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Integrating Care: Moving Beyond Interoperability to True Collaboration, Part IV

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We’re nearing our destination! In this blog series over the past several weeks we’ve identified the importance of integration and collaboration as expressed through the impacts of severe mental illness (SMI). We’ve seen the practical use of applications like referral process automation. We’ve examined how standards-based transaction and data elements can provide visibility across systems into a patient’s well-being. In short, we have facilitated communication and the collection of massive amounts of powerful information about individuals and entire populations. So, what’s still lacking? Two words – expansion and context.

Let me explain.

The thing we need to expand is our very definition of integration. We can define integration by the ability to share information between organizations and across entire systems but that doesn’t ensure that the information is consumed or even that the data is helpful. A more helpful definition of integration consists of not only of having the ability to share information, it requires that the data is received and disseminated within clinical workflows that have been optimized to make the delivery of holistic care seamless.

Likewise, the data that’s being shared within a given clinician’s daily workflow has to have context. It’s not enough to know that a patient is experiencing co-morbid conditions. We must take a broader view. We have to ask, what social determinants of health are causing or at least impacting the co-morbid conditions the patient is living with? Social determinants can range from housing to family support. It’s only when we feed the physical, mental and social data into an easily consumable clinical workflow that we begin to fully realize the benefits of integration and true collaboration.

A given patient may interact with a vast range of services including education, justice, social service and more. Care providers and modalities must be assembled in the following forms: patient-centered team care, population-based care, measurement-based care, evidence-based care and accountable care.

Moving beyond interoperability to true collaboration is an audacious goal but the reasons to pursue this goal are compelling, the applications are numerous, and the technology and systems are available. If we collectively work to define integration is its fullest terms and to contextualize the data produced, we will have created a holistic care delivery system that produces far more positive outcomes and reduced costs.

 

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