Posts by :
The verdict is clear: Interoperability progress has been disappointing. Almost without exception, healthcare experts agree that the industry has fallen far short in its efforts to foster meaningful reform.
Consider these assessments in recent articles:
“We’ve spent half a million dollars on an electronic health record system about three years ago, and I’m faxing all day long. I can’t send anything electronically over it,” said Dr. William L. Rich III, a member of a nine-person ophthalmology practice in Northern Virginia. New York Times
“While most providers have installed some kind of electronic record system, two recent studies have found that fewer than half of the nation’s hospitals can transmit a patient care document, while only 14 percent of physicians can exchange patient data with outside hospitals or other providers.” New York Times
In its annual report to Congress, Office of the National Coordinator for Health Information Technology (ONC) wrote, “Electronic health information is not yet sufficiently standardized to allow seamless interoperability, as it is still inconsistently expressed through technical and medical vocabulary, structure, and format, thereby limiting the potential uses of the information to improve health and care.” Healthcare IT News
A recent study of 62 Accountable Care Organizations (ACOs) found that all of them experience at least some trouble combining data from different sources, and 88 percent said these integration obstacles are “significant.” Becker’s Health IT and CIO Review
One theme emerges from articles like these: Health care is making progress with adopting technology, but we’re frustrated that technology is not reaching its fullest potential.
Even competitor EHRs need to be interoperable
Solutions need to be able to share data with each other, even if they are from competing vendors or use different vocabularies, formats and semantics. Until clinicians can share information among disparate systems, the value that can be derived from any of them is severely compromised.
Over the past few years, the industry agrees on three main strategies that can help improve patient and population health, while controlling the spiraling cost of health care:
1. Coordinate care – to better manage conditions, close gaps and reduce duplicative services across care settings.
2. Engage patients – to improve compliance with treatment and wellness plans, and encourage more regular communication with clinicians.
3. Analyze data – to identify at-risk patients, enhance disease management, and improve both clinical and operational performance.
None of these foundational strategies will be successful if systems containing critical information are not interoperable. If healthcare providers and executives can only see a portion of the information available, results will continue to be suboptimal.
We need more solutions that overcome the interoperability barrier, such as Allscripts dbMotion™ Solution. Its capabilities are the ones that will help healthcare organizations advance.
Our industry has achieved a great deal over the past decade or two, thanks to the increased sophistication and functionality of electronic health records (EHRs) and other clinical systems. Now it’s time to take another leap forward, achieving the level of interoperability that will not only reform, but also transform, health care.
In a recent post, I explored the promising nature of clinically integrated networks (CINs) and outlined how this model differs from previous efforts to “fix” health care. Now let’s look more closely at the technological underpinnings critical to success for organizations participating in CINs.
Data sharing criteria require HIT interoperability
One key attribute of the current CIN model is a focus on information sharing among members—and an acknowledgement that success is highly dependent upon the use of interoperable health information technology (HIT). In other words, CINs require that members be able to share data, aggregate data and analyze data.
Let’s look at what this means in practical terms: how interoperable technology is essential as a CIN focuses on reducing hospital readmissions.
– When a patient is discharged, providers in the community must be informed about the treatment delivered in the hospital, instructions given to the patient and follow-up care that needs to be provided by the broader care team.
– All clinicians then need visibility into the comprehensive patient record. This level access allows them to monitor not only the care delivered by their own organization, but by all others in the community as well, to ensure the care plan is followed and eliminate gaps.
– Analytics performed on comprehensive, aggregated data enables the CIN—and participating members—to identify patients presenting the greatest risk and pinpoint providers whose readmission rates need to improve.
Access to information that improves care
Interoperable HIT systems enable providers to answer critical questions:
1. Are patients getting the care they need from their various providers to recover and remain healthy?
2. Are these patients complying with their care plans?
3. Are we able to identify when an immediate intervention is needed to prevent a readmission?
dbMotion harmonizes data from disparate systems
The focus on HIT promoted by the CIN movement fortunately coincides with the availability of highly effective interoperability solutions like the Allscripts dbMotion™ platform.
dbMotion sits on top of EHRs and other clinical information systems, aggregating data from disparate technologies and harmonizing it into a longitudinal patient record. This actionable information is then delivered directly into the provider’s native EHR and workflow, to support point-of-care clinical decisions.
Because it draws data from virtually any EHR used across a CIN (as well as radiology and laboratory information systems), dbMotion delivers a truly comprehensive view of the patient and allows data to be shared seamlessly. The result? Better care coordination and management, and real-time clinical decision support.
Opportunities for patient engagement
CINs also recognize the importance of engaging patients more directly in their care—asking them to be more accountable for their health and encouraging regular communication with the care team outside of scheduled visits.
Patient engagement, too, is highly dependent upon technology. Patient portals are not a new concept, but the industry increasingly demands a more sophisticated approach to engagement. Existing portals too often are tethered to a single EHR, requiring patients to log in and out of multiple solutions.
Patients are accustomed to and expect a more consumer-friendly approach, and CINs will find that a “multiple vendor/multiple portal” strategy simply doesn’t work.
Alternatives are available, however. Allscripts FollowMyHealth® is vendor-agnostic and integrates seamlessly with all systems across the enterprise. This means patients have a single point of access regardless of the individual provider’s software.
In addition, patient-generated data flows directly from FollowMyHealth back to the EHR, automatically populating the medical record so critical information is readily available to the care team. Plus, FollowMyHealth can integrate consumer wireless devices—like scales, blood glucose monitors and blood pressure monitors—so patient status can be monitored remotely (and caregivers can be automatically alerted when potential concerns arise).
CINs offer a promising approach to the challenges that face health care today. Supported by interoperable technologies, participants are equipped to effectively coordinate and manage care for better outcomes and lower costs.
Over the past few decades, industry thought leaders have displayed a voracious appetite for new and improved ways to fix health care—and embraced an “alphabet soup” of acronyms to describe them: HMO, IPA, PHO, VBC, ACO, PCMH, to name a few.
And now they’re dishing up CINs: clinical integration networks (aka clinically integrated networks).
The difference is that CINs build on what we’ve learned from predecessor models that were only partially successful and add elements that promise to help the industry achieve the goals of reform.
3 shortcomings characteristic of earlier models
While well-intentioned, previous attempts to address the challenges facing health care met with only limited success for three primary reasons:
1) Incentives intended to motivate stakeholders were rarely aligned. Often, community-wide healthcare networks were driven by hospitals, looking to build loyalty among referring physicians. Local providers, however, were often suspicious and wondered what was in it for them (and typically never found out).
2) The ostensive goal was cost-cutting. But leaders promoting these efforts neglected to consider the larger issue of quality, which offers a significant opportunity to control the cost of care for both individual patients and populations of patients. Plus, measures to reduce expenses typically benefited the hospital, but the rewards seldom trickled down to community physicians.
3) Healthcare organizations lacked the technology necessary to access pertinent information and apply meaningful analytics. Patient information—as we all know—has historically been siloed. Providers who wanted to analyze care and outcomes had to gather data (often inadequate or of poor quality) manually. Or, if they had adopted health information technology (HIT), they needed to synchronize the data so it could be used meaningfully. (Side note: And even those organizations who were ahead of the curve when it came to analytics often focused on the wrong things—such as, I believe, mammography rates. Research on the value of mammography offers only controversial data on outcomes and cost benefit.)
CINs represent new approach
But, unlike the solutions du jour of the past, CINs address and mitigate many of these obstacles.
Briefly put, CINs are legal entities, governed by Federal Trade Commission (FTC) regulations, which have been established by collaborating hospitals and physicians. CINs do not entail hospital acquisition of medical practices or the transfer of assets among participants. All parties retain their independence.
They are designed to meet specific objectives that might range from enhanced care coordination, to elevated quality objectives, to collective negotiation and management of payer contracts. CINs are physician-led (a critically important attribute), promote evidence-based medicine, require participants to meet performance criteria and advance data sharing via HIT systems.
Physician-led, focused on evidence-based medicine
These details are significant. Because CINs are physician-driven—rather than being controlled by hospital or payer administrators—clinicians across the continuum are fully engaged and reap the benefits of success. At the same time, this model makes clinicians fully accountable for achieving quality and cost-containment goals based on scientifically proven metrics.
In the past, for example, quality programs addressing patients with congestive heart failure (CHF) might require the patient be treated with ACE inhibitors and have an echocardiogram every six months. But these “measures” represent only the most basic care for CHF; it would be unthinkable for any provider NOT to treat in this manner.
CINs, with performance criteria based on evidence-based medicine and tied to financial incentives, will up the ante and refocus quality efforts on measures that truly matter—like examining factors that impact CHF hospital readmission risk such as patient engagement, the effects of co-morbidities and social influences.
HIT critical to CIN infrastructure
The final ingredient foreshadowing success with the CIN model is its focus on HIT. These networks require connectivity among participants so information can be readily shared. The availability of up-to-date, comprehensive, high-quality patient information allows providers to improve care delivered in the exam room and at the bedside.
In addition, providers are able to coordinate care between settings to eliminate gaps and proactively address emerging problems. And, access to comprehensive data enables CINs to leverage analytics to identify risk and opportunity with the goal of improving quality and outcomes.
For an industry hungry for change and improvement, CINs offer great potential. It’s time to dig in!
Editor’s Note: Dr. Diamond’s next blog post will look more closely at this focus on HIT and at the solutions which promote success with CINs.
Tucked between large metropolitan centers on the East Coast, Berkshire Medical Center serves a population of about 130,000 people across 1,000 square miles of western Massachusetts. Clinicians there have launched a health information exchange (HIE) using dbMotionTM Solution, proving that small communities can harness big data.
At Population Health University, our recent annual user conference, we gained insights from Berkshire’s Chief Medical Information Officer Mark Snowise, MD. “In a small community like ours, if we want to progress, we had to find some way to get everyone connected and talking to each other,” he said.
Launching the Berkshire HIE
Three years ago, the hospital approached the broader healthcare community with a plan to improve data sharing. Initially the hospital hoped to align the various providers by using the same electronic health record (EHR).
The hospital-based practices and several community practices chose Allscripts TouchWorks® EHR; however, it was just one of nine EHRs deployed in the community. Building a regional HIE, powered by an EHR-agnostic solution, was the logical solution. Clinicians agreed an HIE would help improve care, and they identified specific priorities for acute and ambulatory providers.
Physician practices were looking for quick, easy access to meaningful data held in clinical notes. They recognized that understanding the thought processes of other providers across the continuum would enable better care coordination. Clinicians also want tools to enable better population health management, and to help them meet Patient-Centered Medical Home or Accountable Care Organization measures.
On the hospital side, clinicians likewise needed quick, easy access to comprehensive patient health information. But Dr. Snowise observed that it was imperative to simplify existing processes. Physicians needed a consolidated way to access the data, and they wanted to provide a consolidated way for patients to access the data. The hospitals also wanted to connect to regional and state HIEs.
Building out the dbMotion-powered HIE
Dr. Snowise was part of the team that selected the dbMotion connectivity platform after seeing a demonstration. “We loved the idea that we could get clinical notes,” he said. “We loved that we could access patient information in dbMotion from our individual EHR in patient context.”
The project officially kicked off in February 2013 and the first feeds went “live” this spring. Along the way, Berkshire had to wrestle with questions common in HIE builds:
What data should we send? At first, it seems the obvious answer is to send everything. But the Berkshire community carefully weighed its options and decided to pare it down. For example, the team chose to exclude medication lists from the hospital for various reasons, including that it is difficult for hospitals to indicate when a patient stops taking medications.
How do we meet patient consent requirements? This question is difficult in an environment where local and state HIEs have different opt-in/opt-out participation requirements.
What is the most user-friendly way to present the data? Berkshire spent time structuring the views so that the order and content was familiar to physicians.
How do we protect confidential encounters? Certain types of treatment (e.g., for substance abuse or mental health issues) require sensitivity and confidentiality. EHR vendors have different ways of blocking confidential encounters, and HIEs must be able to reconcile these approaches.
“We’re just starting our journey with an HIE,” said Dr. Snowise. “But our small community is well on the road to big data.”
5 lessons learned from Berkshire’s HIE implementation
Dr. Snowise concluded with invaluable advice for organizations about to embark on an HIE implementation:
- Don’t undertake major IT upgrades to existing system during implementation.
- Nothing is out of the box. Plan to do a lot of mapping.
- Usability testing is key. Get physician involvement early on.
- Understand limitations of system. Take into account in the build and training of providers.
- Maintenance is just as important as the build. It’s important to discuss ownership of ongoing HIE responsibilities.
In the end, the effort will be worth it. “What we can do now with Allscripts and dbMotion, we could never do five years ago,” said Dr. Snowise. “I believe that it will lead to improved patient care.”
Resolute Health (New Braunfels, Tex., U.S.A.) opened its brand new hospital campus June 24. The 56-acre site reflects the future of health care, emphasizing population health management and overall wellness.
Chief Information Officer, Roderick Bell II, shared Resolute’s vision at our recent annual user conference, Population Health University. With more than 20 years of healthcare IT experience supporting four “greenfield” hospital projects, Bell is well qualified to re-imagine the possibilities for healthcare technology.
7 visionary features on Resolute’s wellness campus
“Resolute Health is the innovation lab for Tenet Healthcare,” said Bell. “All the new technology, all the new workflows…everything new goes through Resolute Health first before we push it out to the rest of the 77 hospitals across the system.”
Resolute’s innovative approach is evident in the way it uses technology and the types of services available onsite. Here are some of the new features you’ll find on Resolute’s wellness campus:
- Just 127 beds dedicated to acute care; leadership believes the focus on health and wellness will result in reduced demand for inpatient care—and smaller hospitals—as more patients are seen in lower-cost ambulatory settings.
- Green spaces host community events and encourage physical activity.
- 25,000-square-foot fitness center welcomes all members of the community to get fit and stay active.
- Retail shops promote healthy lifestyles through products and services.
- Restaurants offer healthy and tasty dining choices.
- Day spa focuses on healthy habits.
- BeneFIT program stores medical records, gives access to discounts, and offers rewards for healthy choices at local and national retailers and restaurants.
With these innovative approaches, Resolute is helping redefine the ways a hospital can improve a community’s overall wellness.
Challenges that sparked Resolute’s creation
Resolute Health was born from the realization that Americans aren’t getting what they want and need from today’s healthcare model. Resolute Health selected Sunrise Clinical ManagerTM and the dbMotion SolutionTM to power its vision for better health care.
In today’s healthcare model, insurers analyze claims data, but that information is not available to clinicians at the point of care. Claims analysis is retrospective and often delayed 60-90 days while claims are adjudicated.
Claims data is also limited in that it does not include detailed clinical information, nor does it inform what patients can and should do between visits. “We didn’t have a full broad picture of that person’s life,” said Bell. “If we’re going to be about wellness and population health, we needed a full picture.”
According to Bell, good data — which has volume, variety, velocity and veracity — is a key attribute of an effective clinically integrated delivery system. Resolute aims to reduce risk and improve health by managing clinical data in real time, and using it at the point of care and between patient encounters.
The future of health care must be Open
Bell closed with some thoughts about how an Open platform enables the future direction of health care:
“Watching where the trends are going within health care here in the United States…everyone is now going to an Open source platform. Wonder why? Because they need to bolt things on that they didn’t have to bolt on before.”
“We chose Allscripts because it gives us an Open platform as well as a single database solution for physician practices and hospital needs,” said Bell. “I wanted to create a foundation that…if I needed to move left or right, I could easily do it without going back to the EHR vendor for another million dollars to do it. I could actually build some of this myself.”
When re-imagining health care, visionaries must recognize the value of an Open platform. It’s the best foundation for comprehensive population health management, which is the future of health care.