HII-C is addressing the need to provide new functionality for our healthcare system. We recognize the many electronic health record (EHR) systems, knowledge resources, and big data analytics services now available and appearing. But there is a lot of chaos in the market currently, arising largely from the fact that the major EHRs have arisen over the past 20-30 years, and not only are based on old technologies, but on a view of the healthcare system that is itself changing. EHR systems were developed to optimize the functions, workflows, data capture, and financial operations of a practice, a clinic, or a hospital, and more recently larger healthcare enterprises. They do a good job at that, by and large.
The disruptions and transformations
But the healthcare system is transitioning to a “health system” – person-centered rather than enterprise/practice focused. We are moving toward management of health rather than primarily focusing on optimizing healthcare encounters/processes/interventions. In fact, the two goals may be directly at odds with one another. To keep a person healthy, or to manage their disease early and aggressively, we must obtain data from all sources, have an integrated view of the care plan, and ensure that transitions of care and coordination across venues occur in an optimal manner. We also need to rely on the patient to collect data through mobile apps, devices, and other tools, and to be able to monitor for deviations and be alerted to conditions requiring attention. We need to constantly update our knowledge based on advances in precision medicine, technologies, and treatments available.We need to track our performance and costs against metrics and function as a “learning health system”. In a recent publication, we identify eleven key disruptors contributing to the transformation of healthcare and the new IT needs.
Implications for health IT
What kind of capabilities are needed for this evolving health/healthcare milieu? We can do some of the needs by adding plug-in health apps to existing EHRs, such as SMART on FHIR apps. But a fundamental problem remains that much of the functionality we need for care coordination, connecting patients and monitoring them, and use of data analytics to inform our processes live outside of or span across EHRs and other data sources. And single view, single-purpose apps plugged into EHRs cannot provide the kind of advanced functionality needed for the capabilities we have described. Also the capabilities need to persist and live in a platform and environment that accesses all the data sources but runs independently of and coordinates with them.
The kinds of capabilities we describe need a set of infrastructure services, to extract data from EHRs (largely using the evolving FHIR standard), normalize the data, encode it with standards-based coding schemes, represent the data in a standard information model, provide context/identity/role-based security access protections, and a variety of other services. In addition, they need access to knowledge, not only in the form of information models and terminologies, but in terms of context-based relations among problems, goals, data to assess them, and actions, care pathways and guidelines, predictive models, and other resources – to help providers and patients organize and visualize and navigate and make decisions.
Today, most knowledge resources, even if provided by knowledge vendors, need to be imported and translated into proprietary EHR-specific formats to be managed by their own editors and integrated into EHR workflows, triggers, and notification procedures. That means they are not transparent and that they cannot operate in a cross-platform environment. Thus the platform for an IT system to meet the needs of our transforming health system must contain a set of knowledge resources as part of its infrastructure. EHR-specific knowledge resources should be enabled to sync with and update themselves as these knowledge resources are changed over time.
We have described the above issues to explain some of the background for why interoperability – which is so loosely defined and used in different ways by many parties – is such a key concept, and why health IT of the future must be built on an interoperable, standards-based platform and infrastructure that supports coordination among the many parts of the health system. HII-C is devoted to evolving these ideas through collaborative development, instantiation, iterative design and refinement. We select high-value driving use cases arising from needs of our collaborating partners to demonstrate value through prototypes to both inform visually, engage stakeholders, and help define the requirements for the infrastructure services and resources. As we increase the range of use cases, refine our design and implementation of infrastructure, and evaluate, the platform is expected to mature and develop increasing capabilities.