Procuring Interoperability: Achieving High-Quality, Connected, and Person-Centered Care (2018)
Chapter: VI. Procurement Implementation: Action Checklist
VI.
PROCUREMENT IMPLEMENTATION: ACTION CHECKLIST
Seamless system-wide digital, structural, and functional interoperability is critically important for health and health care activities to meet their full potential and the fundamental aims for health care set out by the National Academy of Medicine (formerly the Institute of Medicine) in the 2000 report Crossing the Quality Chasm–care that is: safe, effective, patient-centered, timely, efficient, and equitable (Institute of Medicine, 2001). Rapidly-developing capacities of the digital infrastructure of health care bring us much closer to the potential for achieving that vision. Our clinicians and our administrative leaders must have access to meaningful information, delivered at the point of care and at the point of decision making, to promote excellence while ensuring affordability. Data liquidity and functional interoperability can help eliminate waste and reduce unwarranted variation in care—a prerequisite for optimally leveraging constrained resources. Seamless inter-provider and inter-facility communication can ensure continuous and well-connected care. Because current circumstances are far short of the potential, achieving the vision requires determined commitment and leadership throughout the health sector, beginning with the choices and requirements of those who directly interact with the patients and families whose care they are stewarding.
Requisite standards and policies are still evolving, and the process will be one of ongoing continuous improvement, but there are many ways to accelerate the progress. Presented next, in checklist form, are opportunities and responsibilities for those who lead health care delivery at the front line, and, to whom the performance of each item is entrusted by their patients and families.
HEALTH CARE ORGANIZATION BOARD AND EXECUTIVE TEAM
□ Understanding. Has our organization explicitly and adequately assessed the experiences and potential consequences due to shortfalls in digital interoperability for patients, families, and clinicians?
□ Commitment. Has our organization expressly committed to seamless and affordable interoperability and meaningful information sharing as a core element in the care we provide, and in every acquisition action for our systems, services, and tools? Have we devoted resources to initial investment, implementation, and training, as well as to ongoing needs for maintenance and continuous improvement?
□ Governance. Have we established an organization-wide safety, security, and interoperability steering group accountable for driving progress and guiding organization-wide procurement activities?
□ Priorities. Has our organization inventoried our interoperability shortfalls and established corrective priorities for those areas in which the care experience and outcomes are most vulnerable?
□ Procurements. Is our organization participating in/drawing on best available sector-wide language for interoperability specification requirements in procurement agreements for all our systems, services, or tools?
□ Protocols. Is our organization adhering to our procurement protocols and thresholds to implement system-wide functional digital interoperability as a requirement of our purchases?
□ Cooperation. Is our organization fully cooperating with other health care systems, payers, associations, vendors, and standards agencies in supporting a shared capacity for system-wide digital interoperability testing, clinical use case assessment, and best-practice purchasing specifications and strategies?
□ Assessment. Is our organization actively cooperating with other organizations on assessment approaches that measure and incentivize progress in digital interoperability in health and health care, and are we applying them to assessing the core continuity, connectivity, and safety experience of patients, families, and clinicians?
OTHER KEY STAKEHOLDERS
Achieving seamless and affordable system-wide digital interoperability will also require the vigorous commitment and leadership of other central stakeholders:
digital health technology vendors; employers and payers; associations and purchasing cooperatives; and federal government agencies. Corresponding action checklists are presented below.
Digital health technology vendors
□ Commitment. Have we clearly committed to the promotion of sector-wide functional interoperability and connectivity as a core performance feature of our products and services?
□ Transparency. Do we share with our clients the set of compatible data exchange interfaces and standards, as well as assess and share the interoperability performance of our products?
□ Cooperation. Are we fully cooperating with health care systems, payers, associations, other vendors, and standards agencies in supporting a shared capacity for sector-wide digital interoperability testing, clinical use case assessment, and best-practice purchasing specifications and strategies?
Employers and payers
□ Commitment. Have we expressly stated our commitment to full digital interoperability as a core feature in the care for which we pay?
□ Requirements. Do we require the existence of an interoperability strategy, implementation plan, and milestones as a core feature of our contracts for care?
□ Patient access. Have we embedded incentives in our purchasing standards to facilitate access to claims data by patients, families, and developers of patient-facing technologies?
□ Capacity incentives. Have we embedded incentives in our purchasing standards for adopting technology with certified capacity for effective and efficient information storage and sharing, including socio-demographic and behavioral data relevant to population health management?
□ Data sharing. Do we have operational data-sharing and all-payer claims strategies to improve access, efficiency, and transparency with our data exchange partners, including care coordination managers, clinicians, regulators, and patients?
□ Cooperation. Are we fully cooperating with health care systems, other payers, associations, vendors, and standards agencies in supporting a shared capacity for sector-wide digital interoperability testing, clinical use case assessment, and best-practice interoperability purchasing specifications and strategies?
Associations and purchasing cooperatives
□ Commitment. Have we expressly committed to full digital interoperability as a core feature of the purchases for which we are the fiduciaries?
□ Procurements. Are we drawing on, and contributing to, sector-wide performance specification language for interoperability requirements in procurement agreements for systems, services, or tools?
□ Cooperation. Are we fully cooperating with health care systems, payers, associations, vendors, and standards agencies in supporting a shared capacity for sector-wide digital interoperability testing, clinical use case assessment, and best-practice purchasing specifications and strategies for our members?
Federal government agencies
□ Commitment. Have we expressly embedded seamless interoperability as a core expectation and priority for health policy, in the standards in which we invest, in the care we deliver, and in the care for which we pay?
□ Policies, standards, and regulations. Are our policies, standards, and regulations carefully aligned to ensure the existence of both the foundational starting points for seamless digital interoperability and the strategic vehicles for practical adaptation and continuous improvement?
□ Facilitation. Are we fully supporting, encouraging, and facilitating the cooperative work of health care systems, payers, associations, vendors, and standards agencies to develop a shared capacity for sector-wide digital interoperability testing, clinical use case assessment, and best-practice purchasing specifications and strategies?
□ Care delivery. In each of our care delivery agencies, and for each of our care delivery facilities, have we established an organization-wide interoperability steering group to drive progress and guide organization-wide and system-wide procurement and implementation activities?
□ Care payment. Do we require that each facility receiving our reimbursement for care have an active organization-wide interoperability steering group working intra- and inter-organizationally to drive progress?
□ Assessment. Have we established the taxonomy of the features of system-wide interoperability, set in motion to assess progress and identify opportunities for continuous improvement within organizations and across the nation?
The emergence of digital technology as a resource for progress in health and health care will yield transformative progress. That potential is achievable, but will be captured only with the determination of all participants to take the necessary steps for seamless system-wide interoperability. The opportunities embedded in the checklists above represent initial steps on which to build and improve. The dividends for patients, families, and clinicians throughout the nation can be historic.
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