In healthcare, many patients are moving through a variety of clinical workflows. Their information is being created or collected every hour of every day, and many professionals need to consider data from multiple sources in the moment in order to perform daily responsibilities. Software supports these facets of care in different ways.
More and more health executives refer to workflow software — like electronic medical records (EMRs) and their many modules, staffing and other systems, as well as software on diagnostic machines — as “Level 1.” This category serves specific workflows and organizes the information within them. What’s known as “Level 2” software builds on this by connecting the dots across silos to serve use cases that are only possible within that full context. Put simply, Level 1 software is vertical, whereas Level 2 is horizontal.
Defining terms
Before we can understand Level 2 software, we have to more fully understand Level 1. Its purpose is to support care processes, such as receiving and processing lab specimens, scheduling patients in the operating room and registering patients who have arrived in the emergency department — and then recording their orders, results, therapies, progress and so forth.
In hospitals, there are dozens and dozens of workflows that existed before there were any electronic information systems (“workflow” being another way of saying “process of care”). Over time, software replaced paper, first in single-workflow systems like computerized physician order entry (CPOE) or lab information systems (LIS), along with two dozen more, which eventually combined into EMRs. These all fall into the category of Level 1 software, because they handle specific specialized workflows (think of it as one stovepipe that only carries certain information about a process of care). These essential technologies keep information tidy and organized in their context, and this first level of organization is vital to modern efficient care but has the downside of creating islands of data that don’t easily combine in a given moment.
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Care facilities need more than just Level 1 software
The problem begins when a decision or prioritization algorithm requires immediate information from multiple Level 1 workflow software. A patient’s lab specimen’s progress fits neatly into one stovepipe, for example, but what if we need to know that a patient with a likely discharge this morning is going to a skilled nursing facility (SNF), and their lab results will be back in the next 45 minutes? To manage that, we would need data from four stovepipes, and therein lies the limitation of Level 1 systems. For that use case, and thousands more, a new type of software is required — one that connects these dots outside workflow system in real-time. Only with that combined information organized constantly (which is easier said than done) can we build horizontal real-time optimization algorithms.
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Level 2 software does new things with data, like prioritization, synchronization, spotting risks and finding patients to manage for any number of specialized caregivers. This is particularly useful for activities like discharge planning, which benefits from using pharmacy, lab, physical therapy, occupational therapy, surgery and flow sheet data in advanced ways.
Level 2 also helps with risk management. To derive that there may be a risk with a patient, you need to connect data from various stovepipes like lab results, medication and the patient’s whole health history. Orchestrating the daily ballet between all disciplines of acute care can only happen using Level 2 software, and the ultimate benefit for patients is faster care, faster diagnoses and higher compliance with protocols, which leads to better outcomes.
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Getting data out of stovepipes
With Level 2 software, it’s a challenge to get information out of stovepipes and maintain integrated and horizontal data models in real-time. Though this is a complicated task, it’s not impossible — it’s been done, and more firms are working on it all the time. For users, the difference between activities in stovepipes and activities across stovepipes should be seamless: The information should match and be easy to access.
The best ways to implement Level 2 software
To use Level 2 software, you should first form a cross-functional team with heavy front-line representation to evaluate it. This is important because the limitation of Level 1 software is not always obvious to those who don’t know it well. A report that’s generated once per day may seem useful to a senior executive, but to a charge nurse, information that is more than a few minutes old becomes useless quickly. Thus, the real operators who understand the information context and know the true day-to-day operational realities should be the loudest voices in the evaluation.
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Software ultimately helps free up time
Importantly, the first benefit of Level 2 software is to save caregivers’ time, which is precious. Take multi-disciplinary rounds as an example. While they take many forms, a key component is to review each patient’s holistic status with the whole team quickly, perhaps less than 45 seconds per patient. Such coordination is only possible with real-time cross-silo information.
To illustrate the point, consider a scenario wherein a patient is going to a skilled nursing facility, but that particular facility requires a physical therapy note written within the last 24 hours to ensure that it’s a good fit. Determining if such a note exists can take a minute in the EMR. That single question bogs down the process.
Software is essential for streamlining daily workflows
This is one example (out of thousands) of how Level 2 technology allows teams to see the situation, notice risks and take the next steps immediately, instead of searching multiple places and waiting. In a field where seconds are so valuable, this is essential for improving workflows, helping patients and making the lives of caretakers easier.
