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In the wake of medical home certification, meaningful use, the Cures Act and the pandemic, it’s clear that virtually all of healthcare is now built on a digital foundation. EHRs are pervasive in the delivery system, and they are increasingly connected to practice management software, virtual visit and mobile capabilities, health information exchanges and population health platforms. As we consider the criticality of interoperability throughout this evolving digital ecosystem, I’m moved to reflect on the issue of interoperability in another time, the 1960s. 

A firsthand view of clinical practice 

As a child I had the opportunity to observe my father in solo pediatric practice. Sub-specialization was relatively new. General practitioners would come to him as a pediatric “specialist” to consult on their complex patients. There were no neonatologists, intensivists, hospitalists, or emergency physicians. He took care of his patients throughout their healthcare journey. If they needed surgery, he would follow them pre- and post-operatively along with the surgeon. In the office he and his nurse developed seamless workflows to manage patient care throughout the day. With house calls a routine component of the care model, he easily identified and assessed financial, social, and cultural issues that might impact his patients and integrated those assessments into his care plan.

Minimal regulation and a simpler business model 

Even as this clinical picture harkens back to simpler times so too were the business models and regulatory requirements. Ambulatory care was largely a cash business. Many still had insurance that only covered hospitalizations. Even for those with coverage of ambulatory care, the patient typically paid the doctor and filed a claim to get reimbursed by the insurance company. Medicare and Medicaid weren’t even signed into law until 1965, and then took most of the rest of the decade to get implemented. HMOs were rare and geographically isolated, there was no such thing as prior authorization, and HIPPA was three decades away.

Technology matched the need

In these simpler times, simpler technologies were sufficient to support interoperability needs. With so few hand-offs, face-to-face discussions and telephone calls for “sign-outs” worked just fine. Typewriters, carbon copies, and snail mail sufficed for formal sharing of assessment and plan in the referral process. Urgent or abnormal test results were delivered via a phone call to the ordering physician. In the absence of pagers and cell phones every doctor had an answering service that was kept informed of who was on call and how they could be reached, e.g., at home, in church, or at a restaurant. There was continuity of care stemming from less specialization, fewer sources of information, fewer providers in need of information, and a much simpler business model. Getting the right information to the right people at the right time was a fairly straightforward issue.                                            

Lessons for today 

In contrast, today’s healthcare is characterized by increasing complexity in every realm—clinical care, business models, regulations, and technology. Providers have historically depended on their own diligence to ensure they had all relevant information at the point of care. Given the vast and growing number of sources of information, continuing segmentation of care across time and specialties, and the rapidly advancing diagnostic and treatment modalities, it is no wonder that providers experience enormous stress related to information sharing. While great strides have been made to present meaningful information from other care settings to providers when and where it is needed, the sheer volume of data flowing across systems requires leaders and data engineers to be diligent about what information flows directly to the care team. At NextGen Healthcare, we are focused on harnessing the capabilities of our integrated EHR, health information exchange, population health management platform, as well as mobile and virtual technology. Providers can leverage our portfolio of solutions to collect, sort, and present this growing volume of clinical data to effectively and efficiently support their clinical decision-making

To learn more about NextGen® Healthcare’s interoperability solutions visit our website.

To delve deeper into the history of “interoperability,” check out our latest podcast.

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Dr Lustick

Dr. Martin Lustick

Senior Vice President, NextGen Advisors

Dr. Martin Lustick is a principal and senior vice president with NextGen Healthcare focused on supporting provider organizations in their successful transition from volume to value-based care.

Dr. Lustick earned a BA in History from Cornell and an MD from Columbia. After completing his pediatric residency at Children’s Hospital National Medical Center in Washington, DC, he was in clinical practice for 17 years with Kaiser Permanente of the Mid-Atlantic States. While there, Dr. Lustick held various management and leadership roles, including chief operating officer for the 800-physician medical group. He oversaw development of their hospitalist program, population health capability, and open access delivery model.

Dr. Lustick then served as chief medical officer for ThompsonHealth—a small health system in Canandaigua, NY—where he provided clinical oversight for hospital, SNF, nursing home, IT, and out-patient physician practices.

In 2005, Dr. Lustick assumed the role of SVP & CMO for Excellus BCBS which covers 1.6 million lives comprised of Medicare, Commercial, and Medicaid. In his 13+ year tenure there he led a variety of strategic initiatives, including a patient-centered medical home program which served as the foundation for the plan’s value-based payment strategy. He also led the implementation of an automated authorization program for care management services, development of a clinical quality improvement strategy, and creation of innovative programs in management of low back pain, screening and prevention, opioid addiction, and chronic disease management.

Dr. Lustick has also been very active in the community, serving on boards and committees confronting issues such as: healthcare capacity planning, Health Information Exchange, mental health, substance use disorders, social determinants of health, and childhood obesity.