By Sarianne Gruber
Twitter: @subtleimpact
“With technology solutions, it’s very tempting to fixate on the technology. And as technologists we love technology, but it is really about solving problems for health organizations,” remarked Joel Rydbeck of InforTM Software Solutions. At the Inforum 2016, I had the pleasure to meet with Joel Rydbeck, Strategy Director overseeing technology for Infor Healthcare, and learn how their software and cloud services help their clients advance towards interoperability. Fortunately, it was a very timely conversation since ONC had just released two new measures addressing “widespread interoperability” based user input and MACRA requirements. A recommended read is the article by Seth Pazinski and Talisha Searcy entitled Measuring Interoperability: Listen and Learning. The authors’ uncovered four areas of concern with respect to measuring how well we are reaching interoperability in our nation’s care system: (1) burden, (2) scope, (3) outcomes and (4) complexity. Infor’s clients: HealthlinkNY and GRIPA (Greater Rochester Independent Physician Association), which are two HIEs in New York State, Hackensack University Medical Center in Bergen County, New Jersey and Saint Francis Hospital in Tulsa, Oklahoma, encountered these topics as they moved towards a fully interoperable organization. Here are highlights gently edited from our discussion:
Broadening Scope Reduces Gaps in Information
“We are bringing a large number of hospitals together so they could effectively exchange patient information,” Rydbeck shares with pride. He considers one of the larger challenges health organizations face today is having patient information ready when the physician or care provider can diagnose, treat or addresses the patient. This is very difficult for a health organization to do because a patient is moving around the hospital or care system. A patient can be in the ER, receive outpatient services, or visit a private physician. “We are able to connect not just the systems inside the hospital together, but also the non-acute affiliates. Your private physician’s information can be transferred directly into that hospital system for your treatment or diagnosis and then back to your physician. What we’re doing in the tri-state area for the HealthlinkNY health information exchange in New York’s Southern Tier and Hudson Valley as well as for the Greater Rochester Independent Practice Association health information exchange (GRIPA) is connecting a substantial number of hospitals, so that patients can move around. The crux is connecting the patient information,” verifies Rydbeck.
Reducing Additional Reporting Burden for Clinicians
Rydbeck retells a personal incident disclosed by Hackensack University Medical Center’s Chief Information Officer, Dr. Shafiq Rab, when he spoke earlier in the day. He mentions that what makes their story distinguishable from other health organizations is that they are taking on the White House Precision Medicine Initiative. Dr. Rab’s presentation opened with a picture of his children in a hospital room. His daughter is there with a concussion, and he has another daughter with a broken leg. He was extremely moved by how challenging it was for him to admit his own daughters into the hospital where he worked. There were extensive forms that had to be filled out, an inordinate amount of requested information, coupled with the disconnected nature of care. The lack of communication observed by how one staff person does not talk to the other. He witnessed the care team asking questions and when they left someone else comes in and the same questions get asked all over again. One of the eye-opening statistics Dr. Rab put up was how a coordinated care patient costs on average about $3,000 whereas an uncoordinated care patient costs them $15,000 – roughly 5 times more per patient. The “real” question Hackensack needed to address was how to connect the care of their patients? Hackensack’s initiative started with the patient’s entry into the hospital system. Rydbeck poignantly retold his client’s path to interoperability, effectively reducing multiple reporting at the same information.
“Think about the last time you went into a hospital where you have to fill out a form, even if you have been to that hospital 15 times before, you still had to fill out the forms in multiple. What Hackensack did was to set it up so as you walk into the hospital you get a text on your phone. Click the link and you go in and complete information or you make changes to information they already have on you. Immediately, they update that information on you in the system. Next, is a text prompt with physician questions such as do you have a headache or do you have a fever. Whatever those questions may be, you answer them. And then the final step is scheduling your appointments. Maybe it is not an emergency and you will see you the next hour from now. You even could go out and get a coffee or do something more relaxing than sitting in the hospital waiting room. How was Hackensack able to have this all setup? The reason they were able to do this is because they leveraged the technology called FHIR (Fast Healthcare Interoperability Resources). And the beauty of it was they were able to write a mobile app to interface with the FHIR platform they built entirely on Cloverleaf. Then Cloverleaf went into these backend systems such EPIC, their scheduling system as well as all the other systems, extracted all that data and exposed it. The hospital’s EHR vendor, EPIC, also invested a lot to get the EPIC system up into FHIR.
Hackensack was able to take all the arcane protocols, HL7, different dialects, even FHIR, because Cloverleaf’s integration engine acted as a conduit for translation—it was able to do all that plumbing. ”
Beyond Outcomes: Usage and Usefulness of Democratized Information
Data now is able to speak each other. Rydbeck references the 80’s when there was point of service systems such as separate account receivable systems, accounts payable systems and a general ledger but nothing was talking to each other. Today in an internet era, the cardiologist picks his top system and the pathologist picks her top system. Interoperability helps hospitals survive with all these systems and let the data talk to each other. A hospital can use a real-time data platform, plus an information archive on Amazon cloud, all aggregated. “We may be leapfrogging that era data governance and going into more of a semantic era based on relationships among doctors, nurses, and patients. We start to see things as relationships, and less as flat files and relational databases. Think of it in terms of LinkedIn with first levels of connections, then a very big second level of connections, and lastly, a massive third-degree connection. Those are relationships, and those relationships can be transverse. Our responsibility to help hospitals take the information put it in formats where they can explore it, digest it and work with it. Some of that data needs tight governance. In a general ledger, there is not a lot of relational touchy-feely information. When you get into areas where which nurse was on which floor, or at which time, which prescription was delivered, which physician prescribed it, at what time it was administered, where did that prescription come from, how much did it cost us, how long did it sit in the warehouse? These are not an uncommon thought tracks in a hospital and that is something we can deliver with a semantic platform, where we are archiving this data. It doesn’t require the effort that a highly relational or structured conventional data warehouse requires,” explains Rydbeck.
Technology Reduces Complexity of Multiple Data Sources
Using a network diagram provided with permission from Saint Francis Hospital, Rydbeck demonstrates how interoperability is attained from multiple data sources. The Cloverleaf, diagram tracks three different medical records systems including GE Centricity, NextGen, Allscripts, some Philips equipment, RIS-PACs, and Abbott Lab equipment. Rydbeck says all these systems are speaking their own language, some of them don’t even speak HL7, and some just have a database. As technologists, they go into the database and extract information. Then it gets published on a BUS, a Cloverleaf interface engine, as HL7. Cloverleaf is doing all the translation as a conduit layer. Any time a new patient is admitted into any of the EHRs, NextGen or Allscripts, immediately there an admit discharge message published to all the other systems with the date of birth, insurance information, allergies, and medications. When an order is placed for a patient’s blood test, the Abbott lab system already knows everything there is to know about the patient. “That’s how a smoothly operating, well-oiled hospital is going to operate as opposed to you going into the lab and them saying we don’t know about you. And they say “quick”, let’s get some more information and fill out some more forms in the lab. We have eliminated that. We are an interoperability platform for a hospital system,” smiles Rydbeck.
Learn more about Infor’s Healthcare solutions on their website. For Joel Rydbeck’s bio click here.
Also, check out this summer’s Inforum 2016 held at the Javits Center in New York City.