Throughout the 1990s, individual departments within organizations were delegated responsibility for their own software.
Even when organizations charged their IT managers with working across departments, they often dealt with dozens of disparate applications simultaneously ... and in a number of industries, they still do.
In the healthcare industry, for many physicians, clinics, hospitals and health provider networks, the situation grew untenable years ago. Now, with the pressure of HIPAA and other government-regulated data management guidelines weighing down on them, healthcare providers are struggling to provide integrated security and privacy for their patient records, even when the latest version of their software pre-dates HIPAA.
Their goal is the unified patient record (UPR): an integrated data store where sensitive information can be managed in a normalized, predictable fashion. But the very act of integrating old record formats with new data can introduce security vulnerabilities, privacy violations and unmanageable risks.
At the heart of the issue: who owns the integration process. A healthcare provider’s choice of technology could — perhaps inadvertently — make that decision on its behalf.
The Pilot Ward
“The importance of ownership is shown in the commitment of the pilot ward to making the UPR work,” wrote Deb Thompson and Kim wrote in Developing a Unified Patient Record: A Practical Guide, “contrasted with the disinterest in updating handover practice on two of the rollout wards.”
Thompson and Kim told the story of one project to implement a UPR project with one healthcare provider. The “pilot ward” was the driver of the project, and an assessment of how well it was able to implement change management – and cope with the consequences – came in the form of what the authors called a “force field analysis.”
The team that best articulated the goals of the UPR project, with this particular provider, ended up owning the project. That was the documentation team.
Stop for a moment to think about this. In most organizations across all industry verticals, the team that best articulates the goals of any project is not IT, but marketing.
With this provider, the team managing the content provided the greatest threat to the other teams that provided the service. And vice versa.
“Experience during this project has shown that those who have ownership of a past change obstruct future changes,” Wright and Thompson wrote. “The key may be in developing staff to alter the culture of the organization to one that continuously learns, adapts and improves.”
Put another way, technological change at this scale may be impossible without a reconfiguration of the organization.
Operations managers may be happy to spend any amount to avoid that path, or even just ameliorate its effects.
The Risk Score
On Monday, data warehouse provider Teradata announced a partnership with Knowledgent, a producer of predictive analysis tools. On the surface, the purpose of this partnership is to offer healthcare providers a kind of “single source of truth” for patient data, particularly to enable an evaluation technique called risk scoring.
“Big data technologies form a framework allowing organizations to leverage all relevant enterprise data when calculating a patient’s disease state-specific Risk Score,” reads a Teradata white paper on the subject [PDF, registration required] published this week.
The objective of risk scoring is to reduce the likelihood that a patient will need to be readmitted for disease treatment, especially if she could have received that treatment during a previous visit. Teradata makes the case that a multitude of data sources, including “Claims, Electronic Medical Records (EMRs), Lab Results, Medical Images, Care Management notes, member surveys, and demographic and psychographic data sources,” must be analyzed collectively in order to yield a reliable and trustworthy score.
“The Risk Scores that insurance companies calculate for risk-adjustment purposes can be used as a barometer to identify the sickest patients,” wrote Teradata, “but they don’t provide specific or actionable insights into improving the member’s health.”
It just so happens that, once you put all this data together, it becomes far more feasible to produce a UPR.
Teradata’s partnership with Knowledgent could end up producing a sort of virtual format for a UPR, where the record manages to assemble itself from a variety of sources without the need for explicit re-streaming or translation.
“While the need to combine and organize the data cannot be eliminated, it can be accelerated in the process so that it can be leveraged for a variety of use cases,” wrote Knowledgent’s Mitchell Shuster in a company blog post last June. “UPRs are an excellent way to accomplish this. The UPR is designed to capture all information on a given patient in a longitudinal view, rather than to have that information spread across numerous databases and tables.”
Yet this unified record scheme could also serve Teradata in another key respect: If the data sources for this record are all maintained in on-premise data warehouses, using discovery platforms such as Teradata Aster, then the UPR would also, by extension, reside on-premise.
If the UPR is, in effect, already there – latent, waiting to be harvested – then healthcare providers would have less incentive to move their data to cloud service providers. That’s important for Teradata, since some SaaS providers already have a one-year head start on them.
The Engaged Patient
Last April, a portal for health information exchanges (HIE) called RelayHealth launched a redesign, with the new and unique purpose of fostering what it called “patient engagement.” Specifically, RelayHealth tried a Salesforce-like approach to data availability, producing a platform with which patients — not just physicians — would have access to their data through a mobile app.
“Patient engagement should never be a standalone strategy,” stated the company in an e-book published that spring [PDF, registration required]. “It should always be driven by the organization’s larger, long-term strategic objectives to provide maximum results for the investment of time, effort and money.”
Put another way, a provider’s patient engagement initiative doesn’t need to be delegated to one, exclusive “pilot ward” in order to drive change. Rather, it can be accomplished as a kind of side benefit of another initiative, whose practitioners could perhaps use a bit of encouragement.
That project, namely, is UPR.
“Parsing specifics from Health Summary Documents, such as medications and laboratory results, is critical to creating a unified patient record,” wrote RelayHealth. “Simply aggregating a list of documents will not achieve the desired result.”
RelayHealth’s value proposition is that its platform already includes the tools and techniques necessary to render a UPR, without leaving the integration process to trial-and-error. It is a cloud platform of sorts, in that it does offer its service through a subscription model, although its data centers are centralized and not hybridized — in order to ease compliance with HIPAA and other sets of regulations.
In both these cases, “disinterest” appears to be one of the major roadblocks to the implementation of a UPR project in healthcare organizations, and one pointer towards a solution appears to be “engagement.” In one of the most sensitive affairs involving human beings and their well-being, it’s psychology — not technology — that needs to be managed and maintained first.