Category 9 of 12

Multi-System Reconciliation

Integration connects systems. Reconciliation decides what happens when they disagree. These questions cover the difference and how reconciliation decisions should be recorded.

1. How do we connect EHR, accounting, workforce and CRM data?

   Connect them in two layers.

2. Does integrating all our systems create a single source of truth?

   No.

3. How do we prevent integrations from spreading incorrect data?

   Put a governance step between receiving data and sending it on.

4. What happens when integrated systems disagree?

   If nothing is designed for it, the integration’s technical rule decides, usually "last write wins," and the disagreement disappears from view.

5. How should data conflicts be surfaced to operators?

   Surface conflicts to the person who has authority to resolve them, in their normal workflow, with the competing values, sources, timestamps, likely cause and the affected decisions shown side by side.

6. Should software automatically resolve conflicting values?

   Software should automatically resolve conflicts only under rules the operator has approved, and it should record each resolution.

7. When should a human make the governing determination?

   A human should decide when no approved rule covers the conflict, when the impact goes over a set threshold, when the conflict involves clinical safety, regulatory reporting or money movement, or when the evidence is unclear.

8. How should reconciliation decisions be recorded?

   Record each reconciliation decision with the conflicting values and their sources, the rule or person that decided, the governing value, the reason and evidence, the time, and the decisions and reports it affects.

9. How can reconciliation rules be standardized across an organization?

   Keep reconciliation rules in one enterprise register, each with an owner, scope, logic and review date, and apply them the same way in every community.

10. What is decision lineage and why does it matter?

    Decision lineage is the record of how a governing number came to be: which sources supplied evidence, what disagreement existed, which authority decided, what was determined, and which reports, recommendations and actions then used it.