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Healthcare IT System Design: Lessons For The Future

What would healthcare information management and health IT workflow look like today if we focused on automated workflows first, and data second? Visualizing what might be true today if this had happened is a useful exercise for understanding how structured messaging may be the missing link—from our current, relatively workflow-oblivious health IT systems, to the kind of seamless task and workflow interoperability I mentioned in previous posts in this series.

Imagine you are a health IT CIO in a rapidly modernizing country. You have relatively few HIT systems running in your environment, but you’ve been charged with drawing up a five-year plan to achieve “digital healthcare transformation” within five years. You’re assured of substantial, but not unlimited, resources to achieve whatever you envision.

You could start where healthcare organizations in the United States started several decades ago—by beginning to collect, store, and leverage ever-increasing amounts of healthcare data, especially in electronic health records and related clinical systems. But first, let's look at your strategic priorities:

  • Reduce medical error
  • Coordinate with community physicians
  • Improve patient experience

Rather than automatically implementing an EHR first, think about how some countries skipped the telephone poles and wires in favor cell towers and smart phones, effectively leapfrogging already obsolete infrastructure. Might there be a similar skip-a-generation-of-technology play here in the area of digital healthcare transformation?

A technology like secure structured messaging, on a sophisticated and feature-full platform, allows healthcare organizations to address all three strategic priorities—laying the groundwork for your workflow-first strategy, driving which data to collect, where, and how to manage and redistribute.

The largest single categories of medical errors are caused by interruptions and mismanaged handoffs. A customizable system like Telmediq, supporting clinical teams messaging back and forth, is ideal. And if you’re looking to coordinate between your healthcare organization and outside physicians? A secure, structured messaging platform can assist there as well.

Finally, regarding patient experience: there is no magic bullet or technology we can place in front of patients that will magically transform their experience with the healthcare system. Patient experience is most directly driven by their interactions with frontline healthcare providers. Superb task and workflow management among that team of providers taking care of the patient is the key to improving patient experience. It is what the hospitality industry labelled the “System Behind The Smiles”—the robust systems and processes employees need to exist in the background so that they are set free to live the ideals of their organization’s culture and to extend fantastic service. Healthcare needs both great people and great workflow. The technology they put in place needs to support both.

Today, most organizations employ kludgey healthcare and HIT systems with thousands of different brands and functionalities of health IT systems in operation. We are engaged in a massive investment in both databases holding patient data and initiatives to unlock that data via standards and infrastructure. However, for the immediate future, we will continue rely on communication among all members of the healthcare team to fully leverage this data. The best candidate for digitally empowering these workers lies in some form of sophisticated structured messaging.

Structured messaging is an excellent candidate to become the task and workflow management glue, among people, among teams, and among healthcare organizations. Obviously, widespread data interoperability efforts will be necessary and ongoing, but we’ll also need a layer of task and workflow interoperability working in conjunction with that. Lightweight, in-the-cloud, BYOD (Bring-Your-Own-Device), task and workflow communication technology, such as Telmediq represents, will play an important part in achieving the kind of interoperability that makes the difference, moment-by-moment, in the workflows most directly affecting patient care, safety, and experience, the workflows of their care teams.

Charles Webster, MD, is a Google Glass Explorer with degrees in accountancy, industrial engineering, artificial intelligence and medicine. He designed the first undergraduate program in medical informatics, was CMIO for an EHR vendor and wrote three successful applications for the HIMSS Davies Award for EHR Ambulatory Excellence. Chuck opines about healthcare workflow and other topics from @wareFLO.

blog, Clinical Workflow, Pager, Technology