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It's not uncommon for hospitals or providers in a healthcare organization to use different EHRs. Unfortunately, it poses an interoperability conundrum that hinders implementing other health IT solutions such as a population health management platform. Many healthcare organizations are turning to third-party health IT interoperability vendors to solve this problem.
As SearchHealthIT reported in an earlier article about the lack of EHR interoperability, this was true for the University of Pittsburgh Medical Center (UPMC), which was using Epic Systems' EHR for ambulatory and Cerner's EHR for inpatient. Harun Rashid, vice president of global health services at UPMC and CIO of Children's Hospital of Pittsburgh of UPMC, told SearchHealthIT how the two EHRs wouldn't "talk to each other" and therefore the hospital created an in-house solution in partnership with dbMotion, an Israeli software company.
Hardin Memorial Health, an integrated healthcare delivery network in Elizabethtown, Kentucky, had to deal with a similar problem.
Christi Curl, director of performance improvement and clinical quality at Hardin Professional Services, explained that, "We had multiple EHRs within one system [and] we didn't have a tool in order to look at a complete patient record without literally accessing two or three different EHRs," she said.
Hardin's network of care facilities and providers includes specialty clinics, primary care clinics and ambulatory services.
Christi Curldirector of performance improvement and clinical quality at Hardin Professional Services
"Ms. Smith might see one of our primary care doctors via the hospital and see a specialist and each one of those visits would live in a different EHR," Curl said. "So when you followed up in order to get a conclusive picture of that patient, you would have to literally log in to three EHRs to do that."
This setup is not conducive to achieving population health or providing continuity of care to patients, Curl added.
That's why Hardin turned to Transcend Insights' HealthLogix technology, a population health management platform that normalizes data to better enable data sharing.
Technologies that enable interoperability
Creating interoperability is no easy task and that's why Transcend Insights has employed the help of several healthcare technologies in order to allow the various Hardin healthcare organizations that are all using different EHRs to share data and therefore give caregivers the full view of the patient's healthcare story.
Health information exchange: In order for interoperability to happen and for caregivers to be able to get the full view of their patients' care without signing in and out of a bunch of different EHRs, the data needs to be in one, accessible place, according to experts.
That's why Transcend Insights has created a health information exchange (HIE) among its users. This means they are pulling patient data from various sources -- such as EHRs and lab results -- being used within Hardin's healthcare network into the HIE. However, Tom Van Gilder, vice president of informatics and analytics and chief medical officer at Transcend Insights, said when the company is able to pull data from outside the network, it does.
"We're more focused on moving information among not only EHRs but also information that comes from administrative data, for example, medical claims and other bits of information that are available in silos but not necessarily cross-linked," Van Gilder said.
Normalizing data: Van Gilder explained that this population health management platform can normalize data at the point of data ingestion or transmission.
"For example, to bring … a bit of information that's coded in one system and bump it up against the same information in another system, we use some tools to make sure that we're all talking about the same concept, regardless of the source of the coding," Van Gilder said.
He added that a similar process happens with the analytics engine that is also involved in the population health management platform. However, with the analytics engine involved, this process is able to convert a laboratory code into a code that may be found in an EHR for a similar condition.
"Hardin as a group has about 180,000 to 200,000 patients … for which we are ingesting continuity of care documents," said Kristin Russel, vice president of marketing and product management at Transcend Insights. "Information from the electronic health record as well as claims information, pulling all of that together, ingesting or cleansing it, normalizing that data, and that equates to almost three million different records that are running through our engine at any point in time."
Furthermore, this population health management platform has also cleansed and normalized 2,803,541 elements of exchanged patient data, a spokesman for Transcend Insights said.
Leveraging Fast Healthcare Interoperability Resources APIs: Russell explained that Transcend Insights is also using FHIR APIs so it can have a variety of different applications sitting on top of the population health management platform.
"We serve this information from all of these different silos back to end users in a way that makes sense for them," she said, noting that it doesn't matter whether the information is served up via a dashboard type application or a mobile application.
Interoperability and population health management
As noted in this article about population health strategies, if a doctor is unable to access all the health data out there about what a patient has been through, the doctor is unable to see the full care story of not only one patient, but all patients. Without this comprehensive view, population health management is difficult to achieve.
"I think in an ideal world we'd all have the same EHR everywhere and we'd be able to look at everything across the world," Curl said.
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