Collective Blog of Health IT
Beyond Clinical Data: Connecting Social Care Through Interoperability
Healthcare interoperability is often discussed in terms of hospitals, health plans, EHRs, APIs, and clinical data. But what happens when the information needed to improve someone’s health exists outside the walls of the healthcare system?
That question was at the heart of WEDI’s recent podcast episode (#262) with Kemper Tell, CEO of LACIE, the Lewis & Clark Information Exchange, a Kansas City-based 501(c)(3) organization serving Kansas and Missouri. LACIE’s community-based model focuses on connecting social and clinical care and addressing the challenges people experience in their daily lives—not simply what happens during a healthcare encounter.
Why Social Care Belongs in the Interoperability Conversation
For LACIE, interoperability is about more than moving clinical information from one system to another. It is also about understanding the circumstances that affect a person’s ability to access and benefit from care.
The conversation highlighted the importance of looking beyond traditional healthcare settings and recognizing issues such as food insecurity and other social needs. LACIE’s community-based approach grew out of the needs of the communities it serves, with an emphasis on addressing healthcare challenges where people actually live their lives.
Interoperability Requires Trust—and Partnership
One of the clearest themes from the conversation was that technology alone does not create interoperability.
Kemper emphasized that successful interoperability requires partnership and trust, and that the work needs to move at the speed of the people and communities being served. That becomes particularly important when data must move across organizations with very different missions, technologies, resources, and workflows.
The Missouri experience illustrates that challenge. The eLTSS effort involves health information exchanges, home- and community-based service providers, community information exchanges, and social care referral platforms. While technology is available to address many of the technical challenges, building the relationships and trust necessary for organizations to work together can be the more difficult part.
From Paper to FHIR: Moving From Concept to Reality
Missouri is implementing a digital health standard designed to replace paper-based consent processes for individuals with intellectual and developmental disabilities (IDD). The system requires signatures from providers, case managers, and individuals and uses HL7 standards to support better tracking within modern technology.
The implementation also demonstrates an important lesson about moving from a proof of concept to a functioning statewide program. Missouri worked with HCBS providers and used a phased “wave” approach to support the transition from the sandbox environment into operational use.
But technology was only part of the equation.
Funding and Supporting the Ecosystem
A significant challenge identified in the discussion was funding. Home- and community-based service providers often do not have additional resources available for technology initiatives, even when those technologies could ultimately improve coordination and outcomes.
The state’s decision to support both the HIE infrastructure and the EHR technology used by HCBS providers was highlighted as an important component of the implementation. Just as importantly, continued support after implementation was identified as critical to ensuring the effort succeeds beyond the pilot phase.
This is an important consideration for interoperability initiatives more broadly: successful implementation cannot stop when the technology goes live. Organizations need the resources, relationships, governance, and ongoing support necessary to make the technology part of everyday operations.
Could the Model Expand Beyond IDD?
The eLTSS model originated around the needs of individuals with intellectual and developmental disabilities, but the conversation explored how the approach could potentially be applied to other populations with complex needs.
Aging populations and individuals in foster care were discussed as examples of populations that could benefit from better connections between clinical and social services, particularly where state-funded programs such as Medicaid and Medicare are involved.
One of the potential advantages of the model is that expanding to additional populations could leverage the same underlying technology rather than requiring an entirely new infrastructure or approach. But scaling also requires maintaining the governance and trust that make interoperability work in the first place.
Rethinking What Interoperability Means
Perhaps the most important takeaway from the conversation is that interoperability is ultimately about people, not technology.
FHIR, APIs, EHRs, HIEs, and other technologies provide the infrastructure. But successful interoperability depends on organizations being willing and able to work together, communities having the resources to participate, and individuals receiving information and services in ways that actually support their needs.
LACIE’s experience demonstrates why the next phase of interoperability may require the industry to look beyond traditional clinical data exchange and consider how healthcare and social care can work together as part of a connected ecosystem.
The conversation with Kemper Tell of LACIE is available as part of the WEDI podcast series, available at www.wedi.org/category/podcasts