The Patient, Interoperability and the Quintuple Aim

This post was originally written for the 2020 HIMSS Interoperability Showcase.

At the age of 95, my Great-Aunt B is as spunky and spry as they come. While she never had children, she’s always been very proud of her extended family—excited to dole out attention and then retreat to her all-white-everywhere apartment, free from the sticky fingers of little babies.

Never one to hold back how she really feels, her idiosyncrasies are adored—only wearing black and white; picking out the specific pieces of asparagus she wants, rather than the bunch at the grocery, or announcing “So, is this the one?” any time a non-family member attends a family gathering.

As she’s aged, my family has ensured she is properly cared for. Her nieces split the duty of her care, arranging appointments, providing transportation, accompanying her, checking in on lab work and results, explaining next steps in terms she can understand, and ultimately helping her make decisions. Even as an extremely opinionated and with-it individual, she relies heavily on her nieces to navigate today’s complex healthcare system.

Elevating Patient and Caregiver Involvement

My family is certainly not alone. With an aging population, the reality of healthcare today is that many patients rely on families for assistance in accessing and understanding their care. Yet, the patient is the only constant across care settings and providers; while the provider and patient-accompanying caregiver may change, the patient has a front row seat to their care the whole time. When patients can’t recount their care, or advocate for themselves, how do we account for that in our healthcare system?

Working in the healthcare industry, we hear about the Quadruple Aim all the time: decreasing the cost of care, increasing care quality, improving population health and ensuring a better working environment for healthcare providers and staff.

More recently, the Quintuple Aim has been tossed around. I know you may be thinking, “How many aims can we have?”— but the quintuple aim calls out a specific piece somewhat missing from the others: the patient.

The Quintuple Aim elevates patient engagement and the experience of their care to the same importance as our other agreed-upon aspirations for our nirvana healthcare industry.

As we evolve our healthcare delivery system, it’s important to consider the Quintuple Aim as our new beacon for improvement. While we’ve made strides in patient access through portals and other means, what about care across organizational boundaries? Patient and caregiver involvement is critical, not just in siloed experiences, but especially in interoperability.

Interoperability and the Patient

When patients are informed and involved in their care, they can inform providers of previous care, adverse reactions and relevant family history. But when the patient is not a reliable informant, interoperability is crucial for providers to update other providers.

360 Exchange, and Integrating the Healthcare Enterprise standard most frequently referred to as 360X, centers on the idea that closing the referral loop can facilitate improving quality of care by providing relevant information to other providers, as well as ensuring the referring provider is briefed on the care of the mutual patient once complete.

For patients, their referring provider pushing relevant information to their next provider sets the patient up for success: the patient attends their appointment and the provider has the foundational data they need from the get go, saving time and allowing the provider to focus on additional important aspects during their appointment.

Once the visit is complete, the provider pushes information back to the referring provider, closing the loop, sharing information on the mutual patient to then decide next steps of care. Knowing all parties are properly informed is the hallmark of 360X.

Full Circle

For the many patients like my Great-Aunt B, closing the referral loop offers my family an opportunity to be more confident in her care. My aunts and Mom don’t have to share a physical binder to keep track of what happened when or fear something will be missed among differing providers. 360X and the promise of a closed-loop among providers ensures the patient is at the center of care, aligned with the quintuple aim. It also ensures that providers are properly informed for the best delivery of care and that patients like my Great-Aunt B gets the care she needs.