When it comes to housework, even though there are more time-saving tools than ever — dishwashers, washing machines, vacuum cleaners — families today spend about the same amount of time each week on housekeeping as they did in 1900. 

Similarly, I look at all the technological improvements we’ve made in medicine over the last 20 years and wonder whether care has improved or efficiencies have been made. And a recent article got me thinking about technology integration and interoperability challenges that hospital systems are facing -- that may need to be solved sooner rather than later.

At this point, EHR and EMR adoption is widespread. There are very few medical contexts in which technology isn’t a major component of our medical practice. But the ongoing problems (like interoperability and workflow issues) presented by many technologies may be more challenging to solve than the initial implementation was.

For instance, this article looks at several hospital systems that are struggling with interoperability. The University of Pittsburgh Medical Center uses three separate EHRs — one for oncology, one for ambulatory, and one for in-patient. Of course, up until recently, none of the systems talked to each other or were interoperable.

And as we move into a value-based era of medicine, the complications that present themselves in technology become even more challenging to manage.

The example of the University of Pittsburgh Medical Center using three different EHRs in a fee-for-service era may make sense. But when medicine is value-based, it simply won’t work. Chronic, complex conditions (those that tend to be most expensive for hospitals to deal with) are often the ones that bridge multiple areas of the hospital system. And having a separate EHR for each area, that doesn’t integrate or “talk to” the others, presents costs and care coordination problems that will be unmanageable, if they aren’t already.

That hospital’s solution was to develop interoperability software (developed in house) for one EHR to communicate with the others.

Ed Mcallister, CIO at University of Pittsburgh Medical Center says that “although EHRs took healthcare in the right direction by digitizing information that was once in a folder in a drawer, they are still lacking and not the right model for documenting patient information or for sharing it. More so than a vendor product that would tie [EHRs] together… [we need a technology that would] pull the information at the point of care into a layer that is more tied to patient care than what an EHR is today”

In other words — EHRs certainly do not meet hospital system needs for medical collaboration and care coordination. And interoperability problems aren’t just about transmitting information from one EHR to the other. The issue is facilitating care for patients, even in the complex context we find ourselves. What healthcare is seeking now is true care coordination, technological support for medical collaboration, and (certainly) interoperability, so that healthcare providers can access key information about their patients.

iClickCare plays a part in meeting the demands for a system that supports true medical collaboration -- but we can't do it alone.

If your hospital system struggles with Health IT interoperability or care coordination challenges, hybrid store-and-forward telemedicine may be one piece of the puzzle. Get our pictorial white paper report on it here:

Photo by Daniel Wirtz on Unsplash

I'd like to start by saying that I have huge respect for the VA (of course). The work they do is deeply honorable, incredibly challenging, and skillful. Especially as we approach our Independence Day, I believe that the VA is a key part in protecting our nation. 

That said, they do face the challenges of being a large, underfunded government agency. And the scandals that have roiled the institution over the past few years reflect the challenges that so many organizations face, even if (slightly) less bulky and (a little) less underfunded. And the VA potentially reflects the same solutions that we all need to consider if we're to advance -- it's just starker in their case.

Exhibit 1: a year after the Department of Veterans Affairs was scandalized by long wait times (as well as falsifying wait times), the number of veterans on waiting lists of one month or more is now 50 percent higher than last year. Not for lack of trying, either. The VA has expanded care. Its doctors and nurses have handled 2.7 million more appointments, while authorizing 900,000 additional patients to see outside physicians. Physician workloads increased by 18-21% in most regions. And yet the department’s deputy secretary, Sloan D. Gibson said, "if we don’t do something different we’re going to be $2.7 billion short.”

Exhibit 2: the VA has developed an in-house system to allow caregivers to access their patients' records across the agency's facilities. (Something you would think would be a nonnegotiable for anyone providing medical care.) The VA is currently looking for an EHR for the system (an $11 billion bid) but it seems that most of the options won't be interoperable across the VA system. "I feel like we're in a thicket here and we can't get out," Sen. Bill Cassidy (R-La.) said. "We're about to spend $11 billion on a system that the VA's system is not interoperable with? Please tell me that I'm absolutely wrong."

The VA's challenges of interoperability, collaboration, and capacity are challenges we all have. And missteps may be impossible for them to avoid -- but that we probably can.

These are two key learnings from the VA to consider in the effort to find sustainable solutions:

1. You can't just make physicians work harder -- you have to find a way for the organization to work smarter.
   The fact that physicians output is up by around 20% over last year -- in an organization with infamously overworked providers -- is not a sustainable situation. As we saw last week, this kind of "optimization" is a recipe for burnout -- which is ultimately bad for the organization. Other initiatives, like this one to use telemedicine to decrease workloads -- are going to be a better path forward, even if they have less immediate rewards.
2. Enable healthcare collaboration, even if it is outside of your EMR or EHR. 
   Interoperability can be very challenging, especially with the existing EMR and EHR options. That said, if medical providers aren't able to share information and collaborate with each other, results and metrics will suffer. We've found that it is often better for an organization to use a collaboration platform (iClickCare is a telemedicine based one) to bridge the gap and collaborate even as EMRs and EHRs catch up with interoperability concerns.

We can root for the VA even as we learn from their mistakes. And if we're going to improve medicine in this country, we must do both. 

Hybrid store-and-forward telemedicine is a key solution for collaboration in organizaitons with limited resources. Learn more with our free guide:

In the past weeks, the Office of the National Coordinator of Health Information Technology (ONC) published an ambitious, lucid, and fairly comprehensive roadmap to IT interoperability across the country. It follows a 2014 commitment to interoperability and "proposes critical actions that the public and private sector need to take to advance the country towards an interoperable health IT ecosystem over the next 10 years."

The key components of the roadmap are:

• Establishing standards and "rules of engagement."
• Creating the conditions for good, safe, seamless sharing of electronic health information for “small” (individual patient), “big” (population level and beyond) and “long” data (wrapping around the individual and telling their health story over time).
• Motivating the use of those standards through appropriate incentives.
• Aligning states in policy, payment, and other levers.
• Making data more portable and transferrable.
• Creating a trusted environment for the collecting, sharing and using of electronic health information. 

Quite honestly, we're incredibly excited to see this kind of conversation happening at the governmental level. For so many years it seemed that the government was willfully ignoring health IT and telemedicine.

When managed care, care coordination, and PMPM payments are such big focuses, there must also be constructive conversation about IT interoperability.

To achieve this, however, the health IT community must expand its focus beyond institutional care delivery and health care providers, to a broad view of person-centered health. This shift is critical for at least two reasons:

1. Health care is being transformed to deliver care and services in a person-centered manner and is increasingly provided through community and home-based services that are less costly and more convenient for individuals and caregivers.
2. Most determinants of health status are social and are influenced by actions and encounters that occur outside traditional institutional health care delivery settings, such as in employment, retail, education and other settings.

This shift requires a high degree of information sharing between individuals, providers and organizations. It is vital that a high degree of interoperability exists between many different types of health IT, such that systems can exchange and use electronic health information without special effort on the part of the user.

The goal of this shift is to a nationwide learning health system—an environment that links the care delivery system with community and societal supports in "closed loops" of electronic health information flow, at many different levels, to enable continuous learning and improved health. This kind of system allows individuals to select platforms and apps to share and use their own electronic health information to meet their needs without undue constraints.

In other words, we need to remember that healthcare is about people. And people have human lives with human complexities that happen outside of institutional settings. To do coordinated care well, that's the reality of the context. And that's why we support medical collaboration that uses hybrid store-and-forward telemedicine® as a key part of health IT. It's the most efficient path to keeping the patient at the center of the technology -- and allowing interoperability to emerge from that center point.

If you're curious how health IT and telemedicine can actually contribute to that kind of person-centered approach, watch our 60-second primer:

Image courtesy of automania on Flickr, used under Creative Commons rights.