As we have discussed previously, interoperability is the foundation to build a collaborative care structure where the individual receiving care is at the center of a sphere of care providers that are communicating and sharing data effectively. Sharing healthcare consumer information though systems such as the electronic health record (EHR), case management and managed care enables an individual to transition from discharge with one provider to admission with another, and yet still enable each provider to have a comprehensive view of the whole person in front of them.
Why is interoperability so critical? Because to build a complete view on the healthcare consumer, you need to aggregate, normalize and share healthcare data from multiple care providers in the continuum. This means data coming from different applications, different vendors, and even home-grown systems. The need is ever-present to create longitudinal care records that not only to meet immediate care needs, but to drive strategic health measures such as population health initiatives.
Why Service Oriented Architecture is a sold strategy for successful interoperability
Interoperability was attempted in the past by trying to synchronize data between disparate systems. The advantage of Service Oriented Architecture (SOA) lies right in the name. By delivering data as a standardized service (not proprietary), it is synchronized for use across applications and completely different healthcare organizations. Users no longer need to switch between systems to complete a workflow. And processing capability can be increased without the purchase of expensive, “best of breed” systems.
SOA unifies care givers, processes and systems across multiple healthcare organizations in a single comprehensive view. That delivers the agility to change direction quickly if an individual’s current status changes. Information can be tailored to meet the needs of different practitioners to drive value-based care and make sure that no one needing either physical or mental care falls through the cracks.
Why we use SOA
We use an enterprise-level certified electronic health record and a case management system to build collaboration and coordination for our own clients. We leverage SOA with these technologies because it connects disparate systems to enable health and social services organizations to improve communication, optimize care plans, integrate eligibility determinations, eliminate inefficiencies and reduce administrative burdens.
With a central database linking multiple systems together, a care provider gains a 360-degree view of client information. While every agency has unique processes and requirements, through SOA we can utilize a platform that can be molded to work across every organization to maintain complete visibility and real-time information to really make a difference in outcomes and the lives of healthcare consumers.
Strategy for SOA Success
Microsoft recommends a “middle-out” approach when trying to develop SOA architecture to enhance interoperability. They cite the limited success of the bottom up method of developers trying to develop a solution on their own, and they point to the massive investment in time and resources of taking a top-down approach. By the time an SOA project following either of these paths is tried the solution might no longer map to care needs. Microsoft instead supports SOA deployment by clearly defining care needs and business drivers, and taking an incremental, iterative approach to SOA to meet these goals.
Microsoft states that the goal of any SOA project should not be to rip and replace the entire IT infrastructure. The focus should be on connecting vision with software while the vision is still relevant.
A great time to think about interoperability
Two pieces of legislation have been introduced (S. 1685 by Senator Rob Portman R-OH, and S. 1517 by Senator Sheldon Whitehouse D-RI) that both have the same goal: to add psychiatric hospitals, mental health treatment facilities and substance use treatment facilities to the types of entities that may receive incentive payments for meaningful use of electronic health records. With this type of potential funding on the horizon, enhanced interoperability can be within the reach of every care provider. Segmented care may finally be a thing of the past, if more institutions, clinics and agencies start to think of interoperability as a core requirement in any technology initiative. The result could be an exponential improvement in outcomes for the healthcare consumer.
 Microsoft Dynamics, “Enabling a Real-World Approach to Service-Oriented Architecture,” Microsoft, (November, 2009), http://www.microsoft.com/dynamics/en/za/soa.aspx
 Rebecca Farley, “Behavioral Health IT Coordination Act Introduced,” National Council for Behavioral Health, (November 14th, 2013), http://www.thenationalcouncil.org/capitol-connector/2013/11/behavioral-health-coordination-act-introduced/