Procuring Interoperability: Achieving High-Quality, Connected, and Person-Centered Care (2018)
Chapter: Executive Summary
EXECUTIVE SUMMARY
The rapid movement of digital technology into all aspects of health and health care sets the stage for truly transformational opportunities to improve effectiveness, efficiency, and safety in health care as well as to envision the achievement of a health system that continuously learns and improves. However, that achievement will depend on the degree of system interoperability: the ability to share information across time and space from multiple devices, sources, and organizations. Although standards development and research on achieving safe interoperable systems have contributed to enhanced health information technology (IT) interoperability, much more work is needed (JASON, 2013; Rahurkar, Vest et al., 2015; Holmgren, Patel et al., 2017).
In other industries that have achieved a high degree of IT interoperability, standards support the work, yet its achievement is also simultaneously driven by vendor action and the demand from purchasers and users of technology. In health care, leveraging procurement specifications remains an important yet underused approach to drive health care integration, quality improvement, and cost containment. With better procurement practices that facilitate the acquisition of a fully interoperable digital infrastructure—electronic health record (EHR) systems, medical devices, and remote-site reporting tools—health care systems will advance much more rapidly into the health care environment of the future.
In this paper, we explore the state of play in the development and acquisition of interoperable health IT solutions and devices. Although we recognize that there are various ways to describe and categorize interoperability, in this paper we consider data exchanges in three levels: facility-to-facility (macrotier), intra-facility (meso-tier), and at the point of care (micro-tier). To support health care transformation toward value-driven, whole-person care, interoperability is required across and among all three levels. The Technical Supplement further describes the necessary elements for each health care organization: an organization-wide interoperability steering group, a long-range interoperability
road map, an interoperability needs identification process, and an interoperability procurement specification process.
To counter the prevailing challenges for acquiring interoperable technologies in a sustainable and cost-effective fashion, we propose an acquisition strategy applicable to health systems with different needs and serving diverse patients. Progress is particularly needed at the point-of-care level, where the lack of plug-and-play interoperability represents a fundamental impediment to patient safety, care coordination, and cost reduction. Rather than placing a narrow focus on price and features in the procurement of each product, health systems should establish a comprehensive, ongoing procurement strategy demanding functional system-wide interoperability. The goal is for health care systems to move away from serial purchases of individual software and hardware with proprietary interfaces, toward purchasing certified technologies that will interoperate with others through a vendor-neutral open platform.
We have identified five action priorities for each health care organization and system leader:
- Commit. Declare interoperability a primary priority and form an organization-wide interoperability steering group or related capacity to champion the IT acquisition strategy.
- Identify. Charge this group with identifying the set of interoperability goals, requirements, and model use cases for the procurement process to support organizational priorities and patient outcome goals.
- Collaborate. Create a sector-wide strategy and partner with other stakeholders to align on common contracting requirements and specifications to move toward the next generation of interoperable health IT.
- Specify. Use the collaboratively developed specifications to state clear functional interoperability requirements in existing and future proposals, purchases, and contracts.
- Assess. Establish and monitor short-term and long-term metrics for the progress and contributions of interoperability to system-wide learning and improvement of health outcomes.
Standards-based, industry-driven, and modular acquisition of truly interoperable products is necessary for health care delivery systems to achieve the desired care quality, safety, and efficiency. It is important for health systems to work collaboratively in developing shared technical requirements for procuring industry solutions, as well as in moving toward an agreed-upon open architecture layer for seamless end-to-end interoperability and data exchange in the long run.
The interoperable infrastructure envisioned is also necessary for patients and families to be full partners, decision makers, and managers of their care. Only then will the health care industry begin to create truly integrated care systems that continuously provide better experiences for clinicians and patients while achieving better health and health care at lower cost.
