Faxes should have gone by the way of smoke signals. In, The Fax of Life, the author suggests that faxes are the cockroaches of healthcare: Despised by all, but, they thrive in a poorly designed healthcare environment. Faxes still dominate communication between disparate entities in the healthcare food chain. The dream of creating a longitudinal record for the senior with all related information, remains a distant dream. While the barriers could be largely economic, social and even political, technology implemented the right way can provide a path to success.
Let’s examine the underlying methods by which data is stored and exchanged between systems:
ACID vs. BASE Data Interoperability:
Databases with ACID (Atomicity, Consistency, Isolation, Durability) properties have been around for a while. They allow transactions that guarantee data validity even in the event of failures and errors. However, scaling such a system distributed across organizational boundaries is going to be difficult as it requires very tightly coupled systems. This will be impractical for most scenarios in which organizational and business boundaries exist.
A more practical approach to scalable data exchange across boundaries is to use a BASE (Basically Available, Soft State, Eventual Consistency) system that provides “Eventual Consistency.” This philosophy has even been applied at the organizational level by companies like Netflix to promote a “Highly Aligned and Loosely Coupled” culture and accelerate scalability and growth in their organizations. Similarly, this Eventual-Consistency approach provides scalability for data interoperability across enterprises which need to be highly-aligned and loosely-coupled.Technology implemented the right way can provide a path to success! Click To Tweet
The tradeoff with Eventual-Consistency is that data consistency can take time to converge (usually milliseconds to seconds except for failures). This is sufficient for most of the data that flows between healthcare systems. However, in a case where a data element (e.g. critical change to medication) is linked to a patient’s safety, it becomes necessary to provide an alternative that guarantees data-integrity or flags system unavailability. In such a case, it might be better for the physician creating a change-order to know if any of the systems are unavailable. For example, it might be preferable for the order to fail and force the physician to call/connect with nursing staff to alert them of the upcoming change. Business analysts are required to work closely with engineering teams to provide the right application-driven guidance for data exchange depending on the use case.
Such a system of checks and balances provides a practical approach to scalable interoperability across large distributed systems in healthcare.
MatrixCare’s CareCommunity™ leverages the methods described here to provide a scalable platform that overcomes the challenges of coordinating long-term care in multiple settings by collecting information from electronic medical records and other sources across provider and care setting boundaries. It routes key information to the right care team member at the right time, so that all caregivers—from doctors and pharmacists to patients and family members—can make decisions and coordinate care in real time through a single access point.
Dare we dream of a day that faxes will be eliminated from our healthcare infrastructure due to innovative ecosystems like MatrixCare’s CareCommunity™? Yes, and we believe it’s coming soon!