Sunday, June 21, 2015

CODA's Interop Narrative Project

The power of narrative is essential to the alignment required for shared understanding.

Over and over, experts agree the problem with interoperability “isn’t the technology, it’s cultural and social, 'human engineering,' not computer hardware and software engineering.” Yet we persist in focusing on technology and technical standards, expecting different results.

It’s time for a smarter approach, building on work being done by organizations and individuals in communities across the country to improve the quality of care, enable delivery system transformation and payment reform, conduct research, and empower individuals through access to their own data.

Through a carefully-structured, nimble process, CODA will build a set of narratives that all illustrate cross-boundary, multi-sector, multi-organization, multi-disciplinary coordination and communication requirements. That process itself, like CODA, like the Learning Health System, is iterative and agile. It begins with the people gathered together at the 10th Annual Stewards of Change Institute Symposium, as we start to compile the stories, personas and actors implicated in the cross-sector narratives.

We will continue it via the Collaborative Health Network and other in-person convening opportunities, such as the Medicaid Enterprise Systems Conference in August and the Strategic HIE Collaborative's first Annual Meeting in September. (Speak up if you would like to host a CODA-conversation to consider cross-boundary narratives from the perspective of your organization, association, or constituency! Simply use the contact form on the right side of the blog.)

What goes into these cross-boundary narratives? What are they about?

Consider the requirements for coordination of care and services necessary for each of the following examples:
  • a child in a state's foster care program
  • a family with children with special needs
  • an adult child of aging parents facing multiple healthcare needs
  • someone leaving the corrections system
  • an individual on a clinical trial
  • an active duty or retired service member using DoD Health, VHA, and private sector providers

CODA's Interop Narrative Project takes those scenarios and asks:

  • Where do you and your organization fit into those narratives? 
  • What are your stories? 
  • What business requirements do you have? 
  • What services do you need?
  • What services can you support?
  • How do your requirements and your offerings map to the needs of others in the LHS? 
  • Do you see yourself and your story reflected in others' stories?
Only after defining common ground will we turn to discuss the enabling use cases and standards, which then leads to a conversation about what governance is necessary to ensure the communication requirements of the narratives can be met.

CODA is not starting from scratch! There is a rich body of work on these types of narratives and the personas that populate them to draw upon. We also have the tested, operational model of the Michigan Use Case Factory, which we'll be adapting to provide structure to the Interop Narrative Project process.

CODA simply seeks to leverage and align that work, using it to inform what needs to be included in the Declaration of Interdependence of our shared commitment to transparency, accountability, and aligned effort to create the "coordinated governance process" ONC has challenged us to devise.

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