A guide to selecting a powerful EHR for population health management with a high level of interoperability for improved outcomes and sophisticated interfacing capabilities.
As the buzz surrounding Population Health Management (PHM) continues to grow, healthcare providers and organizations recognize the need to implement an EHR, but the question remains, which one? Two main influences in the industry are the growing number of clinical quality programs (PQRS, MU, eRx, PCMH etc.) and the rapid formation of various physician organizations, (ACOs, PHOs, etc.). Organizations are beginning to understand that it is critical for an EHR/EMR to have a high level of interoperability. When contracting for a PHM solution, there are competing priorities of getting the system up and running and the quick demand for improved outcomes. A powerful EHR with sophisticated interfacing capabilities simplify access to data and clear the runway to successfully meet complex quality measures.
The Capabilities and Cost to send data
1. Getting the RIGHT Data
Although the increased use of EHRs has resulted in larger quantities of electronically stored patient data, this data is not always stored in a structured, consistent format, nor is it easily accessible. A responsible population health management solution views data consistency and access as imperative. Common stumbling blocks for organizations include not knowing the types of data they can get out of their systems and rely on an HIE to share the data for them. The fact is that most HIEs currently only handle Result, Immunization, and ADT information, which does not provide a complete data set required by quality programs. HIEs are still a great source for data, but they shouldn’t be viewed or leveraged as a sole source. The general data domains needed to support a quality program are:
• Medical Conditions/Diagnoses
• Vital Signs
• Smoking Status (Social History)
• Care items/Services
2. Getting the RIGHT Connections
Oftentimes, once organizations understand the extent of the required data types and their various sources, they must re-contract with their EHR vendor to obtain their data in a format acceptable for sharing. Prices for an interface feed can vary drastically between vendors, ranging from $500 to $30K for a single instance, so it is critical to check costs with both the sending and receiving vendors as well as the number of instances and/or databases within your organization. Many EHRs are set to have a single instance running at each practice, so even if you use a single vendor you may incur individual interface charges, thus substantially raising your costs. Looking at an enterprise model may be a good way to help contain interface cost.
The need for multiple interfaces to send data from a single source also increases interfacing costs. Some vendors have a “per domain” charge or require different formats to send various data types (e.g., separate charges for demographics, results, and claims).
3. Getting the RIGHT Format
A common misconception is that a CCD (Continuity of Card Document) can be used to send all relevant data. Although the use of the CCD format is becoming more popular, there is inconsistency between vendors and many vendors only support producing a CCD on a patient-by-patient basis. Improvement is expected as vendors pursue Stage 2 Meaningful Use certification by adopting Direct and CCDA (Consolidated Clinical Document Architecture), but it’s important to remember that one of the primary uses of Direct remains sending data on a case-by-case basis from one provider to another.
4. Getting the RIGHT Method
A business intelligence or reporting tool can be utilized for data extractions and although effective, it can be a more manual, labor-intensive process.
Organizations can also extract their data directly from the database. With a knowledgeable resource of the EHR’s data architecture, you can obtain almost any type of data needed. Unfortunately, many practices don’t often know the location or credentials needed to access their databases or for remotely hosted EHRs, the database and servers are typically not accessible.
5. Structured data… how much is actually structured?
With Meaningful Use, much of the data needed for quality programs are stored and transmitted as structured data. Unfortunately, establishing the technical foundation for formatting and transmitting data doesn’t guarantee that workflow decisions will seamlessly conform to the exchange or consistency of some data elements.
For example, a patient’s height is stored as a structured piece of data; however, it can be recorded in feet, inches, or cm. In some systems the units can be charted many different ways so you may see data represented as 5’ 4” or 5 ft 4 in. The result is more of a free text field molded to a user’s preference rather than a truly structured field. Similarly, flowsheet and note data can often lead to missing data for quality programs. PHQ-9 scores may be present on a flowsheet or custom template, but may not necessarily be stored in a structured format. Thus, the system doesn’t acknowledge this data as standard, and omits it from a CCD, making it necessary to document data twice.
No one wants to double document or log into multiple systems during a busy clinic day. Single sign-on (SSO) can dramatically improve workflows, allowing users to access multiple systems quickly with a single login. Selecting an EHR with this capability can greatly improve the workflow and adoption of quality programs.
6. Asking the Right Questions
In short, all of these issues are not insurmountable, but they can delay organizational integration. If you haven’t selected an EHR/EMR yet, we suggest knowing the answers to the following questions before making your final decision:
What rights will you have to your data?
What interfacing capabilities does the vendor have?
How much will it cost to integrate your system?
What types of data can be interfaced to and from the system?
Is there a standard format for sending data out of the system?
How often is the data sent, and does it require any manual work to do so?
Are there any workflow considerations you need to be cautious of that can affect the data that is sent?
Being armed with this information will make participation in quality programs more straightforward and potentially make it easier to join a larger organization.
About the Author
Jason Gwizdala is the Director of Services & Support at Wellcentive where this article was first posted. He is responsible for delivering physician-facing, end-to-end population health management solutions that help clients improve both clinical and financial outcomes.