Establishing a business oriented taxonomy to define data integration requirements
Population health management (PHM) continues to evolve as health plans accelerate implementation of advanced analytics, configurable care management systems and intelligent engagement solutions. The underlying foundation along with these system updates is increased data access. Clinical interoperability has long been a talking point in the industry and through its realization, organizations are finally beginning to benefit from integration between provider EMRs and health plans.
In many ways, this is the new frontier for PHM as industry standards and updated systems provide real-time interface opportunities. Seamless integration and timely access to clinical and transitions of care events enable the health plan to optimize their PHM operations while simultaneously improving quality through comprehensive member summaries and real-time activity awareness. This aligns to the PHM care team’s desire for complete longitudinal views of the member’s health journey, and their ability to prioritize engagement and intervention opportunities.
The challenge becomes prioritization of clinical interoperability opportunities and overcoming communication breakdowns between the business and technical teams. While everyone shares the same end goal—harnessing data to improve care and keep members healthier—the two groups often lack a common language to get from point A to point B. The business team often perceives the need to access all data while the technical team weighs the level of effort and challenges related to establishing secure partnerships across company and organizational boundaries. Requirements definition is often further challenged by discussions about data hygiene, ownership, source-of-truth and field alignment considerations.
To bridge the gap, I employ an easy acronym to outline the four categories of clinical interoperability: NOER. Broadly, each letter represents one of four data integration methods while providing a common language to discuss the degree of integration required to meet the business need. The simple mnemonic also alludes to one of our population health missions—KNOWLEDGE: to focus on and improve member wellness before major health issues arise.
NOER: A clinical interoperability roadmap
I define the four methods of NOER for PHM clinical interoperability as:
- N: Notification
- O: Observation
- E: Exchange
- R: Reconciliation
The NOER roadmap defines degrees of integration that can advance clinical interoperability while ensuring data is transferred only when required. Simply put, we want to ensure that the right people get the right information at the right time while also maintaining clinical data integrity within our systems.
• N: Notification
“Notification” is where I believe we have the greatest immediate opportunity. From a data perspective, it’s “small data” but the potential for significant impact is high. The emphasis is on the transmission of events and alerts between one or more systems to ensure team member awareness and to trigger one or more workflows. Significant opportunities exist to drive complex workflows and to improve efficiency by exchanging event triggers through standards-based interfaces or real-time system integration. For example, a care management platform may receive an HL7 ADT (admit, discharge, transfer) message indicating that a member has been admitted to the hospital. Using the “Notification” event alone can be beneficial to alert the care team on the member’s location, to place scheduled PHM activities on hold and to initiate discharge planning. Throughout the healthcare ecosystem, these events and alerts have the potential to improve outcomes by getting a patient’s entire PHM care team aligned at the moment care is being delivered rather than after the fact.
• O: Observation
“Observation” provides the PHM care team or the provider with a read-only view of information from one or more systems. The data may be accessed or received in a structured format, but it is viewed and optionally stored as a summary. Using an on-demand request process presents a current comprehensive summary view while maintaining the clinical integrity of the member’s record. An “Observation” example includes a role-based member summary using an enhanced Continuity of Care Document (CCD). In this case, the CCD structure can be augmented and transformed from a structured XML format to a read-only view for analysis along with creation of a PDF for historical reference in the member record. The real-time nature and enhanced summary provide a vast improvement over the previous use of fax or scanned information that must be pieced together.
• E: Exchange
The “Exchange” method is historically the most common, and it is generally the approach business teams initially request. Clinical interoperability becomes much more challenging when we start to consider transferring structured data from one system to another. There are many benefits if the data can be scrubbed, aligned and imported into PHM systems but these results are often overshadowed by the technical uplift required to ensure data integrity and system stability. Technical teams often try to avoid moving data throughout the enterprise, but this has historically been required for most legacy systems to operate. Advanced analytics solutions are often very capable of consuming diverse data sources while many other systems, such as EMRs and care management systems, traditionally have been more restrictive in order to maintain the clinical data integrity of the member’s record. Using our previous examples, the “Exchange” method could use additional structured information within the HL7 ADT message to create an inpatient authorization, and the enhanced CCD document could directly populate care management platform fields such as medications.
• R: Reconciliation
“Reconciliation” provides an alternative option for information from multiple sources to be presented in a summary for interim review before it is merged into a single record. Using this method the business team benefits from the integration of structured data while also ensuring that clinical judgement can be utilized to validate the final result. From a technical perspective, the initial development of a summary representation is more challenging but the usage model provides an effective approach to maintain data integrity within the target system. Automation techniques can further augment this method to guide and improve the review process. An example of a “Reconciliation” approach would be the visual presentation of member medications from multiple source systems that enables a pharmacist to review and reconcile the final list before submission to the member record.
Establishing Common Ground
This is an exciting time in our industry as clinical interoperability between providers and health plans becomes a reality. There are significant opportunities to improve PHM efforts and to improve the quality of care provided for members. Using the NOER framework, business and technical teams can have a common language to both bridge understanding and evaluate business opportunities and data integration methods. Together, they can weigh the challenges and effectively identify the integrations that will have the greatest impact on member care.