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In the East Bay, Two Health Systems Are Building a Virtual Safety Net to Better Coordinate Care for ER Patients

June 22, 2016
by Heather Landi
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Using a data-sharing platform, emergency department providers at two hospitals have identified 900 shared patients that had five or more ED visits in the past year.
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Through a pilot project, Six East Bay hospitals are collaborating on the use of a data analytics tool that enables emergency departments at disparate health systems to share real-time patient data to improve care coordination for complex patients, such as homeless individuals who are often high utilizers of emergency care.

The six hospitals—four are part of the Sacramento-based Sutter Health system and two are part of Oakland-based Alameda Health System—have deployed PreManageED, a technology platform that serves as a virtual safety net to help providers facilitate collaborative care coordination for patients who turn to emergency rooms as the first point of contact for healthcare, sometimes as frequently as three times per week or more. Often, many of these high utilizer patients may not have the resources to navigate the healthcare system due to housing insecurity and other social barriers.

The data-sharing platform, designed by Sandy, Utah-based Collective Medical Technologies, enables ED providers and their teams at six hospitals in the East Bay area of Northern California to securely share health records, care plans and other relevant patient data between emergency rooms in real time.

According to Arthur Sorrell, M.D., physician informaticist at Sutter Health and physician chair of the Sutter Emergency Department Leadership Council, the technology is closing a communication gap that typically exists in emergency rooms across the country with the goal of ultimately closing gaps in care.

Patients who are high utilizers of emergency room care pose a significant challenge to hospitals and healthcare systems. Often, these vulnerable patients, such as homeless individuals, will frequently visit emergency rooms at several different hospitals and at different health systems in a geographic region, such as the East Bay, but ED providers often do not have easy access to other hospitals and health systems’ patient records to understand what care was provided to the patient.

“These patients typically utilize the ER because, one, it’s their only access to the healthcare system, and two, they don’t have a medical home and don’t benefit from care coordination. Some of the may have complex medical conditions that are purely medical issues and some have psycho-social issues. We don’t have a good way of either identifying the population that is the most frequent utilizers and identifying those that would most benefit from interventions so we know where to target our limited resources,” Sorrell says.

Participating hospitals in this collaborative initiative are Alta Bates Summit Medical Center - Summit Campus in Oakland, Alta Bates Summit Medical Center - Ashby Campus in Berkeley, Sutter Delta Medical Center in Antioch and Eden Medical Center in Castro Valley, all within the Sutter Health system as well as Highland Hospital in Oakland and San Leandro Hospital in San Leandro, which are part of the Alameda Health System.

According to Chris Klomp, CEO of Collective Medical Technologies, the health IT vendor partner, the idea for the collaborative technology partnership was conceived when health leaders across the Bay Area, including Better Health East Bay, Sutter Health’s philanthropic foundation partner in the East Bay as well as Sutter’s Research, Development and Dissemination (RD&D) division, came together to discuss how to best care for complex patients. “We were talking about it less from a pure interoperability perspective and more about how do we actually start a collaboration across providers in order to not only identify complex patients via high utilizers or individuals suffering from other complexities, but then also enable providers to interact with one collective effort, irrespective of their provider organization, to make sure the needs of the patients are met,” Klomp says.

In addition to the patient care challenges, on a national basis, the overuse of emergency rooms results in $38 billion in unnecessary expense annually, according to data from the New England Healthcare Institute.

The data-sharing platform fills a niche in the expanding world of interoperability, Sorrell says, as the data analytics tool enables providers to target, in real-time, the high frequency ER utilizers. “So that I, as a provider, can see right away that a patient has been not only at our ER recently, but other hospitals’ ERs in our geographic vicinity, where they might be frequent utilizers there as well, and the data tells me what happened during those visits.”

The data-sharing platform specifically caters to the needs of emergency care providers by fitting into ED physicians' workflow and providing data for care coordination in an efficient way, according to Sorrell. Typically, when Sorrell requests a patient’s health record from another hospital, he will receive 20 to 50 faxed pages. “Buried in there is one page that is going to answer my question,” he says.

The technology platform utilizes a basic provider-level tool, Health Level Seven (HL7) Admission, Discharge and Transfer (ADT) messages. The PreManage ED system extracts ADT data, aggregates it and applies real-time analytics to identify risk patterns and high-risk patients and pushes a flag into the ADT tracking board of each hospital’s respective electronic health record (EHR) system. Essentially, according to Sorrell, the data-sharing platform gets ED providers across different hospitals and health systems “on the same page” to provide patients with a consistent set of care interventions to treat their needs.