Health data and CX: Reaching the ideal state

In my first two blogs on Health Data Interoperability (HDI), I highlighted the importance of HDI in helping government health agencies become data-driven for better decision-making and better outcomes. I followed that up with strategies and practical steps for making 2023 “The Year of HDI."

Industry-wide HDI will improve patient access to their health data, provider access to health data of the patients they are treating, payer access to information related to providers, and other payers and the landscape of prior authorization. It would prevent the nightmare of the surprise billings because all parties contributing to the procedure—anesthetist, surgical assistants, radiologists, etc. —would have been involved in the HDI transactions. The result: full cost transparency for the patient in advance of the procedure and, presumably, less unpaid medical debt.

HDI is equally about reducing provider and payer burden. The high cost of healthcare today is due in part to the difficulty of exchanging vital information about care, providers, costs, insurance—and the laborious, sometimes redundant efforts to overcome those difficulties.

Better customer experience is the goal

To meet these two objectives, health agency CIOs and CTOs need to transform their organizations’ approach to customer experience (CX)—that is, the experience of health agency constituents and employees in using health data. After all, the main purpose of HDI is to improve patient care by putting the patient at the center of their healthcare experience. Through the process of Human Centered Design (HCD), a “user journey” is created, identifying all the ways users interact with all parties to their healthcare, defining those interactions into use cases, and ensuring that all the different processes are included in a system’s design.

So what is the best way of reconciling these needs and objectives? What is the best course of action for federal CIOs and CTOs, specifically those focused on healthcare, to ensure a significantly improved CX—one that’s enabled by HCD and facilitated by Organizational Change Management (OCM)? And further, how can that CX evolve as swiftly as possible so all parties—providers, payers, patients, and policy makers—can enjoy its benefits?

The answer is culture. The culture of the organization needs to make its mission to listen, understand and take action to improve, not just the customer experience but also the employee experience, and implement the technology and processes needed to do so. The culture are the actions and behaviors desired, and they need activators and enablers to help the culture stick. There are a wide variety of enablers. They include new platforms for the public-facing presence, enhanced solution development capabilities through SAFe® agile and software factory approaches, and implementing and enforcing governance on design pattern libraries that build reusable frameworks. These efforts bring adaptability to align with ever-changing user journeys in rapid fashion.

At CGI, we have a saying: what gets measured gets done. We recommend analytics and survey tools to track and analyze qualitative and quantitative metrics that shine a light on behaviors.

How CX and HDI interact

Combining the CX capabilities, born out of culture improvements, with HDI enables an organization to be ready for the coming HDI requirements. HHS is providing leadership in setting standards, working hand-in-hand with commercial developers, in an iterative process of rules proposed by government standards groups, followed by industry review and response and, ultimately, final rules with implementation deadlines. The latest set of rules for building standardized APIs that allow for more secure data exchange target HL7 FHIR. It combines the best features of previous standards into a common specification and further transforms how healthcare data is used and shared, and is proposed to be implemented by 2026.

These are significant undertakings, but the desired outcome of better health through high quality and informed healthcare is vitally important to our country. By adopting HL7 FHIR using the US Core and SMART application launch framework implementation guides, the CIOs and CTOs help health agencies achieve the mission of improving the quality health care and the efficiency of its delivery.

To be sure, it’s an evolution. The ideal HDI system would ensure that electronic health data is shared securely and rapidly as needed among all appropriate parties and through all necessary channels. All parties would have a full picture of the patient’s healthcare ecosystem, and payers and providers could all communicate seamlessly with one another. While that ideal may be a long way off, any progress can have a tremendous effect on the quality of healthcare and the cost-effectiveness of its delivery.

That is why rapidly evolving HDI capabilities requires contributions from all parts of the organization with full-throated leadership from the top. In addition, it also requires the support of an OCM initiative. OCM enables collaboration across all parties, raises awareness and better defines the path forward so that acceptance of changes moves the organization forward and increases the prospects of mission fulfillment.

Learn more about CGI Federal's healthcare services here.