Technological advancements in health data sharing are needed to help Oregon providers support patients more efficiently.
Health leaders discussed the state’s interoperability needs at the 2023 Oregon State of Reform Health Policy Conference. Project Access NOW CEO Carly Hood-Ronick said as healthcare continues to evolve, the volume of work and referrals sent to community-based organizations (CBOs) will continue to increase.
“So it becomes increasingly important that we have systems where health systems and payers can talk to CBOs and do so in an efficient manner,” Hood-Ronick said. “And yet today, our experience as a CBO is that things continue to be very siloed. The data we have access to on the ground is really limited. And often our partners send us referrals and we don’t know what happens to the person. We don’t know if they land in the emergency room (ER).”
Heidi Kriz, director of medical policy and medical management at Cambia Health Solutions (Regence), said proprietary standards have required providers to have to use too many different patient portals.
“And what you do for one health plan doesn’t work for another health plan,” Kriz said. “That’s the problem we’re essentially trying to solve right now. The payers have their medical management systems and providers are operating within their EMRs (electronic medical records). We need to be able to talk together. If we can have true interoperability, which we would refer to as open standards, and use the same data format, we can start to (use) that across health plans (and) across providers. CBOs can communicate to each other. That wraps around to give the best care to patients.”
Many health centers refer patients who are at risk of facing eviction to Project Access NOW, which tries to help them with housing needs, Hood-Ronick said.
“We then have to navigate them to a different referral system to get permission from the (coordinated care organization) to pay for that resource. Our staff spends a lot of time navigating a lot of different referral platforms. And the approval can take additional time. And that person may be evicted or not land in the housing they need to stay well. There’s a lot of opportunity for co-design. Our health systems have done a good job of utilizing EMR platforms and are beginning to harness the power of technology. That’s never happened on the CBO level.”
— Hood-Ronick
Briar Ertz-Berger, medical director of social health and quality management at Kaiser Permanente, said the organization continually looks for opportunities to co-design.
“We in medicine, in the standing of the (ER), are always looking for partners on the outside to help us with the person who is standing in front of us, often coming to us with problems that can’t be solved with an X-ray, morphine, or the reduction of their shoulder dislocation,” Ertz-Berger said.
Ertz-Berger discussed some data integrations that have improved her work practices.
“I have access to care everywhere in the work I do,” she said. “We’re on Epic at Kaiser to connect to other organizations that are on Epic. It becomes very helpful to me when I’m trying to transfer a patient. I work at our transfer center. I have numerous transfers throughout the day, and more and more we’re getting transfers who are not Kaiser patients because access to hospital beds is incredibly tight.”
Epic’s Care Everywhere allows providers to securely access and update records from other healthcare organizations. Ertz-Berger said it allows her to more effectively care for her patients.
“I can go to the Care Everywhere tab and see the patient’s medical history,” she said. “I get to take care of this patient without being blind. Care Everywhere has allowed us to practice much safer, and much more affordable healthcare. You’re avoiding redundant care.”
Another health information exchange Ertz-Berger uses is PointClickCare.
“Their data feed connects every hospital in Oregon, Washington, and many other states,” she said. “As soon as a patient is registered in the ER, I’m able to see a lot of information about them, including where they have been recently, and (if) they’ve gotten Schedule 2 drugs.”
Regence began using Fast Healthcare Interoperability Resources (FHIR) last year, Kriz said.
“It’s basically a common data standard that we can use to all speak the same language to each other. When we get into proprietary workflows, they all have their own data standard. And that’s what has gotten us into the trouble in healthcare that exists today. We went live in 2022. There’s a movement right now to accelerate the work to other health plans and providers. Everybody complains about prior authorization so we’re trying to make it better. But we need partners to come to the table.”
— Kriz
A group of payers, providers, and technology vendors have collaborated to form the Da Vinci Health Record Exchange, using FHIR to try to solve complex data exchange issues and problems, Kriz said.
“If we use FHIR, we can all communicate together and get away from the proprietary workflows,” she said. “Our largest provider is MultiCare Health System in Washington. And we are giving them immediate responses on prior authorization. It’s a direct payer-to-provider EMR exchange. We broke down a lot of siloes between the payer and provider.”
Comagine Health Medical Director Dr. Richard Gibson said the organization is working with its two founding partners to design a community health data utility.
“What we’re trying to do is put healthcare data and social determinants of health data in one place so CBOs can have full client information as they plan to provide services to a client,” Gibson said. “With that, CBOs could see incoming clients’ healthcare information. The CBOs could also see which other providers and agencies have seen that client previously.
And up front, even before the client comes in, the CBO can get a sense of what all the client’s needs are, what has been attended to, and what’s still open and should be addressed. CBOs would be able to get periodic reports on client needs and services to help their own agency plan for the future.”