A Care Coordination Innovation Intervention

John HalamkaWould you buy an iPhone if the only apps that ran on it were written by Apple? Maybe, but the functionality would not be very diverse.

The same can be said of EHRs. Athena, Cerner, Epic, Meditech, and self developed EHRs such as BIDMC’s webOMR are purpose-built transaction engines for capturing data. However, it is impossible for any single vendor to provide all the innovation required by the marketplace to support new models of care I’m a strong believer in the concept of third party modules that layer on top of traditional EHRs in the same way that apps run in the iPhone ecosystem.

There are 3 such companies doing important care coordination work in Massachusetts and we’re expecting a wide rollout of their cloud hosted modules that tightly couple with EHRs, but are not authored by EHR companies.

The Right Place, is an electronic referral and bed management platform that expedites the placement of hospitalized patients to post-acute facilities that can deliver needed services. Unlike tools which push patient information downstream to providers, The Right Place functions more like OpenTable and Match.com. It supports discharge planners, patient/families and post-acute care facilities by providing a “front end” solution for case managers to search/match and a “back end” bed and referral management solution for the post acute care facility. Together, these tools provide real time data to providers on both ends that can improve outcomes, reduce unnecessary costs, and enable hospitals to track what happens to their patients after they leave the hospitals.

PatientPing enables caregivers to track and coordinate care as a patient “travels” throughout the healthcare system regardless of provider type, EHR or geography. The concept is simple. Every time a patient visits a facility, the admit/discharge/transfer data about that encounter is sent to PatientPing servers (with appropriate privacy protection) and all appropriate caregivers/care managers are notified of the encounter in real-time. Although use cases have expanded, PatientPing’s early focus was Accountable Care Organization patients appearing at skilled nursing facilities and hospitals. This community-based approach puts the patient at the center of care and breaks down institutional silos to facilitate higher quality care at lower cost.

Collective Medical Technologies creates products (EDIE/PreManage) that are like “Facebook” for providers, including Emergency Departments. Imagine that a complex patient with a formalized care plan seeks emergency care in multiple locations. Even with health information exchange, it’s hard to coordinate all the moving parts of the healthcare system. Collective Medical creates a “wall” for each patient and ensures that licensed caregivers are “friends” on that wall. When the patient presents at the hospital, the tool pushes real-time alerts, including patient-specific risk factors, visit history, and care guidelines. Thus, communication among caregivers can be better aggregated and visualized. One use case that has been effective in other states is the management of opioid-seeking patients visiting multiple facilities. Given the opioid crisis in Massachusetts, we’re hopeful that new tools like Collective Medical’s PreManage ED will help us better manage patient “treatment contracts”, executing care plans consistently at every emergency department in the state as part of a statewide rollout of the tool.

BIDMC has chosen to implement modular, cloud hosted services such as these in a unique way. We’ve created a single hub for patient admit/discharge/transfer transactions hosted at the Massachusetts eHealth Collaborative. Trusted vendors with business associate agreements can subscribe to these feeds, which are sent via HL7 version 2 messages over an encrypted transport channel. No IT department development or resources are required to add a new trading partner. It’s a very scalable model.

As FHIR matures, I imagine that every hospital and clinician practice will have a curated app store of approved modules that just plug into their EHR and health information exchange infrastructure. Some of these apps will be provider facing and some will be patient facing. My colleagues in government understand the concept of third party innovations plugging into EHRs. Hopefully as MACRA is refined, we’ll have empowering regulation to encourage this ecosystem and move beyond Meaningful Use concepts.

John Halmaka is CEO at Beth Israel Medical Center.

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4 replies »

  1. +1 techydoc – This work is being done in our HEART workgroup http://openid.net/wg/heart/ We have representation from the FHIR side but we desperately need more docs and potential implementers and providers. A provider like BIDMC that has control over their EHR would be ideal.

  2. It is also more challenging in the health IT market due to the high fragmentation of market share coupled with the lack of a common “stack” of APIs. I say stack because it requires more than a FHIR API as it does not provide all the services needed for an ecosystem such as trust, identity, and authorization just to name a few services. Perhaps a coalition of vendors trying to compete against the “incumbents” may be willing to move in this direction (which is happening), but not sure they have the market power and business models to drive it. The one potential saving grace is the movement to value based payment that rapidly changes the functionality profile needed of health IT, which established vendors will have trouble producing in the current timelines. Customers need to demand this type of innovation. Great to see you and your organization leading the way.

  3. John, what happens during a power outage, hurricane or flood — all of which are happening with increasing frequency all around the country/world — when your EHR and related apps aren’t accessible?

  4. Kudos for recognizing the importance of interfaces into the EHR but do the interfaces support a patient or a physician-centered innovation? “Trusted vendors” and “curated app” beg the question of who is the root of trust and curation for apps that access patient-level or physician-level information in the EHR.

    Modern security technology, such as used by Google throughout their systems that manage private data, allows a patient to decide who is a trusted vendor and physicians to decide what is a trusted app without interference – dare I say information blocking? – from the data custodian.

    Patient-centered longitudinal health records and true practice innovation will not come to healthcare until institutions, especially those like BIDMC that control their EHR technology, adopt modern security and privacy standards already common in the cloud.