By Bill Gillis, CIO, Beth Israel Deaconess Care Organization
While these may be uncertain times for the health care industry, technology leaders in the field continue to aggressively move forward — upgrading services and IT infrastructure in order to meet the needs and challenges that the industry will face in the near- and distant future.
At Beth Israel Deaconess Care Organization (BIDCO), an independent, value-based physician and hospital network and Accountable Care Organization (ACO) outside Boston, Massachusetts, that means continually updating, refining, and investing in information technology to provide real-time data analytics that improve quality of care and reduce overall health care costs.
This summer, after years of creating disparate quality data feeds from a network of more than 2,500 physicians across Massachusetts to a centralized cloud-based data repository, BIDCO launched an industry-leading population health management platform. The new platform is designed to integrate diverse data sets from all electronic health record systems (EHR) used by BIDCO physicians in real-time. The goal is to arm physicians with timely, accurate, and comprehensive analytics they can use to improve clinical and quality outcomes and financial performance.
A Look Back
To understand the significance of this next-generation platform, it’s important to acknowledge the hurdles BIDCO faced and overcame in earlier years. In 2007, BIDCO was among the first in the health care industry to build and implement its own home-grown cloud-based EHR platform. The platform was offered to all physician practices in the network that were still using paper. However, we still had significant interoperability and quality challenges — gathering, normalizing, and validating clinical data from the remaining physician practices that were already using commercial EHR systems. There were 45 different systems and each offered varying levels of access to data, and presented data in an assortment of formats.
BIDCO has since changed its policy around which EHRs its practices can use. In the past, practices could enter the BIDCO system as long as they had a Meaningful Use-certified EHR. Under the new policy, practices must use one of five EHRs or the internally developed WebOMR. The approved EHR vendors all have a solid data delivery mechanism and worked with BIDCO to normalize code sets and committed to interoperability. BIDCO now has the ability to build clinical viewers, so that from within one system you can query those other systems and see problems, meds, and allergies on a patient in that other system.
The Quality Conundrum
The next set of challenges presented was profound errors and gaps in the collected data. And the wide-range of information needed to meet complex quality measures in risk-based contracts, whether federal, state, local or commercial contracts, wasn’t always included. Even when it was – it wasn’t always accurate. These issues threatened to derail our efforts to draw value from health care data sets to improve population health.
To address the issue head on BIDCO researched the data quality problems during data captures, structuring, and transport and in the end, successfully identified integrity issues where the EHR failed to deliver expected patient encounter data needed in the reports in order to validate all the various quality standards requirements included in risk-based contracts were being met. Some issues arose as a result of reporting configurations that failed to transmit crucial information. Others were the result of clinical practices, organizational workflows, user errors and other issues.
The Big Data Fix
To effectively address data quality issues, BIDCO developed a standard delivery requirement to ensure all necessary data was delivered to our Quality Data Center as expected. We added new structured fields within the EHRs that mapped to how providers were capturing information in their system, and created EHR optimization teams that worked directly with physician practices to build consistent, reliable data feeds. With trustworthy data in hand, BIDCO could run system-wide analytics that harnessed the power to truly improve health care quality – both at the individual patient level and across populations. In 2013, BIDCO was ranked the #1 performing Pioneer ACO in Massachusetts and #3 in the country.
A Solid Foundation
With a solid foundation in place, BIDCO built on our HIT success by partnering with Arcadia Healthcare Solutions to develop a new, advanced big data analytics and population health management platform. The goal was to build an industry-leading solution that would move BIDCO hospitals and physicians one step closer to realizing the promise of big data analytics.
The updated platform, which went live in August, merges larger volumes and variety of data, including clinical, ambulatory, Admit/Discharge/Transfer, and scheduling data from various hospitals and physician practices in real-time.
What’s more, the data is collected faster, making it more actionable. Prior to the new system, BIDCO received clinical data feeds from physician practice EHR systems on a weekly basis. With the new system in place, clinical care management teams will receive data-driven insights based on information that flows into the system daily, where it will be reconciled with claims data within 24 hours of receipt. This enhanced ability to capture substantial amounts of accurate data from a variety of sources and structures more quickly and efficiently than ever before will move BIDCO and the whole health care industry one step closer to realizing the full potential of data analytics and population health.
A Model Of Success
The benefits of more sophisticated, timely, and accurate data gathering and shared communication capability comes at an important juncture in the health care delivery. Although the debate and uncertainty surrounding the future of the Affordable Care Act continues on, most agree that the transition away from fee-for-service payment models toward value-based care is critical to provide more patients with high-quality care at an affordable price.
Experts agree that population health is the key to enabling success in value and risk-based payment structures, but the challenge of becoming a value-based organization is often underestimated. Success relies not only on providing effective and efficient clinical care, but developing sophisticated information technology tools to allow better coordination of care, information sharing, and perhaps most importantly data analytics.
At BIDCO, it has taken us years to get to the point we are today – and work remains to be done – but we are about to enter a new era of health IT. We continue to plow forward, building for the future and blazing a path we hope others will follow.