With the concept of collaborative care now at the forefront of the healthcare industry, organizations are working to improve the functionality and interoperability of health IT systems. To facilitate the meaningful exchange of clinical and financial information, however, it is essential for various technologies within and among organizations to effectively communicate. Standards are essential.

Building the S&I Framework

In order to expedite the kind of communication necessary to support collaborative care, the Office of the National Coordinator (ONC) launched the Standards and Interoperability Framework (S&I Framework). The S&I Framework is a community of stakeholders across the healthcare spectrum working to develop health IT standards to promote functional information exchanges. The open forum leverages a series of initiatives based on clinical use cases to create the standards and tests the standards with pilot programs.

Without key stakeholder input and participation, various processes or nuances within them are in danger of being overlooked. So that the myriad of workflows and their variations can be understood and accurately mapped, participation is needed from sectors that include:

* Provider practices

* Hospitals

* Health systems

* Medical device and equipment manufacturers

* Standards development organizations

* Regulatory agencies

* Payers

* Technology vendors

Front-end involvement ensures all stakeholder needs are met, and also enriches the community’s discussion by painting a complete picture of healthcare workflow processes. Within the S&I Framework are organization-led communities that methodically discuss standards, workflow processes, and the IT implications associated with each.

For example, the Electronic Submission of Medical Documentation initiative sponsored by the Centers for Medicare and Medicaid Services (CMS) developed guidelines for securely sending medical documentation electronically—including the creation of an electronic alternative to handwritten, “wet” signatures. Standards such as these are incorporated into a community-approved implementation guide for each initiative, and then tested at pilot sites. 

Improving collaborative care

With the S&I Framework, hospitals and health systems can begin implementing secure, structured standards and solutions to expedite their collaborative care efforts. Guidelines developed by the Transitions of Care initiative, for instance, focus on standards and solutions in support of Meaningful Use requirements related to the exchange of core clinical information between providers and patients using EHRs—an essential component of collaborative care.

For example, take the scenario of an 80-year-old patient who falls and breaks her hip while at home. After her fall, she is admitted and treated at a hospital, and then transferred to a rehabilitation facility. During these transitions, key information such as her health history, medications and care plan needs to be shared with her primary care provider, the hospital, the rehabilitation facility—as well as with the patient herself and her caretakers—to ensure continuity of care. The Transitions of Care initiative within the S&I Framework is working to make such information exchanges more reliable, functional and meaningful. The idea is to put the standards and processes in place that ensure providers have all information necessary to provide quality care, and allow patients to better understand and follow their care plans.

To maximize the effectiveness of guidelines within the S&I Framework, healthcare organizations must:

* Pay attention to and be aware of ongoing and forthcoming initiatives;

* Participate in or provide representatives for initiatives that affect them;

* Collaborate with other organizations; and

* Understand the implications new guidelines and standards will have on existing workflows and processes.

Viet Nguyen, M.D., is the Chief Medical Information Officer at Systems Made Simple, Inc. (SMS), a provider of IT systems and services to support critical architecture, data and application challenges in the healthcare industry.