Interoperability and Population Health: Working Across Disparate Systems To Impact Care Delivery

Healthcare consolidation trends 

Healthcare has become more competitive as new entrants raise the expectations of patients with innovations in convenience and access. Additionally, as Centers for Medicare & Medicaid Services (CMS) looks for ways to cut costs and reimagine reimbursement, HCOs are forced to rely on their market share to negotiate higher reimbursement rates with commercial payers to stay afloat. Meanwhile, many smaller organizations, especially those in rural areas already struggling to survive and further devastated by the COVID-19 pandemic, have been forced to merge or shut down entirely, leaving their communities without convenient care options.

According to Healthcare Finance, “In 2021, 31% of CFOs plan to acquire physician practices, 30% want to join a clinically integrated network, 28% expect to merge with another organization, 24% plan to enter into a joint venture, 20% may need to sell to another organization and 17% expect to acquire another organization.”

What are the population health and interoperability consequences of acquisitions, mergers, and partnerships between healthcare organizations?

Although there are many financial and operational challenges associated with acquisitions, mergers, and partnerships, we will focus on the population health strategy and interoperability challenges related to multiple EHRs.

Regardless of the type of relationship formed in these transactions, one challenge is always present: How do you get everyone using the same EHR or, at least, sharing clinical data between systems to allow for seamless care delivery? Even when the organizations and practices involved in the relationship use the same EHR vendor, this remains a problem, because customizations make it difficult to effectively share data and standardize workflows across the newly formed system. This leads to the question: Why not all be on the same EHR instance?

There are a variety of reasons why these organizations remain on different EHRs, but they can all be boiled down to cost, resources, culture, and change management concerns. Let’s break it down:

• Cost: This is a hugely expensive endeavor and the question of who is going to pay for the conversion is always top of mind, especially for smaller organizations.
• Resources: All organizations have a never-ending list of infrastructure priorities, and an EHR conversion or data exchange is another item that must be added to the long list. Large IT projects are major lifts for all parties involved, so aligning those priorities and resources is another challenge that often quashes conversion efforts.
• Culture and change management: Every organization or practice that purchases an EHR will have it customized to their specific workflows, often resulting in hesitation and unwillingness on the part of the smaller entity to give up what they know.

Why is having multiple EHRs a problem?

The COVID-19 pandemic has positioned population health and value-based care at the forefront of every healthcare leader’s mind. Since the main pillars of population health are data analytics, streamlined workflows, and patient engagement, having access to consistent and reliable data is key. The lack of a shared EHR and an effective data exchange mechanism can stand in the way of this goal for the following reasons:

• Lack of standardized care and processes: A shared EHR will have standardized documentation practices, workflows, point of care reminders, and reporting tools. This ensures that, regardless of where a patient is seen in the system, they receive a consistent, high-quality experience which they have come to expect from their provider, especially at reputable organizations. In addition, ineffective or incomplete data exchange can lead to fragmented delivery of care.
• Difficulty in carrying out population health and value-based care strategies: Population health and value-based care strategies are largely dependent on analytics to drive initiatives and track performance. The quality and usability of data rely on having the same EHR or accurate data mapping to ensure a one-to-one match. Otherwise, there is a lack of visibility, incomplete or fragmented reporting, poor performance in value-based care contracts, revenue loss, and gaps in care delivery.
• Impact on patient care and patient satisfaction: At the end of the day, the focus should be on patient care and patient satisfaction. Lab mix-ups and records transfer delays, as examples, are not only burdensome to the patient, but these issues also impact their ability to receive necessary care. Fragmented care frustrates both providers and patients. It also impacts the overall reputation of an organization.

How can this be fixed?

Although the end goal may be to get the entire health system on the same EHR, the reality is that this may not be immediately feasible, so it’s important to find solutions for the here and now. However, this is a very complex issue involving entities that often vary greatly in terms of their financial and technical ability and cultural identities.

There is no out-of-the-box solution that will work for everyone. The selection process resembles more of a buffet where providers can pick and choose through a spectrum of options to find a sustainable working solution. The most successful strategies will include some mixture of technical and operational components.

Some of these options are outlined below, using a hospital with the Epic EHR as the example:

Technical:

• Host organizations can offer affordably priced Community Connect options for instance alignment, standardized workflows and documentation practices, and a shared data source.
• Host organizations can offer EpicCare Link and/or Healthy Planet Link options to non-Epic organizations so they can keep their non-Epic vendor for their daily work and use Link options for care coordination and performance and quality tracking.
• Epic organizations on a different instance and non-Epic organizations can utilize Care Everywhere functionality to send relevant clinical data to the host organization to gain visibility into clinical care, population health, and other regulatory reporting.
• Organizations can set up a Health Information Service Provider (HISP) and/or join Care Equality as part of their Meaningful Use infrastructure. This will help with data exchange, allowing visibility into non-Epic practices.
• If none of the above options are available, custom development integration is also a possibility, allowing data exchange between the host organization and affiliates.
• In addition to the data exchange pieces of the equation, a non-manual reporting tool can help with communication, care delivery, and performance tracking between the organizations.

Operational:

• A major consideration in adoption and sustainability is understanding the needs of the affiliate organization and meeting them where they are.
• Since many of the smaller practices may not be able to afford comprehensive technical solutions, the best option may be electronic reporting and optimized workflows that incorporate data to support population health initiatives and streamlined patient care.
• A solid change management strategy should assess workflows, as well as an affiliate’s readiness, to adopt new technology, whether that technology is a spreadsheet, an interface, or an entirely new system.

Summary

The consolidation of HCOs shows no signs of slowing down, which means the number of organizations facing the multi-EHR problem will continue to grow. With population health and value-based care at the forefront of healthcare, don’t get left behind. Start exploring your options to stop the frustration and deliver seamless care across your health system.