A measured approach to change: interoperability and the road to digital transformation

HITN: Interoperability has been the dominant topic of our Summer Conversations – perhaps because it’s integrated with so many other strands of digital transformation. Why do you think the pandemic has made it such a talking point?

Alessi: Well the pandemic has brought to light the issues around interoperability, or rather the symptoms that show how much we lack it. There’s an underlying malaise – we fix the symptoms every time they occur, but we don’t fix what causing the problem!

Why is interoperability so challenging? Well, it’s very difficult to see how organisations can come together when the income driver for healthcare institutions in Europe is still activity-focused. We’re asking people to ensure there is a level of interoperability when there is also an element of competition.

HITN: What do you think needs to change if we’re to fix the actual problems?

Alessi: Within healthcare, we still have the body-by-medicine concept, we still think of ‘people with cardio-metabolic disorders’, ‘people with diabetes and dementia’, ‘people with cancers’. We have all these separate streams, guidelines and processes, and getting them together is an incredible challenge.

There’s only one way to cut through this, and it’s to take a brave step to address the metrics that drive health and care, and to introduced elements of population health within them, slowly, deliberately and at pace. In other words, not immediately turning a switch and thinking a health and care system can suddenly pivot.

It will be in everybody’s interest to have interoperable systems, to manage non-communicable disease in a way that reduces the number of presentations and activity. Of course it’s difficult, but you need to signal where you’re going; start very small, but make the direction clear. Eventually, systems will start to understand that there is a chance of us overcoming these issues – which are going to plague us unless we do something about them.

HITN: Is it just the systems that have to change though? What about cultural attitudes?

Alessi: We’re seeing some pushback on digital transformation, that’s clear. A lot of clinicians haven’t chosen to move into digital transformation and telehealth overnight. To a degree, they were dumped into it because of COVID-19, so it’s inevitable that there will be some pushback.

We need to understand that and why it exists: very few clinicians have been trained in digital consultation, and we at HIMSS are doing a lot of work around trying to assist them – not CMIOs, not the converted, but the majority of jobbing nurses, pharmacists, clinicians, GPs, consultants, around the value of digital transformation to them and their patient, and how to use this.

Training to help them see the difference between face-to-face and digital consultations is notable by its absence. It’s disgraceful. I’ve seen courses which talk to clinicians about the importance of bandwidth. Of course the technology is important, but you need to know how to communicate and that’s what really matters. We call these soft issues because we don’t know how to manage them. I think this is where we need to concentrate in our thinking.

HITN: Then there is the patient – how do you think can we encourage citizens to see digital health provision as desirable?

Alessi: Exactly the same is true of the system/citizen relationship. Globally, I don’t think the process of blanket consent washes anymore. We need to become far more sophisticated – and because we are using digital technologies and modalities, to have a more blended approach with elements of face-to-face consultations.

People need to understand the value of this, the behavioural changes required – and that is about trust. Moving to a blend of digital and analogue means consent can be more dynamic. If you are in constant contact with a patient, there is no reason you can’t be asking them about consent on a regular basis on a particular issue, and I think that is the basis for the future.

I believe we should encourage people to start having more difficult conversations around issues of trust, and the barriers to interoperability – not what appear to be the barriers, but what’s behind them – and also defining that relationship between the healthcare provider and the population. Because in many respects those are going to be the big issues. We all, including vendors, have a duty to start these conversations.

HITN: Vendors won’t be enacting change, though. So where will the leadership come from within health systems, to drive consumer confidence in this blended world?

Alessi: I think that’s a really good question – and there isn’t a simple solution! Clearly the people who have the power to make those changes are the policymakers. In state-funded systems, that’s governments or insurers. But whoever is paying for the care needs to grasp the nettle of including risk reduction and an element of population health in the payment systems of the future.

The population needs to be exposed to these conversations so they can also drive change. At the moment, healthcare access can be a lottery, and I don’t think that’s acceptable. If people understand this, they will agree that it isn’t. This is a movement, and it’s something that everybody needs to talk about. We need an open debate about it. The more people hear, the more they will reach their own conclusions about where this should go. Leaving aside social responsibility, commercially it’s in vendors’ interest if they start to tickle populations and healthcare professionals about the importance of managing this.

HITN: But we often hear a negative side of population experience – how terrible telehealth is because people see it as an obstacle to GP access. Where is the touchpoint that will change that perception?

Alessi: Well for them it is terrible, because how does a person in their late sixties with dementia manage a digital conversation if they live alone? And it is sad that global health systems still think in terms of a binary approach. It’s either one or the other, there’s nothing in the middle. But it’s the middle we want to go to.

If we consider the most successful health systems pre-pandemic, they are the ones that were most connected to the populations. But the moment a pandemic starts, this falls apart because you have no co-ordination between services that are actually set up not to talk to each other. It’s the centralised systems that work better because you can dictate, mandate. But I don’t think the population would be too happy if this level of control continues forever. Hence you need to find a blend between the two – and that is digital transformation in action. 

Healthcare IT News spoke to HIMSS chief clinical officer Charles Alessi, as part of the ‘Summer Conversations’ series.

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