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December 19 HHS Press Release and BlogposiumChallenges:
§ General
– Lack of trust and accountability
– Politics – finding “neutral” ground
– Pride of ownership
– Fear of loss of advantage
– Maintenance of interest and buy-in
– Individual stakeholder priorities
– Costs
– Motivation
§ Business / Policy Issues
– Competition between stakeholders
– Consensus of common policies and procedures
– Consumer privacy concerns
– Transparency of process
– Uncertainties regarding liability
– Difficulty in reaching multi-enterprise agreements for exchanging information
– Decreasing debt capacity
– Return on investment
– Governance and leadership
– Sustainability
– Costs –Financial and personnel – especially for Small/Rural providers
– Physician and payer incentives
– Economic Factors
§ Technical / Security Issues
– Interoperability among multiple parties
– Standards
– Authentication
– Auditability
– Security and legal issues
§ Internal to the Institution / Network
– Competition for resources
– Dilution of Effort: Project competing against other pressing needs
– Preservation of previous investments
– Increased cost of IT (perceived or real)
§ External to the Institution / Network
– Security – Data & Physical Resources
– Rights in Data – who “owns’ the data and who can make changes (tracking changes)
– Reliability of Data – potential mismatching of patients & data corruption
– Linking Outside: Standards, reliability, controls
– Business Continuity: Destruction/Recoverability of critical resources
– Lack of Accountability & Control (perceived or real)
Overcome Challenges
§ Don’t allow the long list of challenges overwhelm you
§ Obtain buy-in from the highest level of each participating entity
§ Engage State leadership and leaders of healthcare organizations to continue to support dialogue/education on the issue
§ View challenges as opportunities for improvement
§ Identify effective leaders and “champions”
§ Identify financial incentives and provider investments in their internal systems
§ Identify funding sources for information technology and RHIN/RHIOs
§ Identify funding assistance for rural and small providers
§ Educate and communicate with providers and the public
§ Recognize opportunities
§ Recognize improved ease of inter-institution partnering
§ Identify the value and benefits that accrues to each participant
§ Establish standards
§ Leverage the efforts of the larger health systems – collaboration not competition
§ Reduce the number of barriers posed by state and federal regulations (HIPAA, Stark, etc.)
§ Adopt common terminology
§ Address adjudication of liability
Recommendations for Success
§ Involve major players in planning – CEOs, COOs CMOs, CIOs, nurse executives, legal, risk management/compliance, etc ~ avoid “one champion” or pure tech view
§ Ensure leaders of the RHIN/RHIO are accountable to the community, not their individual interests
§ Establish a shared vision and common goals
§ Plan for governance from the beginning
§ Keep patient and security and privacy of information at front
§ Identify all stakeholders and invite everyone to the table
§ Prepare stakeholders for real collaboration
§ Establish a mission and set measurable and achievable goals
§ Address governance accountability and sustainability concerns
§ recognize that discussion dialogue and debate are part of the process
§ Build trust
§ Plan some quick “wins”
§ Demonstrate value and quality, safety, and cost benefits
§ Share stories and data of success with the reluctant and encourage them to join the collaborative
§ Secure the services of an experienced legal firm and keep them informed
§ Address and implement the agreement structure early
§ Spell out all interface & data specifications in excruciating detail, and hold everyone to them
§ Communicate expectations and hold all accountable for their obligations. |
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