Real-Time Data Must Simultaneously be Pushed and Pulled in the Right Ways
By Brian Ahier, Director of standards and government affairs, and Ashish Shah, Chief Technology Officer of Medicity
Twitter: @ahier, @avshah, @Medicity
A physician orders a lab test but cannot receive results back directly in the practice’s electronic health record (EHR). A patient sees a specialist who quickly schedules surgery without the knowledge of the primary care provider. These are the challenges our industry must solve in order to effectively transition into value-based reimbursement models.
While Meaningful Use is an important step for enabling greater adoption of EHRs, it doesn’t provide specifics around the functional use of this data across multiple platforms to improve care. That’s why total system interoperability and data liquidity must be our industry’s ultimate goals. Real-time data must simultaneously be “pushed” and “pulled” in the right ways to create shared insight for every provider involved in a patient’s care.
This is true regardless of the type of model — whether it’s an accountable care organization, a clinically integrated network or a patient-centered medical home.
Innovating around government standards and programs
Public sector programs have certainly lent momentum to this shift. For example, Meaningful Use has been successful in promoting some basic standards for interoperability. The Direct Project, which originated from the ONC and is now a public/private collaboration, has also provided an important framework for security and communication protocols. These programs, however, are simply a foundation on which we must innovate new solutions. The means required to do so are not necessarily outlined in these government standards and programs. In fact, it’s important to remember that Meaningful Use actually predates health care reform and must be expanded to meet the needs of today’s health care models.
Organizations looking to go beyond basic compliance with Meaningful Use standards should consider the following four steps before they invest in any interoperability solution:
1. Determine how your organization plans to identify and enroll all providers and partners in the network over time. This sounds basic, but a network-based reimbursement model requires much more than data integration. The right people must be receiving the right data at the right time. This will promote the best possible outcomes for patients, regardless of who is on their care team. An interoperable platform must also grow with your organization as you add new independent practices, employ new physicians or establish new partnerships.
2. Define your population of interest. Your organization is likely heavily focused on your most at-risk, high-cost patients. Your health information systems should have the same emphasis. In order to filter out the “noise” of information from across a network, it is important to prioritize certain data. For example, you may want to enable care event notifications for at-risk or high-cost individuals. In this way, you can notify a particular set of providers whenever the health status of one of these patients changes in any care setting that requires individual action and/or collaboration with others.
3. Identify the specific initiatives and programs that you’re looking to support. For instance, increasing patient retention is a major challenge for many network-based models. Timely primary care physician follow-up for improved transitions of care and reducing emergency department utilization are also critical for most organizations. These functions may be best achieved through specific applications layered on top of a platform that drives interoperability. Simply connecting data across the entire network would likely result in information overload and a lack of true clinical insight. These are just a few examples of quick-start programs that will drive value in population health programs.
4. Encourage adoption by creating physician affinity. At the initial stages, these initiatives can require physicians to change how they work with little perceived pay-off. That’s why it’s important to build trust by achieving quick wins for network providers. You may want to establish physician champions to identify these priorities. For instance, are your providers looking to improve their referral process? Do they want to receive discharge summaries in a timely fashion? Starting with the programs that build physician affinity will pay off in a big way when it comes to encouraging adoption and developing momentum for other initiatives.
Illustrating the power of this four-step approach
One entity that has used these best practices to its advantage is the Ohio Health Information Partnership which manages the statewide CliniSync Health Information Exchange. This public collaborative serves more than 141 hospitals statewide — helping these organizations meet Meaningful Use standards and achieve greater interoperability. CliniSync initially focused on how to foster collaboration in order to address discharges and referrals among providers using different EHRs. Today, whenever a patient within the identified population is discharged from the hospital or referred to a specialist, a care summary is generated. This summary is then shared with the appropriate providers by leveraging two standards-based technologies, eHealth Exchange (formerly NwHIN) and the Direct Project. Working closely with the governance organizations Healtheway and DirectTrust, CliniSync is helping the hospitals improve transitions of care.
Interoperability remains a worthy pursuit
Interoperability remains a major hurdle for our industry; however, it is not an insurmountable obstacle. It simply requires that organizations take a straightforward, strategic approach, being careful not to overthink the solutions, and align with the right partners to establish a track record of quick wins. If our industry wants to truly move beyond the “walled garden” approach of data silos, we must all share this responsibility.
Only then can we move to a future where interoperability supports improved population health within every community of care.
This article was originally published on Government Health IT and is republished here with permission.