IDN Software - Sense or Nonsense?

Most of these solutions also exchange information with pharmacies, laboratories and primary care facilities, usually based on the Dutch OZIS standard. And within the near foreseeable future, a national exchange (Nictiz) will be in place to further facilitate data exchange.

In many industrialized countries outside the Netherlands, similar progress has been made in automating physician practices with electronic medical records, and with standardizing the exchange of data between the various choices.

It’s been a long, difficult road to get to this point. Most physicians vividly remember the ‘trials and tribulations’ that went along with implementing a small practice EMR. But we’ve come a long way. Still, you often hear the complaint that there are way too many choices out there. Nonsense, if you ask me. As long as these EMRs provide a means to exchange data via open standards I don’t see the problem. Let the market sort itself out.

One of the more recent developments is the trend for physician practices and care institutes to move towards “integrated care delivery”. Integrated care delivery has far more requirements around exchange of information between medical professionals and patients. Additionally, it often puts a strong emphasis on the ability for patients to participate in their care process via patient self-management functionality. This has led to the development of a new category of software solutions: Integrated Delivery Network (IDN) systems. Some physicians are not too excited about this development; they’re not looking forward to having another system to deal with, especially if that will result in duplicate data entry.

They make a valid point, these nay-sayers. It would indeed be a step in the wrong direction if the same data has to be entered in more than one location, or if the physician’s EMR no longer captures all data needed. Fortunately, that situation can be avoided. A new generation of IDN systems is starting to offer full support for bidirectional data exchange with small practice EMRs. This means that physicians can now have all required data in their EMR, while at the same time supporting the specific needs for participating in care delivery networks with their IDN systems. Still, many physicians wonder if they really need such a system. “Just make sure you keep meticulous record of your chronic disease patients in your current electronic medical record solution, and generate accurate and concise reports based on this information. What more do you need?”

Well… that’s not quite right. It’s just a start! I’ll summarize five reasons why an IDN system is a must for every care group that wants to get serious about integrated care delivery:

1) Integrated Care Delivery requires protocol based care, often delegated to a nurse practitioner. This requires structured data entry, including direct feedback to both medical professionals and patients. Some of the small practice EMRs do a fairly good job in this respect, but most don’t. So what to do? Replace your EMR? Wait for them to evolve? Or start using a well designed IDN system that is optimized for integrated care delivery.
2) Integrated Care Delivery requires close cooperation within a care group. The reality is that often, different EMRs are being used within a care group. How can you work together efficiently with different EMR systems within a group? How can you ensure that all participants follow the same protocol? What to do with e.g. claims processing on group level? And what about group level reporting? Perhaps it is better to all standardize on one EMR, and put an IDN system on hold for now? Fortunately, that is not necessary. A well designed IDN system has an open integration strategy and can be made to work with multiple EMRs, so you can start now with integrated care delivery.
3) Integrated Care Delivery is not just for physicians. It requires optimal cooperation with the network, for instance with therapists, specialists, laboratories and pharmacies. Each participant needs access to information that is relevant to them, and should have the ability to share that information as needed. A well designed IDN system fully supports such an environment.
4) Integrated Care Delivery treats the patient as an active participant in the care process. This means that the patient should have online access to relevant portions of their medical record. Many physicians are not too keen on giving patients direct access to EMR data, never mind allowing them to add their own data. Whether that is good or bad is another discussion, but either way I can understand their position. But there is a middle road. A well designed IDN system can provide patients with secure access to relevant data in the EMR only.
5) Integrated Care Delivery is a continuous learning cycle. Over time, more and more data is added to the system in a structured manner. Protocols will be adjusted based on outcomes. Complex patients with multiple, co-morbid diseases are monitored in an integrated manner. A well designed IDN system fully supports this changing environment.

In each of these points I am talking about a “well designed IDN system”. Truth be told, not every IDN system can make that claim. But there are several options out there. At VitalHealth Software, we’ve gained a tremendous amount of experience over the past three years. We have received input from both patient and impatient users alike, each finding it worth their time and effort to share their experiences in integrated care delivery with us. We feel we have reached a level of maturity due to the tireless efforts of these volunteers and our developers. The result is an IDN system that fully supports each of the five issues I discussed earlier.

Any care group that plans to start with integrated care delivery without a suitable IDN system is asking for a major headache. The time is here and now to equip these care groups with a well designed IDN system.