Healthcare is delivered by an entire ecosystem of players in a highly heterogeneous environment.
Successful delivery of care in this environment requires data exchange, interoperability and transparency that puts the patient at the center. Hospitals and health systems must have technology strategies that engage the "affiliate networks" of all relevant providers.
During a roundtable session sponsored by athenahealth at the Becker's Hospital Review 12th Annual Meeting, Michael Kovach, executive director deep partnerships, corporate strategy for athenahealth, discussed interoperability and strategies to activate affiliate networks.
Three key takeaways:
1. Interoperability is evolving: We are entering a period of platform interoperability. Interoperability began in the early 2000s via raw data exchange capabilities through point-to-point interfaces. This was followed in the 2010s by the rise of the "API economy," where more sophisticated data exchanges could take place, but the app frenzy led to providers referring to dozens of single-purpose apps. Providers were overwhelmed and confused. "I have to know which tool to use, in which moment, in which pane of glass," Mr. Kovach said.
Today we are at the beginning of "platform interoperability," where platforms exchange data with other platforms. "When we think about your affiliate network, we want to connect the platforms and not the nodes," Mr. Kovach said. The goal is to create one comprehensive record about the patient. "When we have traditionally thought about health information, we have put the system at the center," Mr. Kovach said. "And I think platform interoperability puts the patient at the center."
2. There are foundational prerequisites to make platform interoperability work. Key foundational prerequisites are creation of a data lake and presenting data to providers within their workflow. A health system might have dozens of different EMRs across its inpatient and ambulatory settings. It is quite costly to get these EMRs to share data, and it is impractical to get everyone on a single platform.
Instead, Mr. Kovach advised, "Stay on your native system of record and we're going to suck all of that data out and put it into a data lake, and then we're going to essentially build an application layer that is powered by the lake and not a particular EMR of record." The data lake enables multi-tenant applications and makes it possible to access data assets from multiple sources. "What we really want is taking the data and presenting it natively within a provider's workflow or within a patient's workflow," he said.
A roundtable participant from a large hospital in California that has about 300 different departments and that is not yet on one EMR said, "No one speaks to each other." She sees great potential in the idea of a central data lake. This would enable any department or affiliate to view complete patient information wherever a patient is present.
3. In practice, an activated affiliate network eases the burden on providers and sets patients up for success. A group of orthopedic affiliates that used athenahealth wanted to be able to refer hospitalized patients to other affiliates in the network for post-discharge appointments. These orthopedists wanted to make referrals and schedule appointments for these patients from their EMR as part of their normal workflow, without having to send faxes or make phone calls.
athenahealth worked with a third party to build a scheduling overlay for the entire health system across multiple EMRs. Clinicians could schedule follow-up appointments from within the EMR. This ensured that patients didn't fall through the cracks after discharge; appointments were already scheduled, along with confirmations, reminders and follow-ups. This leveraged interoperability to "make those last-mile arrangements so you're setting the patient up for maximum success," Mr. Kovach said.
The transformation to platform interoperability is becoming a reality as companies like athenahealth provide the building blocks to get there. "We're getting to the point of interoperability, where that promise is no longer aspirational," Mr. Kovach said.