ECRI Institute, one of the leading patient safety and medical technology research organizations, places health technology cybersecurity at the top of its just-released 2019 Top 10 Health Technology Hazards.
User-driven processes for digital integration
Building the perfect healthcare data-sharing platform means helping clinicians to build the perfect system for patients. Saduf Ali-Drakesmith explains why
The data-driven revolution that is sweeping all spheres of business is especially exciting for healthcare: not only should significant efficiencies be possible, but major advances look likely in terms of early diagnosis capabilities and patient outcomes as well. In order to be ready for these advances, healthcare organisations need total interoperability within their records systems, so that all data can be accessed at any time by suitably authorised personnel or systems.
Currently, most hospitals and care establishments are nowhere near this level. Most departments still operate with a mixture of paper records and proprietary data storage systems. The Electronic Patient Record (EHR) system cannot carry this information, and this inevitably means that practitioners only have a partial view of a patient’s records. The remaining data is often located in silos, accessible only to those along a ’vertical axis’ that is a specialist department’s treatment of individual cases.
That is not to say that there is no will to share data. Clinicians go out of their way to share appropriate patient information with colleagues, but this approach can never produce the kind of 360-degree view that a digital healthcare system requires. In order for patients to benefit from the diagnostic possibilities - which machine learning applications are starting to offer - full interoperability is essential.
It is helpful to define interoperability in a healthcare context. According to HIMSS, interoperability is the ‘ability of health information systems to work together within and across organisational boundaries in order to advance the effective delivery of healthcare for individuals and communities’. These fully interoperable systems should be developed with the patient in mind, and with care needs and excellence of practice at their centre. However, the real key to designing and implementing these are the practitioners who currently use data systems and already have a need for improved sharing capabilities.
For most organisations, the biggest stumbling block centres on imaging. Departments, including cardiology, radiology, ophthalmology and gastroenterology, manage their images in siloed systems, such as radiology picture archiving and communication systems (PACS), the cardiology PACS or other ‘mini’ PACS. The challenge with a PACS-focused strategy is the proprietary design and codesets of these systems. While DICOM has been widely adopted as the defacto standard, PACS vendors continue to use proprietary extensions to make interoperability within and outside the enterprise complicated and costly. This problem is compounded when organisations try to incorporate specialty images that fall outside traditional PACS parameters.
This is hardly an insignificant amount of patient information: Today, 75 per cent of healthcare data is in the form of non-DICOM medical imaging assets. This 75 per cent includes video, photos, oncology treatment plans and other file types that the PACS cannot manage. As a result, they wind up as silos of data, scattered throughout the organisation and inaccessible from the EHR.
If clinicians cannot view imaging and specialty assets from the EHR, they are not obtaining a complete picture of their patients. Healthcare can no longer afford this lack of transparency and its associated costs.
The best enterprise imaging solution is one that can be implemented in a phased-approach. Some organisations begin with a vendor neutral archive (VNA), while others choose to link their PACS systems using an enterprise viewer. No matter where or how you start, it’s important to keep your eye on the goal of an enterprise class vendor-neutral strategy that facilitates the removal of silos, while giving you ownership over your data. Remain committed to that goal and you’ll be well on your way to interoperability that has a direct and measurable impact on patient care and outcomes.
Unfortunately, there is frequently resistance to new technology by staff who are wary of disruptive IT projects that often don’t serve their needs. That shouldn’t be the case. Most clinicians do want to have full access to their patients’ data, and they should be an asset in the delivery of an effective patient-centric data sharing platform.
Bringing healthcare practitioners on board early in the process requires a change of culture: technology should be perceived as an enabler, not a threat. This means a commitment to design the new system around user needs, working patterns and devices - rather than building or buying systems to a management concept and then persuading staff to adapt.
The development process
Introducing any new IT system is more than just a technical challenge: the whole programme should be about developing new ways of working that are designed around the clinician, and all stakeholders should be closely involved in the development process.
Once the project and management teams are confident they have staff onside and a clear understanding of how and why clinicians use information sharing systems, they can target an outcome that directly improves work within the organisation. That outcome should be at the heart of driving implementation.
Such a bottom-up approach to technology development and implementation lends itself to small-scale, which can then be scaled up once problems have been ironed out and successful features identified. While it is tempting to embark on a large-scale project where potential savings or improvements can be expected, it’s wiser to exercise caution and start small. There are untold numbers of failed projects that promise much, but fail to deliver the outcomes.
On a similar note, it is unwise to trial potentially disruptive systems in key operational areas, even though these may offer the biggest potential rewards or returns should the technology be successful. Tweaking a new IT system in a live context places stresses on staff and the business, and many efforts are simply abandoned because disruption becomes too much. Instead, systems can be trialled in smaller teams where there is the highest chance of success - ideally ones committed to the new technology.
When it comes to identifying and nurturing sections that will be willing ambassadors and trial developers of an organisation’s IT, it is useful to have close contacts with frontline staff. Every project should have a clinical champion who can bring the medical perspective to the table, providing representation for stakeholders and advising on patient interests too. This person or people will be enthusiastic and committed to the project, and can help define what constitutes high-quality care and the factors required to deliver it.
Through this user-driven process, in which IT specialists and management could be said to play a facilitating role for clinical staff committed to using technology, digital integration and other advances can be made in a way that is not only efficient but also highly effective. Clinicians will build the best system for their patients, and implement it gladly. From a business perspective, the benefits of such an outcome will follow.
Saduf Ali-Drakesmith is EMEA healthcare manager at Hyland.