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Nick Lecker

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Market Driven Patient Portal: Integration of Data

In our last conversation about  “What the market says you need in your patient portal” we discussed the needs of integration and interoperability. This is an area that, while interesting to the IT team, often does not get a lot of attention. This is not because this topic lacks interest, rather, it’s just not the most appealing topic to talk about. For example, when you are Market Driven Patient Portal: Integrate Dataremodeling your bathroom, you discuss the fixtures, the new shower, the new faucets, even the fancy commode; but do you get excited talking about the plumbing? Likely not, however it is the ability to move and connect the items of interest together that makes the project all come together. If you do not connect something the right way you get water all over…or worse.

So, what does this have to do with clinical and financial data? For one, the data is generally in various systems and data stores throughout the organization and generally it comes from multiple organizations. For example, if you look at these concepts from a health plans point of view, the clinical data is coming from HIE’s, provider facilities, clinical labs, purchased data sources, and others. The financial data is coming from claim systems across multiple lines of business, GL systems, AR/AP systems, and others. All of this data still has to be aggregated, cleansed and organized to make it useful. This is not an easy task and having the strategy, the information models, the plan and the governance are all key to ensuring success of these efforts.

Another reason integration is important is it helps define the consumer of the information. Typically, financial data has been reserved to back office functions or it is used to help define/negotiate the cost of services whether they be premiums, reimbursements, subsidies, etc. With the advent of consumerism, the patient is demanding more information in this arena. Patients want to know what their total cost of services are. They want to know the details of the fees. They want the ability to compare costs, values, outcomes so they can make a well-defined choice. Patients generally look at the cost as the driver, yet there are behavioral changes that need to be overcome; e.g. the higher priced option must be the best, right?

There is a lot still to overcome in this area as providers have typically held on to this information and patients may not be able to understand the complexities of where the money actually flows. Integrating the clinical and financial data is a stepping stone in the path to a full consumer-driven healthcare model. Government mandates are forcing the need for change, however, breaking down the walls to integrate information will not be easy. Meaningful Use Stage 2 (MU2) will be one of the drivers to help make healthcare interoperability a reality.

Core to solving these problems is having a clear understanding of the business capabilities and processes that drive the solutions. Understanding (documenting) the business capabilities, defining the information needs (again documenting) and then defining the business processes (yes writing it down) that act between the capabilities and information will be the blueprints and guides to setting and achieving the vision. With the vision established, we then can begin the process of connecting the dots of where the information lives to where it needs to go and the format which it needs to be in. There are a number of technical challenges given that interoperability is not just a simple plug-n-play solution. The movement of the information needs to follow standards (which by-enlarge exist) yet all of the connections and the subtleties of the content need to be clearly outlined in the road map of integrating clinical and financial data.

This concludes our “What the market says you need in your patient portal” blog series.

Market Driven Patient Portal: HIE Across Diverse Care Settings

So far in this discussion about “What the market says you need in your patient portal” we have been driving toward changes that are core to new engagement models. However, we have not addressed a core enabler: “It’s all about the data!”

Consumers demand access to information that meets their needs and they are not complacent Market Driven Patient Portal: Health Information Exchange Across Diverse Care Settingswith becoming hunters and gatherers for the information is truly about them. Consumers in today’s market demand accurate and up-to-date information about their health profile, just like they do with respect to their financial profile. However, the systems and processes to make that information available are not all there.

There are various sources of the information that are relevant to the patients/consumers (and also to the providers providing care to their patients). Much of this data has been distributed through the provider community. Some of the data is in the provider’s own systems. Some of the data is in the hospitals EHR systems. Some of the data is in outpatient facility systems. Other data is isolated and hard to locate.

With the push to HIEs some of the data is now becoming more available to the providers and to the patients they serve. However integrating the data into a holistic view is still a challenge. The information still needs to be gathered / extracted from the source systems, transformed into a structure that the HIE can understand and then there are the issues of translating the codes and values to normalized/consistent terms following a defined set of vocabularies. Additionally, ensuring a unified view of the individual can be a challenge. Enterprises IT groups are leveraging Enterprise Master Person Index (EMPI) solutions to construct the golden record of the individual but this also has its challenges.

Once all of the data is assembled (assuming that it is) the next challenge is to get the information to the right person at the right time. The HIE now needs to be integrated to the rest of the enterprise. Exposing the information in terms of the services or APIs can now begin. Finally the Portal (and this is just one of the consumers) can begin to consume these services and make the information available to the consumers. What’s also of importance is that the consumers can access this data from multiple perspectives. The provider can see full episodes of care across multiple care locations. The patient can see their health profile all in one location.

Having a single view of one’s health profile (or even the illusion of) is a powerful tool. Not only does it provide insights for better care, it breaks down the walls of information silos that have challenged providers and patient’s alike. Again, it is all about the data, and integration and interoperability are the key.

Managing Agile Projects

While reading various articles in Information Management, I came across an article that has some direct implications to projects that I have seen managed in the past. I often see the development teams applying Agile practices, yet the project management team often does not know how best to “Manage” the Agile development process or teams (I have also seen the development team managing/driving the business, but that is a different thread.)

In the article “Project Portfolio Management Best Practices in Agile Software Development” by Mark Kromer, Mark does a good job as he describes the role of a Portfolio Manager to ensure that the projects align with the corporate objectives, meet the budgets, and ensure that value is returned to the business, while allowing the development teams to operate within their sprints and develop the required solutions.

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The Value of Business and Architecture Roadmaps

Where do current IT solutions fit within the overall business context?

When addressing issues, it is important to assess the overall picture versus the initial pain point. Often there are knee jerk reactions to immediate business requests that fail to get balanced against the overall business and technical architecture roadmaps, if the roadmaps exist. New IT systems are conceived that hold the promise to fix the issues of old, but how do they align with the overall business strategy?  

I find system and software architecture very interesting as compared to more classical engineering; be it civil, electrical, etc. IT organizations start building new capabilities or adopting new technologies but are they challenging their approach and asking “Where does this fit into the overall Business and IT Vision?” I have seen many IT projects start, and get cancelled, because they end up not aligning with the unstated goals. If we built roads like software, how many bridges to nowhere might we have?

We consistently face challenges of doing more with less and still provide high value to the business. These are the correct overarching goals, yet the lack of proper underpinnings be they process, discipline, or established vision cause the value to be diminished. I find that creating and following an architecture roadmap can help ensure the Business and IT efforts are successful over the long term and provide mechanisms to demonstrate true return on investment.

The definition of an architectural and business roadmap can be accomplished in any organization yet there are tough challenges, for both the Business and IT. The business needs to determine what is truly important and what is not (Where to spend your money). Helping our business and IT partners through these challenges by performing the architecture and business assessments, defining the business and technical roadmaps, and helping them define their path forward is a very rewarding and high value endeavor for our clients.

It is all about the data

Today there are numerous discussions about HIE, Meaningful Use, RHIO’s, EMR, and the list goes on. What is consistent about all of these? To quote a colleague several years ago “It is all about the data!”

As I work with multiple clients in support of their architecture strategy, I find that IT organizations have challenges with managing and understanding the overall breadth of all their data. There are multiple systems spanning several business functions often with vast duplication of information. This not only affects the IT organizations ability to develop, test and roll out new capabilities, this inhibits the business’s ability to provide customer facing initiatives such as EMR, HIE, etc.

Understanding the enterprise data and its pedigree is very important in any organization and must be addressed as a part of the overall architecture strategy and roadmap prior to jumping head-long into new initiatives. Personally, I find that it is a “fun” challenge to dive into the architecture and understand the inner relationships of the business systems by following the paths of the data. Ultimately, with a well-documented understanding of the “As-Is” picture of current systems and data, we can help our clients leverage that knowledge to provide higher value. IT organizations need to provide the business with timely and meaningful information; that information is all based on the data.