The harmonization of clinical care and technology

In this blog I want to focus on Stage 5 of your future health information technology HIT infrastructure: the harmonization of health information technologyand clinical design. At this point in your planning you should have a pretty comprehensive HIT strategic plan for 2013- 2015. Now you must think about harmonizing the technology plan with your clinical workforce and strategies. Many hospitals and healthcare systems have recognized the importance of this harmony by establishing the position of Chief of Medical Informatics.

Part of the thought process is deciding what you want to look like in 2015 and beyond. What role do you want to play in your community? Are you involved or going to be involved in an accountable care organization, medical home, health information exchange, beacon community or risk sharing partnership? In all of these care models, long-term and post-acute care (LTPAC) will play an important role in providing person-centric electronic longitudinal care. In some cases, like long-term stays in a SNF or ALF, you will be playing the case manager or navigator in the care of patients within your facility.

In order to define clinical design we have to look at what the clinical technology function could possibly be in 2015. The national plan is to have an integrated, dynamic, person-centric electronic health record based on certified standards. As I have said before, I have been concerned that most of the work to date has been on episodic static care. I am happy to say that June and July have been the turning point, and longitudinal care planning is becoming a major initiative. In fact, in some cases the term electronic health record has been replaced with “electronic longitudinal care record.” If you take today’s workflow, payment and other silo issues out of your thought process and focus on technology requirements of person-centric longitudinal clinical care, you will be able to develop clinical design.

You will require some or all the following:

• Transition of care software between your partner providers;
• Electronic alerts built into your electronic medical record;
• Alerts that are “pushed” from the electronic longitudinal care record to a responsible caregiver;
• The ability to view clinical trending information and to be able to proact on clinical intervention in order to prevent clinical incidents in real-time (real-time is defined by nurses as early enough so they can take action to prevent an incident not to just treat an incident);
• An understanding of where telehealth and telemedicine will fit in your quality of care;
• A reorganization of where quality of life fits with quality of care; and
• The types of eQuality measurements that will have to incorporated in your EMR to ensure longitudinal quality.

I have found many people waiting to take action on harmonizing their clinical and technology teams. Starting in October 2012, we will find increasing evidence that LTPAC will play a very important role in person-centric longitudinal care. LTPAC providers and vendors will need to be ready or they will be behind the curve. As I have mentioned in the past, it is not a revolution but an evolution. But in an evolution environment, you have to plan.

John Derr

John Derr, RPh, currently serves as Health Information Technology Strategy consultant to Golden Living, where he previously served as CIO and CTO. He is currently on the HHS Federal Advisory Committee on Standards, a CCHIT Trustee, and serves on several other federal and state HIT advisory groups. His extensive career has included major executive positions with Squibb, Siemens, Tenet (NME) and AHCA/NCAL. With almost 50 years of experience in healthcare, Derr has also started four companies.