Healthcare Collaboration and Innovation: It Takes More than Tech
By Thomas J. Van Gilder, MD, JD, MPH, Chief Medical Officer and Vice President of Informatics and Analytics
It is appealing to think that we can count on technology—an app, a type of software, a data warehouse—to propel our organizations successfully into a new world of healthcare collaboration and innovation. Nevertheless, I think we have all, at one time or another, had our hopes dashed when it comes to technology that will fix “it” (whatever “it” is at the time). So, what does it take to create an environment where everyone works together to improve care and organizational performance and where everyone is ready to take full advantage of the latest tools? Before an organization begins looking at technology to fix specific problems, I believe it needs to address some core issues first.
Gathering Data through Interoperability
To begin with, we need to do a better job of gathering all the miscellaneous information generated by patient care—a process that does not always lend itself to optimal data collection. When I see a patient who is on multiple medications, I almost always have to spend part of our visit reconstructing a complete medication list. Should it be available to me instantly at the touch of a button? Absolutely, but it usually is not.
Most organizations have to drill down to understand where they may have data gaps. We cannot assume that an organization’s data is flowing into a common database from various electronic health record (EHR) systems, lab systems and other information systems, and being redistributed to various EHRs. In addition, many hospital systems have such fragmented information systems that it is easy to overlook a small but critical source of information.
It is great that our data sources are becoming richer and richer, but until we can share the data and analyze it fully, we cannot make full use of it. The lack of ability to combine data sources is a major obstacle to healthcare collaboration and innovation and should not be taken lightly. Until I know I can rely on the information I get from all of the systems delivering data, I am going to have to continue to verify it myself, which takes up a lot of valuable time.
The Importance of Collecting and Storing Data
Another challenge is the issue of collecting and storing complex data. Clinicians are gradually learning to use standard templates that make it easier to combine databases and use them for other purposes. However, free text fields remain a catchall for information that does not fit anywhere else—at least for clinicians who do not have time to put it where it really belongs. Organizations that do not adopt clear policies for data governance—defining terms consistently and standardizing how and where they are recorded—will be saddled with growing piles of data they cannot use.
Finally, there is the need to protect established, efficient workflows. Any data governance policy that makes it harder to get things done will be doomed to failure as clinicians find ways to bypass it, as they work to deliver high quality care efficiently. Each point in a system where data is collected has an associated workflow to which everyone is accustomed. If you change it, you do so at your peril, unless you understand it well enough to change it for the better. If you do not use the workflow yourself, take the time to walk in the shoes of the people who do. Shadow them as they work in the clinic, and see for yourself where documentation is a burden or where you may be missing opportunities.
We know technology can transform care; we need to undertake the hard, detailed work to perfect some of our internal processes. Such work will reap dividends in efficient, complete use of vital data being gathered. While working as a physician at an outpatient clinic, we used to have specialists come to our office once a week for on-the-spot consults. While those interactions were great, the EHR can now allow specialists to share almost the same level of information without having to wait for those in-person visits. When we have the specialists’ input at our fingertips, both the specialists and primary care clinicians will be able to see more patients and do more for them. That is healthcare collaboration and innovation.
How are you promoting healthcare collaboration and innovation within your organization?