How EHRs, Interoperability, And Workflow Are Helping (And Hurting) Healthcare

TeleTracking President Michael Gallup is leading his company’s transformation from a patient flow automation company to a real-time, automated operations management provider for healthcare organizations. Driving this transformation is his aptitude for identifying the needs of healthcare organizations across the continuum of care and his ability to unify TeleTracking’s various business components to provide broad operational efficiencies, cost savings, and revenue generation as a counterbalance to healthcare reform cutbacks.

Gallup took time recently to talk with Health IT Outcomes about EHRs, interoperability, and workflows and how these three hot-button topics are improving outcomes and, at the same time, hindering healthcare.

Q: Many providers bought an EHR so they could attest for Meaningful Use and didn’t spend time making sure it was the right solution for their needs and, as a result, are suffering from an EHR hangover. What can be done to remedy this unfortunate outcome?

Gallup: The pressure was intense to quickly find an EHR vendor because of the money involved. The irony is the rush only really secured seed money and the bulk of the cost to implement an EHR was/is on the shoulders of the provider, including the burden of managing the interoperability of their technologies. This last component, unfortunately to date, has been marred by varying degrees of information blocking whether that has been performed explicitly, or more subtly through cost prohibitive interface builds.

In situations like that, it is understandable health systems would want to extract as much functionality as they possible can out of their EHR. While combining the functionality of disparate systems often seems logical, to avoid the challenges of interoperability, it doesn’t come without tradeoffs — including domain expertise and role-based functionality that is exclusive to each vendor.

Also worth at least considering are the implications on innovation and competition. Take for example the ongoing events in Connecticut where concerns grow amidst the belief that one EHR vendor is now the de facto health information exchange (HIE) for the entire state. The ONC warns about this very thing in a report to the Senate concerning information blocking by vendors to control referrals and boost market share for providers; sometimes at triple the cost of a given procedure.

The onus is on us as vendors to make the exchange and interfacing of data as seamless as possible. For that reason, TeleTracking has an open integration philosophy where we welcome collaboration with other vendors. We have standard interfaces with over 80 HIT applications and offer standard services for interfacing across a large set of technologies.

Q: In addition to EHRs and interoperability, workflow was a topic heard over and over at HIMSS. Why do you think workflow is taking on such importance? Has it always been this way, or is this a new emphasis?

Gallup: Two things are converging. One, the industry realizes process efficiency is vital to survival as it is to any high performing organization. Two, enabling and automating workflow can have a transformative impact on productivity and the broader patient experience.

Automation used to be taboo in healthcare because it conjured up visions of assembly lines. Obviously if every patient were the same in biology, diagnosis, and treatment healthcare could in fact run in that way. However, each patient remains unique in their situation and needs. The key here is how technologies have emerged to help us manage the variabilities specific to each patient’s need.

Looking specifically at patient flow, the core operational process around the patient journey has an incalculable impact on both time and productivity despite these variabilities. The data at our fingertips today enables healthcare leaders to act as change agents in managing process and flow.

TeleTracking has evolved over the years because we’ve been able to apply what we’ve learned in to a much broader set of needs — delivering enterprise visibility, sophisticated data sets, process redesign — needed for efficiency improvement across the care continuum. The potential impact includes greater patient access, more timely care, fewer ED delays, shortened length of stay, and overall a more satisfying patient and caregiver experience.

Q: What are some measurable outcomes that can be achieved by improving workflow?

Gallup: Access to timely quality care is what drives us. There are tens, if not hundreds, of thousands of hospital beds that sit empty on any given day in America. Meanwhile, the average wait time for an admitted ED patient remains more than four hours, and some estimate close to half a million patients will wait more than 24 hours this year. Patients are boarded, EDs go on diversion, and visibility of patient flow across the care continuum remains largely fragmented.

A recent example can be seen in a study conducted by the RAND Corporation, who profiled Health First, a health system based in Florida. In that study they found a 27 percent increase in total patient admissions in conjunction with a 19 percent decrease in average length of stay. One hospital in Ohio saw their left without being seen rate go from 7.39 percent to 1.82 percent while ambulance diversion hours went from 154 to 9.4, all in a two-month period. That same health system reduced hallway boarding by 4,000 hours. An Oklahoma health system was able to increase their community outreach and accept 36 percent more patient transfers from external referral sources. Knowing the impact of operational efficiencies, we continue to work with clients across North America and the United Kingdom to drive similar results in improving patient throughput, reducing wait times, and increasing overall patient access.

Q: Who within a healthcare system is best tasked with improving workflow and why?

Gallup: It comes from both front line caregivers as well as senior leadership. You need adoption of best practices from those closest to patient care; the ones who will ultimately work within the workflows and processes put in place. But you also can’t ignore the significance of a strong executive champion to rally the organization behind the vision and purpose for something as broad reaching as patient flow. None of those can happen without bringing to bear actionable data and real-time visibility to enable positive change in the organization.

Typical roles we often see (though certainly not an exhaustive list) include Chief Operating Officers, Nurse Executives, VPs of Patient Access, Directors and Managers of Patient Flow, Patient Logistics, Patient Access, and Emergency Services.

Q: There are different definitions of interoperability — how do you define it and how is it more than dumping data into an HIE?

Gallup: The focus has been on moving patient records from one place to another, and so most of the discussions seem to center around HIEs, referring physicians and the like. But there are a number of touchpoints where operational and clinical information cross paths. Because hospital departments in and of themselves can be siloed, this remains one of the biggest roadblocks to operational improvement — the stunted flow of information across the patient journey. When you create a stream of data that can only be dipped into by a very few professionals within a closed system, you are essentially enabling that siloed behavior. That runs counter to our philosophy that information sharing is the basis for improved performance and efficiency.

It’s clear to us and many hospital administrators that hospitals function much more efficiently when clinical and operational systems can talk to each other. Based on the current outcomes of our 900 clients, we think operational automation, synchronized with clinical data, could free up nearly $150 billion for U.S. health systems in productivity and increased patient care. That’s why we remain strong advocates for interoperability.

We encourage leaders in our industry to look beyond just HIEs as a source of data exchange. We’re really talking about cross-functional interoperability, essentially making the clinical and operational side part of the same “whole.”

Q: The road to interoperability has been, at times, slow going. Who will ultimately drive true interoperability and what will it take to get there?

Gallup: As the ones who provide products and services to the industry, vendors will continue to truly drive interoperability. That said, providers and those who deliver patient care also play a role in championing these efforts.

But so far, the interoperability debate has focused on the EHR. Looking ahead, for the sake of providers and the safety of their patients, we call on all healthcare IT vendors to seek true integrations, going beyond simple interfaces that can carry a cost for providers to maintain. The burden, as in other industries, should be placed upon the vendors to work together for the betterment of healthcare, ultimately creating a safer environment for the patient. The goal is about not only providing the appropriate diagnosis and treatment, but also in getting patients access to that care in the timeliest manner possible. As clinical and operational platforms come together, we envision interoperability becoming more than just sharing patient data. We see platforms bound together to deliver the right information, at the right time, in the right place and with the right resources, for the sake of the patient.

It’s our hope that this cooperation becomes commonplace throughout the industry, helping make the U.S. healthcare system fully deliver to both patients and providers.

Q: What barriers stand in the way of improved patient access and what can be done to overcome them?

Gallup: Fragmented patient journey across the care continuum; lack of communication and information sharing between departments and units; poor patient flow into the system due to inefficient referral, transfer, admit, and placement processes; bed scarcity due to poor patient flow through the system; operating room backups; timely patient discharges (in order to get new patients admitted), and lack of real-time visibility into intake processes

The biggest obstacle to landing at O’Hare airport is the other planes ahead of you, which are circling because there are still planes at the gate. Without real-time information, patients stack up at the hospital “gates.” Eventually, that means some patients can’t get in the front door.

Seeing the hospital from 30,000 feet means you can see the problem areas where operations get bogged down. And if you can see them, you can start to fix them. Our operational platform gives hospital personnel that aerial view and the means to do something about those problems. We put the entire hospital online so every function can be seen, noted and modified if need be. That means care can be delivered better and faster, which ultimately means better access to all.