Creating the Conditions for Safe Care: Interoperability Saves Lives Report

Written by Teri Price, Co-Chair of the Alberta Virtual Care Coordinating Body (AVCCB) and Executive Director of Greg’s Wings. 

Two things have been top of mind lately, the conversations we had about safe healthcare during Canadian Patient Safety Week, and the release of the Interoperability Saves Lives report.

Over the last 10+ years, we have advocated for a safe healthcare system, a system that can identify and learn from the cracks that many patients fall through. This matters to both the patients who receive care, and the providers who deliver it. This year’s Canadian Patient Safety Week focused on the need to shift away from just an absence of harm to creating the conditions for safe care. This distinction is an important one and many factors contribute to it –time, teamwork, appropriate incentives, access to information, a just culture, cultural safety, etc.

INFORMATION IS THE CURRENCY OF CARE – INFORMATION IS REQUIRED TO MAKE SAFE DECISIONS.

In the Interoperability Saves Lives report, Tim Murphy, Chair of the Health Data Interoperability Working Group and Vice President, Health at Alberta Innovates, states

“Data is the lifeblood of all health service, research and innovation, and the foundation of a Learning Health System.”

We also know that the ability to share information and communicate effectively is required for effective teamwork. Patients deserve to have care teams that can work together, and it is a safety risk if the team doesn’t have access to the information they need.

If we accept that information is required for safe care, then how do we design a system that enables the care team to access the information that they need? This is where interoperability can play a critical role.

THE IMPORTANCE OF INTEROPERABILITY

Interoperability is the “ability of different information systems, devices and applications to access, exchange, integrate and cooperatively use data in a coordinated manner to optimize the health of individuals and populations.”

One thing that we have realized – both because our own assumptions were challenged early on and through hundreds of conversations where we see others’ assumptions challenged – is that the current system does not easily enable the sharing of information.

There have been some steps in this direction, but we believe we need to build the ability for information to follow the patient throughout the healthcare system into the foundation of the system.

Current legislation focuses on privacy and security more than the need to share information. It spells out the responsibilities of organizations in keeping information private and secure but doesn’t outline the need to effectively and responsibly share it. This approach leads to silos of information and both technical and behavioural barriers to sharing and access. Many of the technologies that are used to store health records do not easily share information and the individuals who are utilizing them are trained to make sure they keep information private. We are in no way stating that privacy and security of health information isn’t important – it is critical – but in addition, we need to recognize the harm that is caused by not sharing information and the unsafe conditions that this causes.

BREAKING THE CYCLE OF OUR CURRENT SYSTEM: THE HARM FRAMEWORK

The Interoperability Saves Lives report includes a harm framework that outlines the harm that is caused by our current approach to information and the need for an intentionally designed health system that creates the conditions for safe care by enabling the sharing and access to information.

At the same time, many assume that the information they provide in an interaction with the healthcare system is shared between the members of the team who are diagnosing and making treatment plans. This can lead to frustration when patients are asked to provide the same information over and over or when patients inevitably don’t know to share information that may be important. The current system relies on individuals to be a conduit of information and expecting any individual to remember everything they are told in a hurried appointment when they are stressed and just want everything to be okay doesn’t work.

In addition to learning that there are a lot of assumptions made about our health information systems, we have heard many many stories about the extra work and fear that is caused by the fact that our health information system is flawed. From providers spending hours trying to find information, to the substantial time spent on workarounds to ensure that information is not lost due to tools and processes that are out of date (think fax machine).  We also hear about how much stress and fear providers feel because they are worried that they are missing something.

As stated in the report, interoperability isn’t just about the technology. We need to recognize that care is delivered by people and to create the conditions for safe care we need to set people up for success.

Ideally, when we get sick and seek care, we would be able to access and build a care team that meets our unique needs, the system would incentivize teamwork, our care team would have a teamwork mindset, and the information and tools they need to be a high performing team.

We also fully recognize that mandating interoperability isn’t a silver bullet, and it isn’t a quick solution.  This will take time. But it is an essential step, and we don’t believe that we will see the transformational change that our healthcare system needs without it.

Read the full Interoperability Saves Lives report.