Just recently, the Sacramento, Calif.-based Sutter Health announced a significant step to improving care coordination and clinical quality across Northern California: the launch of a fully-integrated health information exchange (HIE) system.
Currently, the Sutter Health electronic health record (EHR) from Epic connects five medical foundations and 17 hospital campuses. By 2015, it expects to complete its EHR installation to better support care delivery to three million active patients in more than 100 northern California cities and towns, its officials said in the announcement. An HIE system that integrates Sutter’s EHR with other providers’ systems will help Northern California caregivers improve quality, safety and efficiency for all patients traveling between providers, the organization’s officials said.
Sutter Health is working with Orion Health to build and deploy its HIE, and will begin its work this summer in phases. The first step involves basic data integration with the Sutter EHR as well as testing the exchange of inbound and outbound data to ensure quality.
Like many organizations, Sutter has been exchanging data for years, using the Epic platform, says the health system’s CMIO, Chris Jaeger, M.D. “But then in 2012, we began exploring the potential use of an enterprise HIE solution to broaden our exchange efforts.” Jaeger says he led a series of discussions with internal leaders and clinicians, which helped him educate stakeholders of the value of this exchange beyond what the organization was doing already. “That—in addition to the ongoing evolving healthcare landscape—let us see the potential value in implementing an HIE,” he says.
Being an open integrated delivery network, many of Sutter’s patients get care not just within Sutter but at other non-affiliated organizations such as dialysis centers, nursing facilities, and even competing hospitals and clinics, Jaeger says. “So the HIE will allow us to create a community-based view of our patient’s information that all members of the patient’s care team, including their family, could see. Improved delivery of reliable information can be especially important in emergencies—when every second counts for patients in distress.”
Chris Jaeger, M.D.
Through that improved access to their information and with secure communication, Jaeger says Sutter expects to greatly improve care coordination, especially across transitions of care. “This in turn should help our patients and their caregivers identify problems earlier, better manage chronic conditions, and have a proactive rather than reactive approach, which we often see today. It should also allow us to more effectively leverage population health tools and techniques.”
To that end, Jaeger sees an HIE as a “prerequisite” for effective population health. “Without the HIE, we would continue to have a fragmented view of our patient’s information. So the tools for helping support population health would not be as effective. The goal is to leverage the data you have already to manage the patient populations. And if you have fragmented data, you will be sending messages to patients or having false positive signals in your reports of populations about patients,” he says.
Jaeger admits that launching an HIE is an ongoing effort that will take years to fully develop—in that sense, you can’t even call it a project, he says. But with any HIE, the value of it is really dependant on the network effect, he continues, referring to when you have reached a critical mass of participants and data exchange to provide value to those on board.
Thus far, Sutter has deployed Epic across all of its five foundations, as well as 17 of 24 acute care facilities. “Unlike a lot of organizations who look at an HIE to help them connect disparate internal systems to achieve value, we don’t have that problem,” Jaeger says. We have that single system that we want to connect with our Epic HER, and we will have them connected by end of the year to allow more seamless data exchange and visibility to providers within Sutter.”
Already, Sutter is setting up basic data feeds from Epic to the Orion HIE, sending syndromic surveillance data to California’s San Mateo County, which Jaeger says is the only county right now that is currently capable of accepting data in Sutter’s geographic blueprint. But the health system will continue to expand in that area as other counties are able to take that information, he says. In the next year, Jaeger says he wants to be connected to at least three larger entities to help reach that critical mass. He notes that he would also like to see one of those entities connect to another organization’s HIE, as HIE to HIE interoperability is a big step.
Sutter also is doing a couple of alpha sites in the coming months to confirm configurations and technical infrastructure deployment to support inbound and outbound exchange, Jaeger notes. “In parallel, we are planning future stages, which will include more robust data feeds from Epic and through Orion HIE. We will look to connect with larger care providers and reach that critical mass as quickly as possible. Again, we want that HIE to benefit external providers as well as internal ones. Since Sutter providers are already on an integrated EHR, will need to have external providers connected,” he says.
Fighting Through The Next Steps
While Jaeger says the benefits to HIE are obvious, the greatest challenge for any organization implementing an HIE is security. ‘We know the benefits, but the risks are large as well,” says Jaeger. “We have a responsibility to take every possible safeguard to protect our patient’s health information, and work close with our technology vendors to ensure that we have robust safeguards in place that remain up-to-date.”
There is also the challenge of helping smaller organizations that may not have the same amount of resources or expertise that Sutter has and is developing, Jaeger notes. “Under our HIE umbrella, we can help those organizations— if not connect to an HIE, get on board for exchange doing Direct and Healtheway, and participate in broader things across communities nationally,” he says.
And certainly as HIE continues to grow, healthcare organizations are looking to address the problems they see as hampering the long-term success, stability, and sustainability of health information exchange. To this end, Jaeger says that the Office of the National Coordinator for Health IT’s (ONC) 10-year interoperability roadmap articulates critical success factors for building blocks well in regards to long-term HIE sustainability. “The framework, if successful, would help improve data exchange and integration across care teams, and give patients the ability to contribute to their own record,” he says. “Those would be truly remarkable accomplishments, if we can do them.”