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Embracing Innovation Beyond the EMR for Value-Based Care

News  |  By InterSystems  
   June 14, 2018

Whether you’re on the provider or payer side, or both, making a successful transition from fee-for-service to coordinated, value-based care requires innovative solutions for communication, interoperability, and information sharing. 

Why? Consider these familiar statistics: One study1 showed that a typical Medicare patient sees an average of two primary care providers and five specialists, from four different organizations each year. Another study2 determined that, for a panel of patients with four or more chronic conditions, primary care physicians need to coordinate care with 86 physicians in 36 different practices. Despite the shared care responsibilities, your organization may be the one financially or clinically accountable for all of it.

How will your organization innovate to succeed in this environment, where the information it needs is diverse, dispersed, and frequently changing? Using your electronic medical record (EMR) or claims system is only the starting point. Success in value-based care requires real-time access to all of the information for an individual or a population, from across multiple systems, as a single, unified health record.

The Secret Power of FHIR

It’s rare for healthcare leadership to get down into the weeds of information sharing standards. But support for the FHIR® (Fast Healthcare Information Resources) standard, from the HL7® organization, is critical for rapid innovation.

The key to understanding FHIR and its importance for your organization is to think about the web-based applications you use. E-commerce, airline flight price comparisons, social media, and others rely on accessing data in multiple systems from one point, one client, in real time. FHIR is based on the same technology as these applications and on the definition of data elements and concepts in healthcare. FHIR makes healthcare data truly portable.

FHIR-based applications such as an interactive growth chart for pediatricians and parents, guided data entry for clinicians, or a visual differential diagnosis tool can plug in to a FHIR-enabled unified health record to rapidly deliver new capabilities in a way that the EMR cannot. Gaining this flexibility in how your information can be used to enhance care delivery and outcomes is the secret power of FHIR.

FHIR Accelerant – A Unified Health Record is the Foundation for Innovation

A unified health record is one that brings together patient and population data from EMRs, insurance claim systems, and other sources across the healthcare ecosystem. It makes this complete picture of the patient available as FHIR “resources,” and updates it in real time to serve as the foundation for innovative value-based care solutions.

InterSystems HealthShare customers, for example, are making the transition to value-based care using its unified health record as an innovation environment. Their projects include:

  • Creating a longitudinal health record from multiple EMRs to coordinate care among providers and improve care transitions
  • Identifying strategic performance advantages and network contracting opportunities for a Clinically Integrated Network
  • Optimizing workflow and care team communication
  • Notifying family and friends in real time when a loved one is admitted in the emergency room or hospital, or is transitioned from one care setting to another

Innovate, While Run-the-Business Systems Remain Up and Stable

While deploying new solutions based on the unified health record, the run-the-business EMR or claims systems in these organizations remain up, stable, and secure. For example, Northwell Health, the 14th largest health system in the U.S., has many different EMRs in use across the organization. It leverages a unified health record to bring all this information together to drive better care and lower costs. One such project is Care Tool.

“Prior to the rollout of Care Tool,” said John Bosco, Senior Vice President and Chief Information Officer at Northwell Health, “care managers had to be trained on five different EMRs to be able to manually locate and integrate patient data. Now they have all the information in one place, pre-populated for them on one screen.”

Care Tool results included:

  • 6% fewer readmissions for cardiac valve replacement patients
  • 10-18% more patients discharged to home instead of skilled nursing
  • Up to 56% increase in patients using in-network home care, enabling better control of quality

A Perfect Storm for Value-Based Care

FHIR is more than a pun-worthy, hot new interoperability standard. A unified health record is more than an extra cost you’d rather avoid. Combined, they will enable you to bring together all of the information that matters the most for value-based care, and securely use it to improve clinical and business performance. While FHIR and community-wide unified health records are the future, the systems you have in use now and the standards they depend on will be in place for years to come. New systems you bring on must recognize this fact and, in addition to supporting FHIR, also support the older standards that have brought healthcare information technology this far.

1. New England Journal of Medicine. March 15, 2007. Care Patterns in Medicare and Their Implications for Pay for Performance. Hoangmai H. Pham, M.D., M.P.H., Deborah Schrag, M.D., M.P.H., Ann S. O'Malley, M.D., M.P.H., Beny Wu, M.S., and Peter B. Bach, M.D., M.A.P.P.

2. Ann Intern Med. 2009 Feb 17; 150(4): 236–242. Primary Care Physicians' Links to Other Physicians through Medicare Patients: The Scope of Care Coordination.

InterSystems is the engine behind the world’s most important applications. In healthcare, finance, government, and other sectors where lives and livelihoods are at stake, InterSystems is the power behind what mattersTM. Founded in 1978, InterSystems is a privately held company headquartered in Cambridge, Massachusetts (USA), with offices worldwide, and its software products are used daily by millions of people in more than 80 countries.

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