Posted by: Jenny Laurello
data interoperability, health information exchange, HIE, IDNs, Interoperability, Networking, patient identification, public health information exchanges, Risk assessment
Guest post by Ruby Raley, director of healthcare solutions, Axway
Past interactions between customer communities were all about hub and spoke. There were HIE hubs, hubs as plans of a claims-payment process, hubs as integrated delivery networks (IDNs) of consolidated revenue-cycle management processes, and hubs of communities with physicians. Hubs dictated the structure of data, the frequency of data exchange, and who could join; spokes complied with the hubs, which required them to employ staff to address all the disparate standards. Because of these difficulties and the resulting expense, sometimes the spokes could not comply at all, and the hub had to provide alternate methods, which increased their costs.
Hubs are coming apart in 2013. Public health information exchanges (HIEs) are no longer at the center of discussions. Instead, they’re being marginalized in favor of the network concept, which is basically a collection of peers collaborating.
In health care, however, there are unequal peers — peers using smartphones, iPads, and other devices to receive and process health records, view or collect medical images, send images to remote specialists, and collaborate with a vast network. Peers are using cloud services and interacting with everything from small physicians’ offices to large organizations.
There is also no hierarchical structure governing the role of the person operating the node of the network. In an accountable care organization, a registered nurse, clinical manager, or even a quality-review board — completely unaffiliated with the patient’s physician — may actually be the one sending a note to a second doctor to request tests, procedures, or test results. It’s all happening in real time — much more quickly than it ever did with the hub-and-spoke model, where file-based exchanges like claims and lab results were batched and sent periodically throughout the day.
Today, we’re all part of a network — a collaboration of many hubs and many spokes — and we have to consider several items for that collaboration to be successful.
- Trust and identity verification. There are have unequal peers from all types of organizations across any network, and we must manage our relationships with them. That can be done by standardizing how our communications are secured, how we identify those peers, and how we routinely verify their identities.
- Risk assessments. With networks come increased ad hoc exchanges, and increased risk. Yet we can’t afford to take all of these network collaborations and turn them into connections. Risk-assessment processes must be strengthened to accommodate operating in a network environment, and not a hub-and-spoke environment with static connections and endpoints. This will require additional governance and auditability tools that will give us more visibility over a standard catalog of processes.
- Interoperability. Interoperability is going to be the replacement word for HIE. Interoperating with a large number of people is necessary to effectively collaborate as a peer on the network. That means you’ll need to continue to invest in interaction patterns and data management tools.
- Velocity. In the past, it was acceptable to take six weeks to establish an electronic data interchange connection with a new partner, but in the new world of the network, speed is a critical factor that puts stress on our infrastructure and processes — and we need to plan for it. Soon you’ll be establishing quick, secure connections with parties you’ve never connected with before, and you’ll need to verify their identities in a flash.
A new future is upon us and hub and spoke is a thing of the past. So charge forward into it! Let these items guide your collaborations from the slow, insecure, risky, babelized interaction patterns you’ve been slogging through — where every single connection is a one-off, handcrafted piece of work — and deliver them into a set of manageable interaction patterns.
When you’re looking back at 2013 a year from now, you might be surprised to realize your peer collaborations — however unequal those peers may have been — ultimately managed to exceed every expectation put to them in this humble, hopeful post.