Challenges and Opportunities in Interoperability between Pharmacies and providers of Long Term Services & Supports

iCareManager January 10, 2020
EHR For Long Term Care Services and Supports Organization | iCareManger

You might think that by this third decade of the 21st Century, the computer systems of any long term services and supports organization could talk seamlessly, reliably, and securely to any pharmacy or doctor’s office.

That doesn’t fully exist. It should.

And it will as we work towards it. This article sketches some of the challenges, opportunities, and solutions both now and in the future.

But today, how often do your staff resort to picking up the telephone — a technology well over a century old — to talk to a pharmacy? Telephone calls to pharmacies are probably a metric most of us aren’t even tracking. It would point out how far we have yet to go in moving from a 20th Century, tedious, error-laden mode of communication to true interoperability of medical records.

Consider these achievements of technologists and imaginative executives

  • Space X can return a reusable rocket body to a precise pin-dot in a desert or even to a ship on the ocean, and successfully land it.
  • You can (mostly) relax while your Tesla drives itself in rush hour traffic through Atlanta’s clogged expressways.
  • We can use our voices to tell Alexa to set up a subscription shipment for toothpaste, never run out, always know when the next tube ships, and track the shipment precisely.

But successful networked communication among a pharmacy, medical staff, a doctor, and a long term services and supports organization? All too often, for organizations not focused on reinventing communication, it’s still a kind of sci-fi Shangri-la.

It shouldn’t be that way. It doesn’t have to be that way.

Long Term Services and Supports Executives Face a Minor Mountain Range as they Lead their Organizations toward the Promised Land of Interoperability. 

We wouldn’t even have to imagine a flying car, humanoid robot, 3D video future to feel that optimistic excitement that technologists like to inspire at Las Vegas’ annual Consumer Electronics Show.

We’d be gasping in awe and weeping with joy if a Steve Jobs strode across a stage and demonstrated a networked medical communications system that simply worked for everyone concerned in a user-friendly way.

In that promised land a night nurse, finding a patient that has experienced dizziness, could use secure software on her smartphone to document the side effects for everyone who needed to know. The client who experienced the dizziness would immediately have access to a record of it. So would the pharmacist, the doctor, the doctor’s nursing staff, and facility nurses on other shifts. All right there in one system.

Of course, that level of easy, organized information sharing is routine in investing, in AirBnB rentals, in ride-hailing services.

It’s routine in real estate. If you’ve bought a home lately, you’ve seen the sci-fi efficiency of real estate document production, sharing, signing of all parties, and storage for easy retrieval.

It’s also routine for shoppers at Target or Publix, to name two examples. They can open a webpage to find if a certain brand of ketchup is in stock at a specific store, and on which aisle it’s located.

It’s routine almost everywhere, except in medical records.

Why? What can be done? And what is being done?

HIPAA’s Mythical Barrier to Interoperability

One big reason is misplaced fear and misunderstanding regarding HIPAA.

We should fear to commit HIPAA violations. That’s the whole point of fines, after all. $50,000 per violation is tough. (Source)

Even more important than fines, we should fear a lack of integrity or competency.

But HIPAA isn’t a barrier to interoperability. It’s a system of highways through the mountains. A mountain highway should be the object of healthy fear. If you violate traffic laws or make a mistake on a mountain highway, there are obvious consequences. These include speeding fines as well as the more natural ones of, say, driving off a cliff.

But that highway, like HIPAA, is useful and necessary to reach our destination. It’s designed to get us there if we pay attention to the rules, the map, and the opportunities. HIPAA is specifically designed to facilitate getting us to our destination of interoperability.

Consulting legal and technical experts in HIPAA when designing medical information workflows is smart. We should do that because they’ll help us to see HIPAA for what it is: a codified, systematic, rules-based framework for interoperability and information sharing. Not a barrier. (Source)

Compatibility Challenges

Long term services and supports organizations also face technical compatibility challenges. These are just another version of the age-old challenge of Windows and Mac, iOS and Android, Word and RTF, 32-bit and 64-bit, etc.

Our compatibility challenge in interoperability is just one more instance. This system can talk to that system, but not the other. (Usually, yours or you wouldn’t notice it.) This database can interface with that one, but not the other. Compatibility challenges and opportunities have always been with us, and always will be.

So encouraging, right?

But it is: the great thing about compatibility challenges is that they have technical solutions.

Even better, they have shopping solutions. From our point of view as executives, the compatibility challenge has a shopping solution. And it doesn’t have to be expensive. Doing the homework of compatibility research is far more important than spending more money.

For one example, although of course there are others, iCareManager’s eMAR service interfaces with more than a dozen pharmacy systems, providing a pharmacy portal, physical portal, secure individual and group messaging, and more.

How many pharmacies and doctors’ office systems does an eMAR application integrate with? That’s a key metric when shopping for a solution. The more the merrier, of course.  (“Integration” is simply a software industry term for the ability to interface with another software application.)

Workflow Challenges

The change from paper-based serial communication in medical administration records (MAR) to electronic, complex networked communications is not merely more efficient. It’s transformative.

It goes far beyond the speed of transmission. It’s not just saving paper and money. We don’t even yet fully comprehend all the possibilities and opportunities that it offers.

You can see the nature of this transformation by comparing newsprint communication from 1985, say, to social media communication in 2020. That’s a frightening comparison, given the lawless nature of social media.

But in a rules-based, codified, legally-enforced environment, the opportunities are immense, and the dangers are minimized. That is the environment in which eMAR and other medical communications are growing. (HIPAA makes this possible, as we’ll see shortly in this article.)

Transformation is the truth. It’s here. We’re beyond fax and phone now, and it’s a good thing. And this truth calls for designing new workflows from the ground up.

Designing a new workflow, while continuing the work which can’t be interrupted for even a dose, is a significant challenge. The most exemplary such new designs are those continually reinvented all around us in the retail sector. Leaders in long term services and supports can learn from retail giants who re-invented workflows on the fly.

Take for example Walmart. It was in danger of dying amidst Amazon’s disruption like so many other formerly great retail giants. Only the radical embrace of new technology and new workflows allowed Walmart to transform from a last-century brick-and-mortar business to a thriving 21st Century e-commerce giant. New workflows allow Walmart to now offer in-store pickup, inventory checking, third-party sellers, innovative home delivery, and always lower prices.

We can innovate in our organizations by asking the right questions. And the first question is: “What ideal user experience can we imagine?”

The second question is this: “How can we creatively use the networked, transformative software tools available to us in order to create that ideal experience?”

Just as Walmart focused on customer experience to reinvent workflows, we must find ways to innovate. We must reimagine the ideal experiences for the people we support. Then we must creatively use software and systems already available to us.

If we don’t innovate, then our competitors will. These competitors may come from unexpected quarters. We’ve all watched with some astonishment the number of industries and companies already disrupted and improved by Amazon, Salesforce, and Uber, to name only two absolutely new, but overwhelmingly powerful competitors in various industries.

In 1995, who expected Amazon (in the form of its spinoff Blue Origin), or some other startup (SpaceX), to compete and win against NASA?

Or, more down to earth, who in 1995 imagined Amazon would own and vastly improve a high-end grocery store chain? You’ve seen the result if you’ve shopped at a Whole Foods lately.

And so now that we have seen what technology and imagination can enable, in 2020 it’s not difficult to imagine Amazon venturing successfully into almost any industry which could stand to be improved.

We don’t live in a walled garden. And that’s a good thing. There is an enormous opportunity for improving our user’s experience, and for increasing efficiency and quality.

The Next Horizon: Universal Connectivity

Another challenge we see when it comes to interoperability is the proliferation of devices and endpoints of communication. If we’re managing a person’s medication, we need to do it no matter what device they and their support staff are using. Many devices are living in our information ecosystem: company and private computers, phones, smartwatches, Internet-connected medical devices, with robots already on the horizon.

There’s only one realistic solution for the next few years — possibly decades — and we’ve already seen it in retail.

This solution allows a massive amount of information-sharing among hundreds of retailers, billions of consumers, all facilitated by multiple third-party developers creating shopping databases (Google Shopping for example), payment gateways, marketplaces (eBay, Alibaba, Amazon), automatic price drop alerts, inventory tracking even for the consumer, and so on.

These didn’t and couldn’t have been achieved by a single provider. Nor will eMAR interoperability be achieved by a monolithic system from one provider. That simply is not going to happen. And it shouldn’t happen, even if it could. It would be too much power and not enough creativity for one provider.

The solution also isn’t what’s too often happening today — individual long term services and supports organization piecing together software systems, then futzing around trying to connect them to their strategic partners. That results in high levels of frustration and expense as staff members try to get those systems to work with pharmacies and doctors’ offices.

Pharmacies and doctors’ offices and other organizations will always have a wide and ever-changing variety of software systems. Our organizations can’t possibly keep up with all the jury-rigging necessary to make our systems talk to theirs. And sometimes it’s simply impossible. Our staff is medical professionals. We shouldn’t ask them to troubleshoot software and find workarounds.

The Solution: We need “diplomats” who speak many languages

The solution is choosing a good fit from among the third-party ecosphere of software companies such as iCareManager.

The agile, highly competitive companies in this third-party ecosystem have the flexibility, the investment capital, and motivation to program and maintain multiple integrations.

They specialize in integrations.

Integrations are essentially the abilities of a software suite (say, an eMAR module) to connect seamlessly with multiple end-use systems — for example of pharmacies and doctors’ offices.

An eMAR system which has integrations is like a diplomat who is absolutely fluent in multiple languages. Communication is the key to delivering more and more ideal experiences for people supported by long term supports providers.