A Balanced Approach to Meeting Healthcare IT Compliance
The importance of a balanced approach to healthcare connectivity
Given the evolving nature of healthcare IT, what is the best course of action for healthcare providers who want to ensure their IT infrastructure can easily meet organizational needs related to health data exchange, Meaningful Use requirements, and other initiatives related to the Affordable Care Act?
Should they take a conservative “wait and see” approach until there is greater regulatory certainty? Or, conversely, should they take steps to stay ahead of the curve by pro actively modifying their IT infrastructures?
The best approach for transforming the healthcare IT infrastructure requires striking a balance to ensure that fundamentals are in place while simultaneously laying the groundwork for future needs. Simply put, a balanced yet forward-looking approach to healthcare connectivity is needed.
Approaches to healthcare connectivity and IT infrastructure
As illustrated in Figure 1, providers should try to achieve a model that positions them high on the fundamental elements axis and towards the center, or slightly skewed to the right, on the revolutionary elements axis. This will ensure all the fundamentals are addressed but augmented by a perspective that facilitates future growth.
Healthcare providers should avoid an IT infrastructure strategy that includes elements that are marginal or too extreme in direction and functionality. Adopting technologies too far outside the mainstream or designed to do granular tasks will exact a toll as requirements escalate over time and interface standards evolve. Providers should strive for a stable infrastructure that is architecturally designed to provide flexibility and choice—attributes that will allow adaptability for future growth and standards compliance.
Critical areas of healthcare connectivity and IT infrastructure
Let’s examine four critical areas of an EHR that should be addressed by interface managers as they begin to modify their IT infrastructure.
These areas already represent major challenges in today’s healthcare IT environment and will increase in emphasis as Meaningful Use progresses.
- Interfacing growth Additional interfaces will be required to meet Meaningful Use requirements. How will these interfaces be developed and tested without substantial budget increases?
- Added connectivity More connectivity will be required to external service providers and constituents such as referring physicians, pharmacies, and health information exchanges (HIEs).
- Healthcare standards The importance of ensuring greater adaptability and flexibility will be required to navigate and support multiple standards, including Continuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the Health Level Seven and American Society for Testing Materials (ASTM) to “harmonize” the data format between ASTM’s Continuity of Care Record (CCR)..., Consolidated Clinical Document Architecture (CDA) HL7 CDA uses XML for encoding of the documents and breaks down the document in generic, unnamed, and non-templated sections. Documents can include discharge summaries, progress notes, history and physical reports,..., HL7 is a Standards Developing Organization accredited by the American National Standards Institute (ANSI) to author consensus-based standards representing a board view from healthcare system stakeholders. HL7 has compiled a collection of message form... 2.3.1 and 2.5.1, and others driven by the regulatory efforts.
- Effective management Managing the integrated IT environment will become a challenge given the overall expansion of interfaces and connectivity requirements.
Additional interfaces will be required to meet Meaningful Use requirements. This is an area that is often a bottleneck in the IT infrastructure for many healthcare facilities due to the significant time and costs associated with implementing and testing interfaces for various applications.
Historically, HL7 interfaces were created using point-to-point configurations that allowed communication between pairs of applications independent of other applications. Point-to-point solutions are examples of technology with limited or outdated functionality, incapable of providing advanced capabilities that will be required in future interfacing environments.
Many healthcare facilities now utilize interface engines for interface implementations. Data can be reused from a sending application by filtering or changing the data format through a mapping function so it matches receiving application requirements. This feature substantially reduces the costs of implementing an integrated system. With this powerful innovation, adding and/or replacing existing application interfaces typically requires a fraction of the time compared to pointto-point models, and costs can be reduced by as much as 30 percent.
This is a good example of a balanced approach to making infrastructure improvements—leveraging data capabilities for costs and time saving advantages while allowing the facility to deploy new interfaces that will meet future Meaningful Use requirements.
Interface engines are more than simple connectivity devices—they are healthcare integration platforms supporting the diverse operations of a care delivery organization both internally and externally to the connected community. These sophisticated platforms can now manage application interfaces, optimize workflow, and provide critical data for operational decision making—advanced capabilities that drive major improvements in overall IT productivity and efficiency.
Interface engines can deliver more in today’s environment while ensuring the right capabilities or platform is present for future requirements.
Leveraging a modern interface engine within your IT infrastructure is part of a strategic plan that ensures a balanced approach.
More connectivity will be required to achieve reliable, secure, and accurate information exchange. Providers have been motivated by Meaningful Use, HIEs, and Accountable Care Organizations to lay the necessary groundwork to connect to providers outside the physical four walls of their organization.
There are a number of associated factors driving health IT connectivity:
- Physicians require lab or test results in a secure, electronic format
- Hospitals need demographic data electronically
- Pharmacies require information exchange for patient drug orders
- Radiology practices need to send patient reports to referring physicians
Additionally, many healthcare organizations have strategic initiatives for growth that include creating new partnerships with other healthcare organizations and referring physicians, setting up satellite clinics, and establishing educational and training programs designed to meet the needs of the community.
It is important, as providers reach out to the referring community, that they utilize technology that is easily scalable and minimizes costs for establishing new partnerships.
The latest Health Information Exchange (HIE) focuses on the mobilization of healthcare information electronically across organizations within a region or community. HIE provides the capability to electronically move clinical information between disparate health... systems are platforms for efficient and accurate communication of health data between remote points of care or Electronic Medical Record (EMR), as defined in Defining Key Health Information Technology Terms (The National Alliance for Health Information Technology, April 28, 2008): An electronic record of health-related information on an individual that can be... applications. HIE technologies using Transmission Control Protocol/Internet Protocol (TCP/IP) is a low-level communications protocol used to connect hosts on the Internet or a network. TCP/IP connections are established between clients and servers via sockets. TCP/IP is stream-oriented ... connections through VPN connections are designed with simple-touse interfaces providing centralized monitoring, proactive trouble shooting, and quick setup for adding new clients.
The exchange of health data is another example of a balanced approach to infrastructure design— selecting technology that plays a larger role in the organization’s plans of meeting Meaningful Use goals, improving patient care, and potentially participating in an An Accountable Care Organization (ACO), according to the Centers for Medicare & Medicaid Services (CMS) “is an organization of health care providers that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who....
More adaptability and flexibility is essential for supporting an environment with existing and future healthcare data standards. Today’s common interface standards include all versions of HL7 (including HL7 2.3.1 and HL7 2.5.1), CCD, Continuity of Care Record (CCR) is an XML-based standard for the movement of “documents” between clinical applications. Furthermore, it responds to the need to organize and make transportable a set of basic information about a patient’s health ..., CDA, Integrating the Healthcare Enterprise (IHE) is an initiative by healthcare professionals and industry to improve the way computer systems in healthcare share information. Visit the IHE website. Synonyms: Integrating the Healthcare Enterprise, Digital Imaging and Communications in Medicine (DICOM) is a common format for image storage. It allows for handling, storing, printing, and transmitting information in medical imaging. Visit DICOM website. Synonyms: Digital Imaging and Communications... and The National Council for Prescription Drug Programs (NCPDP) creates and promotes the transfer of data related to medications, supplies, and services within the healthcare system through the development of standards and industry guidance. Visit the NC....
Interface engines offer a number of capabilities that reduce interface development cycle times including the use of a test-as-you-develop approach to interface development, which delivers high quality interfaces within hours. The interface quality is improved by checking conformance against HL7 and other standards as well as user-defined specifications. This is far more efficient and powerful than older methods that use programming languages specific to each application interface.
A major advantage of interface engines is their ability to act as middleware to leverage one application interface to multiple applications,resulting in significant time and cost savings. The interface engine reformats the data by using a map to translate the data into the formats (HL7, CDA/CDR, vendor specific, etc.) required by the receiving applications. This greatly reduces the number of endpoints required for communications between applications and minimizes the overall costs for creating an integrated system.
Key benefits and advantages of this flexibility and adaptability include:
- Test-as-you-develop approach to interface development that delivers high quality, standards-compliant interfaces in reduced cycle times
- Streamlined process for building, testing, and deploying new patient data exchanges
- Standards leverage—meeting multiple healthcare standards through a single platform, delivering time and cost savings
- Rapid deployment of new application interfaces driven by emerging regulatory standards
Managing the integrated IT environment will be even more challenging as new applications and data standards drive additional interface requirements, often without additional budget allocations. Older healthcare IT systems were typically comprised of discrete components designed to perform specific functions—not to provide comprehensive system-wide management.
In the current and future healthcare environment, it’s essential that interface managers have the ability to centrally manage their connected care community.
Today’s interface engines provide the necessary monitoring of all connections from a centralized location. These monitoring capabilities include the ability to quickly view the state of all connections, view detailed information about each connection, and create alerts when problems arise. This has a major impact on maintaining high connection availability, ensuring that physicians receive patient data in a timely manner.
These systems have the ability to provide both proactive alerting and configurable alerts for highly critical application interfaces. Alerts can be set to notify users when issues occur that may have a negative impact. These alerts are visible on the monitoring window and can be configured to send an e-mail to designated support staff that may not be actively monitoring the system.
Another important new role performed by interface engines is providing operational views of healthcare facility operations.
Interface engines have the ability to capture and store data, and then present it graphically to decision makers who use it to gain insights about facility operations. These systems provide multidimensional views of healthcare operations and have the capability to drill several layers deep into the data to gain understanding of workflow or departmental activities. Key metrics and critical information are essential options to improve patient care and facility operations.
Modern interface engines are designed as healthcare integration platforms that perform a range of functions within the “four walls” and to the external healthcare providers, including HIEs. Underlying this approach requires a comprehensive, facility-wide monitoring of all connections from a centralized location allowing the interface and/or IT support team to respond quickly for problem resolution.
Healthcare IT is experiencing significant changes designed to transform our health system into a nationwide electronic health information system. To adapt to these changes, healthcare providers should strive for a balanced approach in updating their IT infrastructures—one that covers all fundamental operations and yet embraces the architectural flexibility and adaptability essential for future success.
About Corepoint Health
Corepoint Health has the healthcare IT experience and strength to deliver a dramatically simplifi ed approach to internal and external data integration and health information exchange for hospitals, radiology centers, laboratories, and clinics. Our next generation software solutions are transformational and will streamline your IT environment, provide a fast track to achieving your interoperability goals, and create operational leverage within your organization. Corepoint Health’s solutions achieve a needed balance of being both intuitive and sophisticated while delivering solid functionality and performance.
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