BY Win Whitcomb, Chief Medical Officer &
Ed Zecchini, Chief Information Officer
Effective exchange of electronic patient data for the purposes of coordinating and managing care is crucial to unlocking value in healthcare. To be successful, alternative payment models, like bundle payments, require an unimpeded view of patient progress over multiple settings including acute care hospitals, post-acute facilities and community-based settings.1
Yet the path to widespread interoperability has proven to be longer and more tortuous than previously imagined. A report in this month’s Health Affairs describes the state of U.S. hospitals’ engagement in four domains of interoperability: finding, sending, receiving and integrating* electronic patient information from outside providers.2 In 2015, the most recent year for which data are available, only 29.7 percent of hospitals engaged in all four domains, while only 18.7 percent of hospitals “often” use electronic data from outside providers for patient care. The authors rightly concluded that movement toward interoperability has been slow and that progress has centered on simply moving health information, not the usability of that information for decision making by clinicians.
In 2013, anticipating the slow uptake of electronic health record interoperability, Remedy Partners embarked on an approach to health information exchange involving the creation of connections, or integrations, between Episode Connect, Remedy Partners’ proprietary software platform, and hospital and other providers’ electronic health records (EHR). The approach entails integrating Episode Connect with EHR systems through hospitals’ admission, discharge, transfer (ADT) feed, using a standard healthcare messaging protocol known as Health Level Seven International, or HL7. The hospitals’ HL7 feed to Episode Connect enables the sending and receiving of multiple data fields including patient demographics, ICD and DRG codes, clinical notes, lab and other diagnostics, and a host of other patient-level data that can be used for care management.
The result? Episode Connect provides a patient view during all phases of an episode of care from acute to post-acute though the time when the patient returns to the community. We have done this for nearly a half million episodes to-date, across 45 states, representing over 18 million EHR transactions each month. In terms of interoperability, Episode Connect now has widespread connectivity with EHRs supporting not only sending and receiving, but true integration of patient data. This enables decision making by clinicians to increase the value of healthcare services to patients and those who pay for it.
Since 2013, the Remedy Partners’ integration team has ingested HL7 feeds from over 1,100 individual hospitals’ and other providers’ EHRs. Recognition also goes to hospital providers who worked to build the interfaces. This monumental task has effectively created one of the largest health information exchanges in the U.S. Our work to build new integrations continues, with a current focus on EHRs used by skilled nursing facilities and home health agencies.
*Finding information is the ability to query for patient data from outside provider organizations. Sending and receiving information enables safe care as patients transition between settings or providers. Integrating patient information refers to the integration of clinical data into the EHR with no manual effort. For this study, “yes, routinely” or “yes, but not routinely” were considered to be integrating information.
2Holmgren AJ, Patel V, Adler-Milstein J. Progress In Interoperability: Measuring US Hospitals’ Engagement In Sharing Patient Data. Health Aff (Millwood). 2017; 36(10):1820-1827.