BookZurman is proud to share a recent post featuring the insights from guest author, Thomas Beale.
BookZurman is proud to share a recent post featuring the insights from guest author, Ioana Singureanu, BZ's Chief Innovation Officer.
Are You Missing Out By Reinventing Rote Healthcare Interoperability Patterns?
Ioana Singureanu
You’re sitting in the dark and you’re hungry. Imagine that you live in an apartment building and you need a burnt lightbulb replaced.
What do you do? You call the super and request a lightbulb replacement and she sends up someone to replace your lightbulb. Now, imagine you’re hungry and would like a sandwich so you call the cafeteria downstairs and order a BLT to be delivered. Requesting a lightbulb replacement and ordering a sandwich are different achievements, but follow the same set of processes — the same pattern occurred: you established a need, made a request, and received a good or service.
The way you interact with the cafeteria is the same way you interact with the super to fix a lightbulb in an apartment building. But, what happens if you forget you paid for food and it doesn’t arrive? That’s inconceivable in food services, but it could happen in healthcare delivery.
Managing Complexity with Patterns of Healthcare Interoperability
Patterns like this one also occur in healthcare interoperability.
While an X-ray and MRI are different medical diagnostic imaging procedures, the referral workflow can be the same: A primary care physician responds to a patient’s concern and refers an order, the imaging scheduling workflow takes over, the procedure is scheduled, the test is completed, a specialist reviews the images to understand it, a report is created, the results go in the patient’s chart, and depending on the results of the test, a next action or no action ensues.
X-ray or MRI, it’s the same workflow, just a different procedure—why rewrite the workflow every time? Although processes are not identical every time, they have a lot in common. In this example, we mentioned a referral workflow. Healthcare organizations sometimes have problems closing referrals, and patterns can help with this. Problems arise when these patterns are not applied consistently – when ordered procedures are not followed up, when results completed are not reviewed by the ordering physicians, and when referrals don’t result in improved care or diagnoses – healthcare resources are misused, and healthcare outcomes become unpredictable.
Recognizing common, reusable patterns has been successful for software development, and can be successful for healthcare interoperability as well. By utilizing healthcare interoperability patterns the same way software uses design patterns for reuse capabilities, the burden of complexity can be lessened.
Further, software design patterns have evolved over time, which can also parallel healthcare patterns that can be leveraged time and time again. Software creation that implements patterns borrows from referral pattern procedure, documents, and follows up. However, unlike “software design patterns” and “enterprise integration patterns,” “healthcare interoperability patterns” refer to those building blocks of processes and interactions that must be in place to automate healthcare delivery practice, research, reporting, billing, outcome analysis, and planning.
For example, the Integrating the Healthcare Enterprise (IHE) Scheduled Workflow was the first building block of this type: an integration of profiles from IHE that standardized the behavior of systems involved in ordering, performing, and reporting on the result of diagnostic imaging procedures.
A similar pattern was standardized by the ePrescribing functionality of EHR systems: an electronic information exchange pattern that allows providers to order medication to commercial pharmacies using standard transaction and terminology, and query the record of medications prescribed or dispensed. The way patterns could be applied universally in the same way across EHRs and clearinghouses is to use standards (NCPDP SCRIPT, RxNorm).
Patterns can help create seamless care. Patterns can handle complexity. How do we breakdown complexity into manageable patterns? Can we envision what it would look like and start working toward it? If you are in the standards business, complexity is not your friend. It is very important to the success of standardization to lessen complexity for a direct and impactful outcome. We have this highly specialized domain that can be the catalyst for creating reusable building blocks for commonly reused processes.
Collaboration Over Competition
Why approach five similar problems in five brand new ways?
Collaboration among healthcare software providers, having well understood patterns with an understanding of each other’s goals, is for the common good. Top healthcare IT organizations compete for business, but collaborate on interoperability to save time and money to understand common problem components. They understand that they can’t control the ecosystem, and found ways to work together to discover how a scheduled workflow fits into the overall system.
If the process of starting and completing diagnostic imaging procedures is similar or the same (of course there could be layers on sets of common patterns), once you define the common way of doing something, you can repurpose it.
Identifying Healthcare Patterns
Healthcare is complicated, if we continue to identify a handful of patterns of interoperability over and over again, we are doing a disservice to the community.
Instead, stakeholders must:
- Decide what the workflow is
- Agree on desired workflow functionality
- Be prepared to act within multiple systems
- Help determine how simple or complex – at the macro level – the role their systems play in interoperability.
We do not have to approach every diagnostic procedure as though we have never seen a procedure before, we need to recognize the patterns of interoperability.
As an award-winning healthcare standards and interoperability consulting group, BookZurman can help your organization assess patterns that your organization is already engaged in but that can become more efficient.
Beyond healthcare patterns, we can be your objective partner to bridge your gap between healthcare and technology for a better patient experience. Our industry-leading team of domain-specific subject matter experts brings an unparalleled breadth and depth of experience to government, industry and community partners to help their systems and projects stay ahead of the technology curve, and maximize longevity and return for their IT investments.
How can we help you stay ahead of the interoperability curve? 
Get to know the guest author!
Ioana Singureanu
LinkedIn
Ioana Singureanu, MSCs, FHL7, Chief Innovation Officer, has been working with BookZurman for more than a decade and is an HL7SM FHIRTM Foundation Founder. Ioana focuses her decades of domain expertise in standards development and healthcare integration to address the needs of BZ clients toward digital transformation. Ioana has assisted federal agencies (FDA, VHA, ONC, SAMHSA, NIST) to develop consensus-based specifications in applying health IT standards to national policy and regulatory requirements (using HL7, NCPDP SCRIPT, LOINC, RxNorm, NCIt, SNOMED CT, GMDN).
Additionally, Ioana is co-chair of health IT standards development organizations critical to the adoption of health IT standards consistent with the Center of Medicaid and Medicaid Services (CMS) and the Office of National Coordinator for Health IT (ONC) rules. Ioana is also co-chair of HL7 Conformance, HL7 Community Based Care and Privacy work group and a member of the HL7 US Realm Steering Committee that manages policy and governance for US-required HL7 implementation guides, guidance, and best practices referenced in the CMS and ONC rules. Ioana is an HL7 Fellow and a certified HL7 professional (HL7 V 2) and Oracle DB Administrator.
