Managing complex information in a digitally hybrid world

On the cusp of the fourth industrial revolution, herein lies a space where digital technologies are intersecting and sometimes colliding. We are anticipating interoperability to the point of imperceptible boundaries between humanity and science. Disruption, agility, and innovation. A fusion of advances in artificial intelligence, robotics, the Internet of Things, Medical and otherwise.

3D organ printing, precision medicine, personalised medications, quantum information science, CRISPR and so many other technologies and disciplines we haven’t even invented yet.

Sounds exciting? Absolutely. Is it here yet? Not quite. Well at least not in the realms of clinical data flow.

Patients rely on clinicians to make sound and safe decisions about their healthcare based on how they present, combined with all the rich data about their healthcare that preceded their current visit.

Not just data generated in your hospital but from their GP, pharmacist or the neighbouring hospital that saw them last week. This is where things can go horribly wrong. Omission of data is as dangerous to the patient in your care as inaccurate data. Either way, this rarely ends well.

As the majority of a person’s clinical data resides in non-hospital systems (paper, electronic or hybrid), and digital interoperability between systems outside of your hospital EMR is far from complete, how do we, as providers of 21st century healthcare prevent 19th century outcomes?

In 2012, the Australian Commission on Safety and Quality in Health Care released The National Safety and Quality Health Service (NSQHS) standards. At their core, the intent was and is to be the framework for and barometer of safe and efficient practice. In other words, a nationally consistent level of care.

The NSQHS Clinical Governance standard Action 1.16 states that healthcare records should be available at the point of care, support an accurate and wholistic clinical and administrative record; comply with relevant privacy, security, and record retention requirements, support clinical audit, and integrate multiple disparate systems where digital interoperability doesn’t exist. Yet, as standards evolve, we still struggle with achieving semantic interoperability and data federation within hospitals. Let alone those systems outside of the inner sanctum.¹

If we had a single personal record that traversed all venues of care, ensured a national standard across all providers, crossed state and national boundaries, these standards would be easier to attain. Unfortunately, even the Australian My Health Record initiative has been unable to achieve this.

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As clinicians, we base our care on best practice, ongoing education, and access to patient history. If we don’t have access to that information, we either repeat examinations that may have already been undertaken or in an emergency, base our judgement on the information at hand. This is traumatic for the patient, can delay treatment and seriously impact clinical outcomes; not to mention the additional expense.

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Remember, not all hospitals or primary care practices with EMRs are completely digital. Whilst public hospital EMR rollouts are progressing at varying paces, the implementation across each state and territory is far from paperless. In the private sector, adoption is still behind its public counterparts.

Perhaps one of the richest sources of current information are the ones we often forget. It’s the documents the patient hands you with a list of their current medications, the interstate pathology report that is faxed to you or the discharge summary with a list of clinical conditions that is awaiting filing and scanning. These are of no use to you in the emergency department with an unconscious patient if they only become part of the patient record at the end of their encounter.

A complete Electronic Health Record is the nirvana of healthcare and good clinical decision making. It was promised in the 1960’s, partially delivered in the path to Y2K and decades later, is still in the process of implementation.

So, hey Mum, are we there yet? Soon dear. It’s a very long and winding road.

Lexmark Healthcare have 30 years’ experience in assisting healthcare organisations.

Solutions to assist the digitally disenfranchised; downtime solutions that cross systems; secure transmission of data and of course, integrating clinical information from other venues of care into your digital records.

See us at Digital Health Institute Summit Booth #37 to learn more about a path to managing complex information in a digitally hybrid world, or click here to learn more.

^{[1] According to HIMSS, whilst 75% of systems have achieved foundational interoperability, only 36% have reached a common vocabulary that paves the way for accurate and reliable communication.}