This is part 1 of a two-part series. This article focuses on processes and agreements in healthcare; part 2 explores how to put these into practice from a technical perspective.
Healthcare professionals don't have time to check yet another portal or dashboard to see whether a patient is doing well. Information needs to come to them: when they need it, in the systems that support their workflows. In practice, things often work differently. Each healthcare professional carefully manages information within their own organization. A measurement that is relevant to someone else in the care chain stays in the original patient's record.
Take a patient who returns home after being admitted to hospital with heart failure. The community care nurse weighs the patient and records their weight in their own system. If the patient gains two kilos in three days, this is an early warning sign of fluid retention. But the GP doesn't see it. Neither does the cardiologist. For the patient, this could mean the difference between staying at home and being admitted to hospital again.
Nobody is doing anything wrong here. The problem is that there are no clear agreements about who needs to know what, and when. Which data is relevant to whom? At what point? And what happens when a measurement falls outside the expected range? Only once these agreements are in place can data flow freely and seamlessly, allowing technology to support healthcare professionals in their work rather than the other way around.
Nictiz describes what is needed for effective data exchange in its five-layer interoperability model. It shows that technology is only part of the story. Let's apply the model to our patient:
It's tempting to start with layers 4 and 5. But the real value lies in layers 1 and 2, where the agreements are made that determine whether data can flow freely.
What do these agreements look like in practice? For our patient, the parties involved could agree to work based on exceptions:
Nobody has to go looking for information, and the patient can rest assured that an abnormal measurement won't go unnoticed.
For the patient, one thing matters: that this morning's weight reaches the right healthcare professional today. Bring the parties in the care chain together and answer three questions: which data is relevant to whom, when is it needed, and what happens when something falls outside the expected range?
Once these questions have been answered, it's clear what the technology needs to do. How this works under the hood, using openEHR, FHIR and a flexible extension to the patient record, is covered in part 2: Under the hood.
Squad Apps helps healthcare organizations turn these agreements into applications that fit the way their professionals work. Interested in how we might be able to help your organization? Contact us!
