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When an EHR Isn’t Enough

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The healthcare industry’s transition away from a fee-for-service environment has spawned a litany of new care models. Patient-centered medical homes (PCMHs), accountable care organizations (ACOs), and the like may differ in certain respects, but they all share a common goal – to improve the quality of patient care and reduce costs through better coordination.

Another thing they have in common? They need the right IT system to be effective.

Technology provides the capabilities, connectivity, and infrastructure that allow organizations to operate under new models of care and payments. And as these models emerge and evolve, the technology used to enable them must change as well. The EHR, for example, has enabled providers to coordinate patient care throughout a hospital. But in a value-based world, patient care extends beyond the walls of the hospital and into the community, requiring a different level of coordination.

In a follow-up to an article he wrote for hfm Magazine, ECG Senior Manager Roey Moran talks about what it means to move beyond the EHR and into a system that can exchange data across a network of partners.

In your article, you talk about moving “beyond the EHR.” Are you saying EHRs are becoming less viable as technology?

Not at all. EHRs are indispensable. They are the reason we can even talk about concepts like coordinated care and data exchange. But EHRs were designed to do something very specific – channel the flow of patient documentation among the various stations of care within the hospital. In a world where providers are expected to engage in coordinated care and value-based payments, the underlying capabilities go beyond the hospital. Hospitals have to exchange data with primary care physicians, nursing homes, and in many cases even community-based organizations. Getting the best EHR out there might be nice, but it won’t necessarily be a big differentiator, since providers can’t control what platforms their outside partners are using. This is why we talk about thinking “beyond the EHR.”

As you explain in the article, moving beyond the EHR means developing an integrated delivery system (IDS). First, how would you define an IDS, and what is its goal?

An IDS is a group of providers that form a complete continuum of coordinated care, with the patient at the center. That means connecting primary care, specialty care, prevention, post-acute care, and others, and trying to shift the patient from costly ED visits and preventable hospitalization. The transition to value-based payments increases the formation of these IDSs, because organizations can’t really engage in value-based initiatives on their own. They need a network of partners.

And certainly, that requires an extensive IT design. How does an organization begin such an initiative?

A good place to begin all IT discussions is outside of IT. That may sound funny, because we’re talking about IT design. But the worst thing an organization can do is to go on a shopping spree of advanced platforms without first understanding what it wants to do from an operational or strategic standpoint.

Instead, start by getting executives together that represent administration, care coordination, finance, and the partners that you’re going to be bringing to the table – and IT – and decide on an area or population to focus on. Then start walking through detailed, patient-based scenarios: come up with an imaginary patient, give the patient a name, and create a whole story for that patient. For example, say it’s a patient who’s an ED “frequent flier.” When that patient gets sick, his or her first instinct would be just to go to the ED. But then comes the question – what mechanisms can you put in place to keep the patient away from the ED and steer him or her toward primary care and prevention?

What role does IT play at this point?

Your IT team is there to explain what technology you need to make all of this happen. In these discussions, you gradually uncover that you need a way to identify and be in touch with the patient. You also need some kind of care coordination hub, maybe one that covers your entire population. If you expect to proactively identify the patient based on levels of risk, then you need some kind of analytics engine. If you need to monitor your patient over time and engage with the patient outside of the clinic or the ED, then you’re talking about patient portals and connecting all the caregivers who are in your continuum.

What you have at this point is an interaction model that tells you how all the pieces need to come together from an operating perspective. Then as you move into a more detailed IT design, your IT team can help translate all those high-level concepts of care coordination and patient engagement into specific tools, such as a case management platform, an analytics management platform, a health information exchange, and so forth.

By the end of this process you get a fairly quick, fairly detailed blueprint for IDS design – within several weeks, not months – which you can use in your conversations with a vendor. It’s a good way to make sure you control the conversation over what you need, and not the vendor.

We’ve been talking about IDSs in the context of larger networks with multiple partners. Does this scenario-based approach work in smaller environments, or for less ambitious initiatives?

It sounds cliché, but when it comes to designing your network and the supporting technology, there’s no one-size-fits-all solution. And that’s why you have to engage in these discussions – to understand what it is you’re trying to implement. If an organization is trying to implement full-scale population health management, involving scores of partners, its needs are going to be very different than an organization that just wants to engage in bundled payments with a limited number of partners. If you’re in the latter category, and your partners happen to use the same EHR you’re using, maybe an optimization of your existing EHR is enough. In that case you’re not yet going beyond the EHR but discovering that your EHR actually suffices.

Roey Moran is a Senior Manager with ECG. For deeper insights into integrated delivery systems, download his hfm article here.

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