by Darcey Trescone, RN
Home health agencies, hospices, skilled nursing facilities, rehab and long-term hospitals, and all other Post-Acute Care providers are not more than a year away from hearing this conversation over and over and over again:
"We would very much like you to refer some of your hospital's discharged patients to our care."
"Maybe we will. Let's find out if you meet our standards."
"Oh, we provide excellent care...5 stars."
"That's not what I meant. Are you a member of Commonwell? Do you have an Epic shared instance? Does your electronic health record have open APIs or HL7 capability? Can we send our hospital record directly into your EHR when we refer, and can you send your patient charts back to us electronically if our mutual patient comes back to our emergency department or is readmitted?"
The right answers might lead to a long-term referral relationship. The wrong answer, especially if the person asking for referrals has not been trained in the language of interoperability, could bring about permanent census disintegration. That hospital is looking for partners that can meet its data sharing needs, and they do not mean with a fax machine.
We spoke with interoperability leaders Jeremy Powell, CEO of Acclivity, and Nick Knowlton, VP of Business Development for Brightree. Acclivity software coalesces providers, patients and payers onto a common, smart platform. Knowlton led the way toward Brightree becoming the first home health software vendor to be a Commonwell member. We will feature our conversation with Knowlton next week in our July 17 issue.
Acclivity CEO Jeremy Powell told us, "Interoperability is a building block for ensuring that what you can know about a patient, that might be known elsewhere in a patient’s healthcare journey, can be known at the point of care for a patient encounter. Achieving interoperability is not a difficult lift, but the outcomes vary to date. Most systems can exchange and pass information back and forth, which is not enough. The definition of interoperability is evolving, and it is expected that the data exchanged or shared between systems helps to tell a story about the patient’s overall healthcare journey."
Powell continues, "Interoperability, the sharing of patient information between systems, needs to be meaningful to the clinician preparing to provide care and all future encounters with that patient, regardless of healthcare venue or technologies in place." Medication is one simple example:
"If a clinician, working at the point of care, discovers from a patient interview that a new medication has been added recently, they can simply add that medication to the Electronic Health Record (EHR). Meaning, most venues support technology frameworks so that the medication can be captured without disrupting the workflow and EHR functionality used by that clinician. The issue is medications don’t often get exchanged between systems in a way that’s useful to the next system needing that information and subsequently the next encounter with that patient. They get flattened or simplified into a note that lands in an inbox of any “Interoperable” solutions. This creates risk for the clinician working in the secondary system receiving information for that patient because the medication doesn’t tie to the context of that patient’s record in a meaningful way. It’s not included in the secondary system's MAR where the next order will be placed and automated medication rules, drug to drug checks for example, within the system would fire against it. The information is outside of the inclusion of what you would expect, and the risk is increased that the new medication gets missed. This is a common occurrence with patient data that is shared between systems."
In response to the interviewer's question, Powell continued, "Standards have been the approach by CMS, IHE, HIMSS, and other bodies focused on interoperability. X12 (for Claims/payment/encounter data – the first platform) and HL-7 (Clinical Data within EHRs – the second Platform) are standards that have been in place for a long time, but these two standards don’t talk to each other. HL-7 is the standard used to share clinical journey transactions (admission, discharge, transfer, orders, results, etc.) X12 as a standard is for financial transactions. It’s a bit like comparing airplanes and automobiles. Different rules, patterns and logistics guide each body and standard, and therefore interoperability across standards is not well developed.
"The good news is a third platform has come to life that is utilizing the standards to pull both clinical and financial content in a meaningful way. Newer, more innovative transaction standards like HL7 version 3 (CMA architecture) and now FHIRR are part of the clinical framework. These third platforms sit on top of both clinical and financial train tracks allowing for us to understand things like what is happening from an encounter perspective, what’s happening clinically in each of those encounters, how much cost is associated with services being provided. And once you get that level of visibility you can start doing incredible things not just at the population health level but at the individual level.
"This third platform often gets bundled under a grouping of solutions: 'Population Health,' 'Care Coordination,' and 'Care Management.' The content provided by these solutions allows an organization to think more broadly about a patient or person entering any health journey. For example, if you begin your health care journey at a primary care office what typically happens is you tell your story, the care provider assesses/documents, diagnostics may be ordered, and a plan is put in place for the remainder of your journey. If you need to see another provider in the continuum of care, then you typically must start this process over. With the evolution of interoperability, these repeat experiences between providers should be minimized. The care providers can begin to better understand what has happened with a patient, where the patient is in their health care journey and what other care providers might need to be involved. It allows us to better navigate all the health care transitions for a patient, care venue to care venue, and from a wellness state to an acute or chronic state and back again."
Register to Watch the 3rd ONC Interoperability Forum
The Office of the National Coordinator of Health IT will host its 3rd Interoperability Forum, August 21-22. Key leaders and stakeholders will discuss the current and future direction of interoperability and provide outstanding content. The keynote and plenary sessions are available to view live through the webinar.
New Guide Helps Providers with Patient Histories: IPG Spotlight of the WeekThis week’s Interoperability Proving Ground spotlight features the Payer Data Exchange, which helps providers request a health history from health plans in a "Fast Healthcare Interoperability Resource" format. It also enables patient-mediated payer-to-payer exchange of a health plan member’s history, according to the Da Vinci project that intends to ballot the process in September.
We wanted to know how much more work needs to be done in order to reach the goals Powell was outlining for us, especially with regard to encouraging hospital systems and physicians to share data with home health, hospice, and home care providers.
He continued, "These third platform capabilities exist, but it's typically specific to what is captured within a single system regardless of venue, like an integrated delivery network. The industry issue is not all care providers servicing a patient are part of that integrated delivery network or on the same system. Therefore, we are seeing more vendors entering the market with system agnostic, 'third platform' capabilities."
"The federal government is setting the stage for system agnostic interoperability as well. For example, Primary Care First was just announced in April, and a provider only needs 125 Medicare patients to participate. The expectation is that, to be successful in this initiative, there must be the ability to manage primary care functions, as well as the opportunity to support severe illness populations and their journeys through severe illnesses. That will require some elegant hand-offs of patient information and will provide much opportunity for the continued evolution of the third platform.
"What the third platforms do is marry the financial transactions with the clinical transactions. By looking at claims, we can begin to determine where there might be clinical evidence and information that needs to be pulled to better tell a story about a patient's actual full, detailed health care journey. Many systems are still focused on transactions. They are not linking the transactions and developing the full, patient-centered story to drive better outcomes."
We thanked Jeremy Powell for his insights and asked him to briefly summarize his message. "When you do something in a space that starts to drive outcomes, that is the holy grail. Being able to shake hands and pull information back and forth between systems by itself does not provide clinical value. We must capture the data at the right time, in the right place and present it in such a way that it enhances the care provided across all health care venues."
About Acclivity Health Solutions
Acclivity Health Solutions provides the platform for connected care communities focused on patients with advanced illness. Using the Acclivity platform, healthcare providers are able to securely connect and collaborate with various disciplines in the care team to provide appropriate and timely services to their shared patient population while meeting the requirements of value-based care. For more information, please visit www.acclivityhealth.com.
Darcey Trescone is a Healthcare IS and Business Development Consultant in the Post-Acute Healthcare Market with a strong background working with both providers and vendors specific to Home Care and Hospice. She has worked as a home health nurse and held senior operational, product management and business development positions with various post-acute software firms, where her responsibilities included new and existing market penetration, customer retention and oversight of teams across the U.S., Canada and Australia. She can be reached at firstname.lastname@example.org.
©2019 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan's Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. email@example.com