Dr. Kevin Vigilante is chief medical officer at Booz Allen Hamilton. This article was co-written with Angela Jones, program manager in digital health transformation at Booz Allen Hamilton.
In our last article, we noted that many health systems and federal health agencies have been understandably preoccupied with addressing the immediate priorities of the COVID-19 pandemic by accelerating their adoption of telehealth capabilities to circumvent physical, in-person care limitations.
We encouraged healthcare organizations to broaden their view of how today’s technological advances – not only in telehealth, but also data analytics, digital sensor technologies, 5G networks, artificial intelligence and machine learning, genomic medicine, and elsewhere – can transform healthcare as we know it.
With the right mindset and planning, these fast-evolving capabilities can transform the facility-based, episodic care models of today into new care-delivery paradigms that are patient centered, data driven, predictive, proactive, personalized and lower in cost.
This vision of future healthcare will look differently from one health system or agency to the next due to their varying missions and constituencies. But an indispensable key to success is that healthcare organizations employ integration as a defining strategic pillar of their modernization approach.
Why so, and what is integration in this context? Too often, people think narrowly about integration, viewing it only in technical terms: making sure that one system can talk to another system, or this data can commingle with that data. That’s certainly part of it. But it must be far more than that.
Put simply, integration is a methodical process which ensures that all aspects of a modernization – particularly the key program offices and stakeholders affected, the clinical and business practices and workflows, the technological components, and the data and security – are thoroughly understood and optimized for maximum business and mission benefit.
Effectively applying this process will create and deploy new capabilities that enhance and seamlessly mesh with all aspects of their surrounding environments, while minimizing downstream risk and ensuring that modernization is tightly aligned with the organization’s enterprise goals.
The task of transformation, even in the best of circumstances, is complex, and fraught with risk. Unless it is conducted with the business and mission needs of all relevant stakeholders in mind in an integrated fashion – as well as the needs of the broader enterprise – the benefits and value of the effort will be limited at best.
We think having an integration mindset is most critical as it applies to four categories:
Key stakeholder requirements
The first place to introduce an integration mindset is at the point of defining a vision for the future. Successfully deploying and integrating new capabilities into an organization’s fabric relies on developing a deep understanding of its systems and culture. This requires bringing all key stakeholders to the table when mapping out what the desired future state should look like. They will all have important perspectives and will play key roles in realizing that vision’s success.
Input and consensus from the field is also critical. This requires a user centered design approach in which the user, and the users’ needs and desires, are the “north star” for all design and implementation efforts.
The users of telehealth and digital care tools are many. They include patients and family members who care for them, as well different members of the provider team – physicians, nurses and health coaches. A continuous understanding of the customer experience through revolutionized and more interactive real-time methods – such as customer journey maps, advanced data science and AI tools – should inform requirements as the transformation process evolves.
Important objectives here are knowing exactly who needs to be at the table to set requirements, capturing the ‘moments that matter’ in the customer journey, analyzing and responding to customer experience data and ensuring the widest degree of buy-in as possible to avoid unexpected downstream impacts.
Clinical and business processes and workflows
Technologies needed to achieve transformational outcomes are present today and growing ever more capable. But they are not, by themselves, sufficient. If clinical workflows are simply “lifted and shifted” when implementing virtual care solutions, they will fail to realize the potential benefits, cause more work for end users, inhibit adoption and diminish return on investment.
Healthcare agencies must rethink clinical and operational pathways and re-choreograph workflows to optimize the benefits of the new digital tools while creating more effective and advanced care models. This broader vision of patient-centered, data-driven, value-based care should operate seamlessly regardless of whether the care is administered in-person, virtually, or in some combination of the two.
Important objectives here are synchronizing workflows, data, policies and training at the intersection of team medicine, virtual care, self-care and traditional visit-based care. Clinical processes, research processes, medical records documentation, scheduling, staff roles and responsibilities, telehealth training, billing processes and coordination with external partners and stakeholders are among the processes and workflows that will need to be reviewed and perhaps re-engineered.
This evaluation should also inform technical requirements to keep a user centered approach where the needs of patients, providers and staff are at the core of the solution.
Legacy and new technologies
The proliferation of platforms, software and devices has added complexity to an already tangled web of technology siloes catering to specific diseases and practice areas. Integration of these new technologies into existing information technology environments requires a bimodal approach.
Oftentimes, innovators are experts in their own technologies but have little understanding of the legacy environments in which their new technology must operate. While new systems are being developed and implemented, legacy systems must continue to provide critical services. A bimodal approach enables technical integrators to understand, support, and operate the legacy environments while new systems and innovative tools are developed, implemented, and integrated.
Furthermore, adhering to and developing new standards that foster integration across software, hardware, and large-scale IT platforms enables interoperability, creates a seamless healthcare experience for both employees and patients, and reduces barriers to the adoption of new innovations.
Important objectives include ensuring that technology integration is considered and planned for at all levels – from the data center and cloud to the end users at the point of care – and is scalable across the enterprise. Steps such as incorporating customer experience into system-level design; aligning various platforms through application programming interfaces; and managing new technologies through software development kits helps improve the probability of a successful technology integration.
Data and information security
The Internet of Things, a foundation to virtual care, is the connectivity of sensors, mobile applications, and medical devices that provide real-time streaming of patient data to inform therapeutic and behavioral intervention. However, the proliferation of telehealth technologies increases the cyber-attack surface and introduces significant vulnerability.
In cyber parlance, we call each of these digital tools an “endpoint” and each endpoint is a door through which a cyber adversary can attack. Digital technologies, while bringing enormous benefit, also invites tremendous vulnerability that will require much more robust end to end secure connected health solutions.
Another important consideration is data interoperability. Being able to leverage the patient-generated health data through telehealth technologies changes the care paradigm from episodic to longitudinal. Patient status now can be assessed in real-time, allowing for both preventive and immediate intervention.
Harnessing these vast amounts of data is essential to providing the highest quality care but requires that data be integrated and standardized so its value can be exploited by the analytical and automation powers of machine learning, AI, robotic process automation, and other emerging technologies.
Important objectives here are developing solutions with added security, taking threat-aware approaches in network systems and care delivery, employing extensive IT engineering and laboratory testing, and applying the right standards to data so disparate data streams can be fully integrated.
In conclusion, integration is the process of assembling and realizing the end-to-end picture of what you are trying to achieve – not just the picture of a new functionality itself, but also of the business and mission value the functionality is intended to deliver.
By mapping out the necessary integrations in these four arenas, health systems and agencies can build a roadmap that will significantly improve the chances of successfully achieving their desired transformation goals.