the providers don’t believe this, well, nothing much will happen.

The MedAllies approach enhances and optimizes the practice’s EHR workflow to process and integrate information exchanged during patient transitions of care. After all, our team includes doctors and health IT experts. Some of us are both. We understand how to work with physicians, physician organizations and health systems.  We know, first hand, that it’s essential for interoperability to align with physician workflow for delivery of high-quality, patient-centered health care.

I have great respect for nerds. Some of my best friends are nerds. But interoperability must not be seen as strictly a technology issue. It’s about people, and processes–and yes, technology. It’s about making meaningful use of technology to support better care, better health and lower costs.

Health IT as a catalyst for transformation: For want of a nail

Clinicians matter. Workflow matters. Data matters. Technology is ultimately just a catalyst for health care transformation. Dedicated providers and their teams are required to create advanced primary care practices, patient-centered medical homes and neighborhoods.

A study recently published in the Annals of Internal Medicine[1] confirms this. Researchers looking at practices in New York’s Hudson Valley found that primary care physicians participating in medical homes improved their quality of care over time–and at a significantly higher rate than their non-PCMH peers, regardless of whether the non-PCMH practice used paper or electronic health records.

EHR technology proved insufficient to achieve improvements in care. It was the combination of EHR use plus organizational changes that was associated with the greatest quality improvement. These results strongly suggest that changes to organizational culture and workflow, as well as how practices implement technology are essential to improving quality of care.

MedAllies was involved in this study. Via  local partnerships and the Hudson Valley Initiative, MedAllies helped hundreds of physicians–including those in the study–implement EHRs and become patient-centered medical homes. Because of our experience here in the Hudson Valley, we understand how to activate clinical interoperability across communities and across disparate EHR systems. We help providers and their care teams define role-based clinical workflow utilization of their EHR tools to maximize their opportunities to capture and use data to assist their transformation efforts.

 So when it comes to implementing Direct in support of achieving a patient-centered medical neighborhood and meeting the Meaningful Use Stage 2 requirements, we are prepared. MedAllies has developed an onboarding process that enhances existing clinical workflow and fosters seamless transitions of care. It’s that mindset of clinical and technical expertise that we bring to Direct — it’s at the heart of MedAllies Direct Solutions™.

MedAllies Direct Solutions provides a simple, secure, scalable, standards-based way for participants to send authenticated, encrypted personal health information directly to known, trusted recipients via the Internet–an approach that works across EHR vendors.

 The MedAllies approach enhances and optimizes the practices’ EHR workflows to process and integrate information exchanged during patient transitions of care. A clinician has pertinent clinical information “pushed” into her EHR system, allowing her to provide the highest quality, safest and most efficient care possible.

 MedAllies operates a leading national Direct network, but our implementation focus is clinically and community centered. MedAllies Direct Solutions builds on existing EHR-based workflows. We engage directly with the clinical staff to incorporate Direct exchange of information into each practice’s regular stream of work. Through our proven three-phase, three-track onboarding process, while the technical team is working on integration and testing activities, we ensure clinicians receive the implementation materials and guidance they need to “go live” in 30 days. We have successfully used this same process with tens of thousands of providers across the country.

Technology is a catalyst. It provides a means to our goal: transitions of care that foster care coordination in service of the three-part aim of better care, improved health and reduced costs. If we don’t make this goal a reality, the technology is just a hammer without a nail.

[1] Kern LM, Edwards A, Kaushal R. “The Patient-Centered Medical Home, Electronic Health Records, and Quality of Care.” Ann Intern Med. 2014;160:741-749.