I want to add the following. I'm an IT professional. In the course of my professional duties, I'm expected to…
Being John Glaser 12/9/08
Last week we held a meeting of the Partners External Integration Committee.
Partners has and is pursuing a wide array of clinical affiliations with other providers in its region. These providers include other academic medical centers, community hospitals, physician practices, health centers, and university clinics. Sometimes these affiliations focus on a specific area, e.g., oncology, and sometimes they are broad, reflecting the mixture of patients and conditions that are seen.
The systems support being requested by these affiliations is all over the map. Merged networks and shared desktops. Access to the other’s e-mail and phone directories. Structured clinical data being transmitted from one system to the other. PDF-like summaries being sent for particular events. Share medical logic that informs one organization when something happens (or doesn’t happen) at another organization. Reports of affiliation activity. Whole scale movement of an application from one organization into the other.
I am a big believer in the national agenda and activities that are focused on advancing interoperability. And I spend a non-trivial amount of my copious free time helping to further those initiatives.
But when I look at the external integration challenges we are facing and I compare that to the national agenda, I think it’s a lot more complex and messier out here in the wilds of Boston than moving structured test results into an electronic health record, as important as that movement is.
And the diversity of integration approaches (and each of these affiliations has their unique combination of integration needs) is compounded by the need to create governance structures for each affiliation that deal with issues such as budget, who is responsible for what pieces of the integration, policies for re-use of data, and mechanisms to enforce the policies, e.g., privacy, of one organization over the staff of the other.
We (Partners) will work our way through these issues. That’s the role of the External Integration Committee. But I suspect that other organizations are also working their way through these issues. It’s probably not a bad idea to augment the national conversation to include conversations that center on the messy reality of very diverse IT approaches to supporting clinical relationships (and patients) between multiple organizations.
This will give me more opportunities to avoid real work at Partners and visit the very fine city of Washington DC.
John Glaser is vice president and CIO at Partners HealthCare System. He describes himself as an "irregular regular contributor" to HIStalk.
“It’s probably not a bad idea to augment the national conversation to include conversations that center on the messy reality of very diverse IT approaches to supporting clinical relationships (and patients) between multiple organizations.”
John, I agree with your perspective – we see this every day. It’s a very large, and messy problem to approach efficiently…
Best,
Don
John, you are absolutely right. It’s even worse when your trying to balance larger IDN governance issues with issues of smaller rural referral hospitals who have their own sets of issues. It is solvable but the approach needs to be viewed from the patient/physcians perspective back to the care modalities involved. If we start there we have a chance to build a 21st century healthcare system.
John has the luxury of trying to integrate organizations that share the same financial interests with one another. It becomes even more challenging when you try to integrate hospital systems that are competing in the same market. Frequently we are asking Hospitals and providers to make the tech investment but the benefits accrue to third parties (outside of models like VA, Kasier) or actually end up costing hospitals money.
Even though we need a systemic or at least community wide approach until you like HIT with financial incentives they are fraught with challenges. A HIE in Oregon for example failed when the hospitals realized that they would lose money when they no longer could duplicate lab tests. A RWJF funding project that included a patient designed PHR coupled with nursing case management (shared care plan) in Bellingham Washington failed when the specialists lost $3000 a year as a result of reduced hospital stays for people with chronic conditions. Once the financing is aligned with Tech we can really start to move.
Thankfully John brings a real world perspective to the table that is often lacking. Now if only we could clone him.
Sherry Reynolds
(most recently the designated consumer advocate for AHIC Successor – Governance Planning Committee and Board of Directors Selection Committee)