“Interoperability is not just the transfer of data, stale pieces of information from one store to another, but instead the flow and use of the various pieces until an action can be undertook or new insight is gained for the care of our patients.” — Donald Voltz, MD (@Donald_M_Voltz and LinkedIn)
[The following comment was left on my HL7standards post, Why is Health IT behind in workflow-friendly technology and process awareness? How do we fix?.]
You article has brought attention to an area dear to my heart, healthcare workflows. Of note, the idea that we all need different workflows to obtain efficient, effective and high quality results is an important one that often is overlooked for total standardization of workflows. Don’t get me wrong, there is a lot to gain from standardized workflows, however, we have to view this concept in the face of the dynamic, complex and interdependent healthcare environment. Each patient, care path and phase of care is to some degree customized for our patients as we interact and care for them. All patients do not respond to the same amount of a given medication in the same way nor are their social, physiologic, psychological and other needs all met in the same manner. This is a problematic issue in health IT but also one that many of us embrace and work to customize the care we provide to our patients.
I have understand the view point you take on BPM software to help develop and understand workflows in medicine and have been working to solve this complex challenge, albeit from a different perspective, one of a middleware platform built upon a service-oriented software architecture that connects disparate health data sources and allows for the development of customized enhancements of EHR platforms so to address the clinical, quality, regulatory and workflow issues that are not addressed in implemented EHR systems.
The picture you presented about data silos is right on. In medicine, data only becomes meaningful in the care of the patient when it flows. Interoperability is not just the transfer of data, stale pieces of information from one store to another, but instead the flow and use of the various pieces until an action can be undertook or new insight is gained for the care of our patients. To further your argument, I completely agree that we all own a workflow, that which is currently ‘hard coded’ in the systems and the way they have been implemented as well as in the ‘soft code’ of policies and expectations of our peers, patients and co-workers. We all find a way to best work in an environment constrained not only by the technology but by many additional factors. If we are to address the needs of healthcare professionals, we need to understand the work they are doing and how we can harness the power to extract workflows to make it easier, more efficient, effective and expansive. But even greater than understanding, we need a way to develop workflows and share these among ourselves. Technology and its adoption, irrespective of the era in human history, has been about more than the tools. It has lead to enhancements and productivity gains through how it is applied to the problems at hand.
With respect to health IT, you are absolutely correct, we can not and should not code workflows into the EHR systems. This is not a viable solution to build scalable, evolving solutions that can be used across EHR applications. In addition, it does not allow for the issues you raised, changing policies, practices, regulations and emerging technologies. Instead of coding this into EHR systems, we need to think differently and beyond the confines of any single EHR implementation. Until we can share not only data, but also the information that arises when data hits the brain of a healthcare profession across the care continuum coupled with best-practices (which are not static but constantly evolving as we have see in the innovation curves of any technology, digitial or not) that can be shared and enhanced between providers, driven by patient needs, we will be stuck throwing more human power at problems that can be more eloquently solved by technology. This is when we start to realize the value from our health IT investments and when the brightness is revealed.