Strategic interoperability —The key to connected care

Introduction

The aging population and increasing incidence of chronic diseases are putting unmanageable pressures on healthcare services, not just in Europe, but worldwide. The current models of healthcare are unsustainable in the face of increased demand for services and rising costs. This was evident even before the financial crisis led to severe cuts in healthcare budgets in many countries.

Patients are increasingly relying on multiple specialists and healthcare organisations for treatment, due to the complexity of their medical conditions and the healthcare delivery system itself. Care providers need accurate, up-to-date, and reliable information from a complete patient record to deliver safe, high-quality care. Today’s model, with its silos of care and multiple unconnected records, is no longer suitable: systems and organisations need to be interoperable. This means that healthcare organisations must look at interoperability from a strategic point of view so that information is available when and where it’s needed across the continuum of care. Health and social care organisations will have to adapt to the changing environment in order to provide the best care for patients — and to survive financially.

The Royal College of Physicians in England produced a 2013 report called The Future Hospital: Caring for Medical Patients, in which it outlined a new model and role for hospitals: “Conventional models of health service design, in which a hospital site is the sole focus for the delivery of emergency, acute and elective services, are dated. These models often lack the integration, collaboration, communication and information sharing across hospital and the healthcare settings necessary to effectively meet patient needs and provide streamlined and seamless care.”

The report recommends fundamental changes in the way hospitals organise and deliver care, along with new ways of working that span medical teams, hospital wards, and service providers across hospitals and community-based care organisations. According to the report’s findings, integrated workflows, shared outcomes, and real-time communication of information among such health and social services partners will become the norm.

This is the vision of patient-centric care — care that is designed around the needs of the patient rather than the disease, treatment, service, or organisation in which the patient is seen — and it is applicable to any healthcare system.

Executive Summary

An accountable care organization (ACO) is a group of providers that are collectively responsible for the total cost and quality of care provided to a specific population of patients. Together, the group assumes risk and shares rewards. As with high-performing organizations in other industries, the hallmarks of ACOs are quality measurement and continuous improvement.

Like other care models that are experiencing changing reimbursement structures, ACOs require new competencies to coordinate the delivery of care, and to manage populations, finances and risk. Issues of governance, leadership and health information technology must all be addressed. Systematic IT changes may be required to build upon the implementation of electronic health records (EHR) across the community and ensure integration and interoperability.

To be successful, ACOs must excel in three broad areas where health IT plays a crucial role: clinical integration, analytics and care coordination. Without capabilities in these areas, ACOs will not be able to meet their mandate to provide quality care while controlling costs.

ACOs should carefully evaluate their technology decisions, since such choices have both strategic and tactical implications. It is unlikely that any single application or vendor can meet all of an ACO’s needs for managing risk, insurance payments, provider networks, informatics, care coordination and more. Therefore, each ACO should find a vendor that offers a strategic healthcare informatics platform along with a robust partner network that can build and connect the applications it requires. In this way, an ACO can meet its needs in the three core areas of health IT in the short term, as well as gain the flexibility and scalability to face changing accountable care requirements and address long-term strategic objectives.