IM/IT in the Heathcare arena – Part 1

Today I would like to talk about the role of Information Management (IM) in the success of Information Technology (IT). The past has proven the IT success in the healthcare arena is dismal; there are studies that cite IT close to a single digit. Many factors play a role in this low success rate, today I am just going to focus on function involvement through IM. Traditionally, the IT community tried their hardest to develop product that they believed would meet the functional’s needs. They developed and modified products that made perfect engineering sense and took into account what they believed were true comprehensive functional requirements. The functional community on the other side of this fence developed functional requirements to the finest degree taking extended periods of time, naturally, by the time requirements development was complete, the requirement that were developed in the beginning of the process are either outdated or obsolete. Moreover, the requirements often did not take into account technical and engineering software designs or limitations. While we would like to believe that there is a sliver bullet to solve these issues, but there is not. However, there is hope. Through integrated requirements design (IRD), which means as the functional community is developing requirements the technical IT experts are at the table helping explain the limitations and at the same time understanding the true meaning of these functional requirements. Sure, IRD is only half of the battle; on the IT side agile development helps breaking the project into smaller “chunks”. This agile approach ensures that the functionals are participating at these sprints and the IT community is receiving streaming feedback about their product. Also in agile development, the IM communities are seeing the fruits of their labor and are taking ownership of the product one piece at a time. In summary, the way to increase functional satisfaction and acceptance of healthcare IT products is IRD and agile development.
In the next installment I will discuss the role of governance in reining both sides in and ensuring that products are developed on target within budget and without scope creep.

 

Universal Unique Patient Identifier

The current HITECH law renewed the restriction placed on the Department of Health and Human Services (HHS) preventing the use of Federal Funds for establishing a Unique Patient Identifier (UPI). On its surface the move seems irrelevant as most entities use the patient’s social security number (SSN) as a unique identifier. However in reality, this restriction is detrimental to data interoperability, Electronic Medical Records, and the Virtual Lifetime Electronic Record (VLER). Furthermore, using SSN is not the best practice as SSNs are being re-used routinely. With many Federal Agencies being subject to the Social Security Reduction Act,  the need for a Universal Unique Patient Identifier is remerging.

Many studies to include the RAND 2008 Identity Crisis Study by Hillestad, R.  et. al. highlighted the flaws with statistical matching algorithms in the absence of UPI. I would argue that a UPI is not enough, the need is for a UUPI, every healthcare entity (private practices, hospitals, the federal govt and insurance companies) needs to utilize the same number to ensure that the correct patient is identified and matched across these entities. One can only imagine the grave consequences of false positive patient identification and the cost of false negative search results. The former could result in the wrong diagnostic results being attached to the patient’s medical record and the latter results in unnecessarily costly test to be repeated.

#ONC #Interoperability #UUPI