"According to the Institute of Medicine and others, the U.S. healthcare delivery system is complex, inefficient, and highly fragmented”[1] costing $1.7 trillion in 2003. The report reiterates interconnecting clinicians, as a national goal so that health information can be exchanged, and provides an estimate of the potential savings through the establishment of a National Health Information Network (NHIN).
The savings based on sharing information is estimated at: $78 billion with Ambulatory EHR's, and $44 billion with Ambulatory CPOE alone. Several other studies have projected a ten to eleven digit benefit from IT adoptions. True costs to deliver such huge savings however, cannot be easily determined. We do not know for example, whether a 50-cent spend would deliver a $1 benefit or would it take 5x to deliver the same result. One amongst several cost factors is Interoperability.
The healthcare system is a disparate environment of several functions such as: Registration, Laboratory, Radiology, Pharmacy, Finance, Clinical Order Entry, Medical Records, and such.
To evaluate the challenges of interoperability, it is first important to understand the information network pathways and bridges between applications across an enterprise. Can computer 'A' communicate health information with computer 'B' inside the organization? Can it share information with systems outside the enterprise? What elements of technology make this possible? What levels of data sharing are involved (paper, email, structured messages, standardized content, ...)?
When the information reaches computer 'B", how do other applications link with it. What middleware systems would be required to integrate it in a way that target systems can easily understand information for their use? Will systems need a language interpreter? If HL7 standard is used for interoperability, what is required to open up legacy environments so that they can share information?
What if? Computer A now demands the updated information from computer ‘B’? What methods and approaches do we use to create flexibility and harmony amongst various enterprise systems?
Overlay information ownership, security, privacy policy, HIPAA regulations, goal alignment, Stark Act, and the roadmaps to go regional before health information becomes nationally, and then globally accessible from anywhere in the world by patients.
Now add "on demand" to every step discussed above so that you get the information when you need it irrespective of what is involved, and control mechanisms to differentiate "my data from your data, and others data," so that, you only get information pertinent to yourself, and one can begin to truly understand the challenge and the cost of bringing all of this together.
We will next discuss innovative ways to achieve Level 4 and the highest order of interoperability across all boundaries in the SaaS series. Stay tuned.
References:
(1) David A. Powner, Director, Information Technology Management Issues, United States Government Accountability Office Memo Dated Feb 16, 2005, GAO-05-309R HHS's Estimate of Savings from Health IT
:- SOWSIA Collaborative Group
Copyright 2008. SOWSIA Healthcare Solutions, Inc. All rights reserved. (blog@sowsia.com) www.sowsia.com
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