By John DeGaspari
Achieving interoperability can be challenging in a healthcare setting, as Intel recognized with the launch of a homegrown ACO this year. An inside look at its initiative sheds light on the approaches the company took to addressing those challenges.
The company launched an employee health program in January called Connected Care, in Hillsboro, Oregon, according to a recently published whitepaper. In that initiative, Intel formed a partnership with two Oregon hospital systems--Kaiser Permanente Northwest and Providence Health & Services--and a separate ambulatory system--The Portland Clinic--all of which used separate instances of Epic's EHR. Intel's system also encompassed two on-site Health for Life Centers which functioned as walk-in clinics, which used Greenway Health's PrimeSuite as their EHR.
One of the key goals in Oregon was the ability to share patient data among the provider organizations. The Portland region does not have a health information exchange (HIE) to facilitate data exchange, so the company worked with the provider organizations, as well as the EHR vendors, to coordinate workflows across the board.
Earlier this year, David Blumenthal, president of the Commonwealth Fund and former National Coordinator for Health IT, called for a "more modern infrastructure to support care coordination between providers."
Industry-wide, lack interoperability continues to be an issue. As FierceHealthIT reported in April, research has found that both clinical site and content vendor groups are frustrated that more progress has not been made by EHR vendors on interoperability and use of standard protocols.
The Intel team faced several implementation challenges. Originally, the providers had read-only patient charts. One of the hospitals needed to be onboarded to Healtheway. Incompatible health information service providers (HISPs) needed to be harmonized. And incompatible consolidated clinical documentation architectures needed to be harmonized.
Four teams of experts from Kaiser, Providence, Health for Life Centers and Intel were established. Two of the provider partners--Providence and Kaiser--already were using the eHealth exchange, while The Portland Clinic and Premise Health onboarded. Direct messaging workflows were established between the on-site clinics and the provider organizations. Clinicians at the Health for Life Centers queried the providers for the employees in real time using pull workflows. And Direct messaging allows the clinicians at the Health for Life Centers to communicate using push workflows over secure email and exchange clinical data.
During the first quarter of operation, Kaiser and Providence Connected care members represented 65 percent of the total patient visits to the Health for Life Centers, confirming the need for interoperability. There also was significant bi-directional communication. Health for Life Center concierges pushed continuity of care (CCD) documents via Direct messaging to the partners, averaging 4.9 times daily; and pulled or queried for CCDs an average of 15.7 times per day, returning data 73 percent of the time. Kaiser queried the Health for Life Centers for 413 patients, and the CCD was returned 302 times; most of the errors were due to time-out errors due to a mismatch between system settings.
To learn more:
- read the whitepaper here (.pdf)