Greater Houston Healthconnect Coordinates Care Delivery for Millions of Texans

InterSystems, September 24, 2018

Houston has grown to become the third largest city in the United States, renowned for its healthcare institutions — Memorial Hermann, MD Anderson Cancer Center, and Houston Methodist, to name a few.

 

These institutions share their medical records through the Greater Houston Healthconnect, a health information exchange (HIE) with all the major area health systems and the majority of physicians contracted as members.

“Our mission is to assist in the coordination of care throughout Southeast Texas,” says Greater Houston Healthconnect CEO Nick Bonvino, who has significantly expanded the HIE’s membership. For more than eight million people in 24 counties, the not-for-profit also provides diagnostic image sharing, real-time notifications, and the secure exchange of healthcare information via Direct Secure Messaging.

Connecting all the electronic medical records (EMRs) in the vast and diversified healthcare system of Greater Houston is no easy feat, given the number and variety of top-tier EMRs, as well as homespun and legacy systems.

“This underscores the importance of our core mission to connect disparate systems across all venues of care,” Bonvino says.

Not surprisingly, the information management and interoperability challenges grew with the membership and volume of disparate systems and EMRs. The interoperability platform Greater Houston Healthconnect had selected when it first began struggled to meet current and future challenges.

Success with InterSystems, J2

Before coming to Greater Houston Healthconnect, Bonvino had worked with HIEs in other states, where he evaluated InterSystems technology. When the Texas HIE began a procurement process for a new platform, Bonvino was sure to include InterSystems.

Greater Houston Healthconnect selected InterSystems HealthShare® to connect the disparate systems among its members and uniquely identify patients represented differently across many providers. For the implementation, it contracted with J2 Interactive, a software development and IT consulting firm that is a longtime InterSystems partner.

“Platform migrations are never easy, but J2 Interactive, in close partnership with InterSystems and Greater Houston Healthconnect, was able to complete a successful migration with an ambitious timeline with no service disruption to existing stakeholders,” adds Mickey Yalon, Vice President and Chief Technology Officer at J2 Interactive.

A Unified Solution

HealthShare seamlessly connects 70 percent of the region’s physician community and 95 percent of the hospital market to the same unified health record, so providers have an accurate, straightforward view of nearly every patient in the Greater Houston area.

“HealthShare allows us to coordinate care delivery to millions of people in Greater Houston, and is essential in disaster preparedness, as we proved during Hurricane Harvey,” says Bonvino.

There are several ways this technology has impacted the community, according to Bonvino. It has had a direct impact on quality, efficiency, and patient safety. With a complete picture of a patient’s medical history at the point of care, physicians can better assess, diagnose, and create care plans that address a patient’s health issues without unnecessary tests, procedures, or admissions.

Bonvino describes HealthShare as “the core infrastructure of our business” and is looking for other ways to leverage the technology — for example, to prevent hospital readmissions and promote value-based care.

Embracing Innovation Beyond the EMR for Value-Based Care

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. http://www.nejm.org/doi/full/10.1056/NEJMsa063979

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. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3718023/