Advancing Interoperability to Reduce Provider Burden and Improve Patient Care
When patient data is fragmented across many providers, it is challenging to coordinate effective care, from both a quality and a cost perspective. The advent of value based care systems has made information sharing a more important metric of success. However, it is true interoperability—the ability for large networks to communicate with one another—that will deliver on the promise of "interconnected intelligence." Fresenius Medical Care North America (FMCNA) is working with a consortium of other healthcare organizations to develop common standards and a practical framework for seamless data exchange.
With patient data coming from multiple venues of care, nephrologists are challenged with "connecting the dots" as well as coordinating across diverse providers to deliver quality patient care. There is a pressing need to advance interoperability and data sharing across information silos to reduce the provider burden.Acumen 2.0 powered by Epic Systems, in conjunction with FMCNA's broader interoperability program, is providing one version of "interconnected intelligence" to meet this need.
Timely and relevant access to patient data is a key requirement in providing quality care for chronic kidney disease (CKD) and end stage renal disease patients.1Early CKD stage identification and progression management rely on accurate and relevant lab data. Empowering patients to make informed decisions on modality choice requires monitoring CKD progression and referral for patient education.2Optimal dialysis starts at home or with an arteriovenous (AV) fistula instead of central venous catheter (CVC) and is predicated on timely referral of CKD patients for vascular access.3
Looking ahead, the transition to value based care is dependent on the ability to aggregate and analyze population-level data to improve quality outcomes with smarter spending. The promise of personalized, precise renal disease care with targeted interventions tailored to individual patient needs requires the ability to manage clinical data sets longitudinally. Simply put, current and future goals for patient care require a holistic view of the records that "follow the patient," offering a comprehensive view of the patient journey as well as support for the nephrologist. To do this, we need to design and deliver data sets that transcend the physical walls of care venues—be it the CKD clinic, the patient's home, the dialysis unit, or an inpatient facility.
The current reality of health information technology is that patient information is largely siloed and fragmented across the multiple systems and disparate venues of care that the patient encounters. For clinicians taking care of patients with a complex mix of chronic medical issues, depression, cognitive decline, functional impairment, and adverse social determinants of health, the time required to communicate with extended care teams is not reimbursed in a fee-for-service structure. As a result, patients are treated by a federation of service providers each doing their best to meet the needs of the individual but also meet their financial goals.
For care providers with many competing priorities, there may be no compelling business case to implement communication standards; doing so has often come at the opportunity cost of other reimbursable services. The transition to value based care models and shift toward "value and outcomes rather than units" has provided the impetus to establish communication standards and to increase information sharing. Providers need portable, integrated patient records that encompass data, regardless of the physical space where the data originated. This information should also be presented to the right clinician at the right time in a workflow-friendly fashion.
According to the 21st Century Cures Act, the term interoperability means health information technology that allows for both the exchange and use of information between two or more systems.4More specifically, health information exchange (HIE) often refers to exchanging information between two or more healthcare organizations or providers. Sometimes, HIE may also refer to an organization that is responsible for facilitating this exchange when conducted in a particular way. This means that interoperability is different than health information exchange. Exchange is necessary for interoperability, but it is not sufficient by itself to achieve health information interoperability.
Interoperability occurs when information flows appropriately across organizational, vendor, and geographic barriers and is retrievable and consumable by clinicians for patient care. The emerging goal is to advance interoperability and systematically present relevant patient data in the context of a provider workflow. FMCNA has partnered with Epic to develop Acumen 2.0—the next generation of nephrology practice electronic health record (EHR) system—specifically to achieve these objectives forits physician customers.5Acumen 2.0 is a single instance of Epic with logical separation across independent nephrology practices within the system. By connecting with Epic's industry leading CareEverywhere network, Acumen 2.0 allows for interoperabilty with other Epic instances and provides several value propositions:
- Meeting CMS quality metrics for Promoting Interoperability
This is achieved through consuming outside records; supporting electronic referral loops by receiving and incorporating health information; and reconciling problems, allergies, and medications. Figure 1 shows the range of interoperability options and value delivered by Acumen 2.0.
FIGURE 1| Acumen 2.0 interoperability value continuum
