Best Practices in Making a Health System Interoperable​: Rochester Regional Health

Rochester Regional Health (RRH) is a non-profit health system of five hospitals and an outpatient care network. In bringing these hospitals and networks together, RRH was tasked with converging a number of systems, including multiple electronic health records (EHRs), other clinical systems, and the regional and statewide HIEs (Rochester Regional Health Information Organization (RRHIO) and Statewide Health Information Network of New York (SHIN-NY)). Currently, they are able to aggregate data from key sources of clinical data beyond the data found in RRH’s primary EHR system, Epic. They utilize Epic Care Everywhere for links with other Epic providers, public health information exchanges (HIEs), a private HIE, emerging networks like CareQuality, eHealth Exchange, and CommonWell, and other methods such as Direct messaging, single sign-on (SSO), and FHIR and open APIs.

RRH has invested in certain infrastructure and utilities, without which the value of interoperability cannot be attained, including:

• Using an eMPI to accurately identify patients across over 30 health system and community (RRHIO) data sources
• Using consent tracking to note who can see sensitive information and how the patient has authorized RRHIO to share their data (per NYS patient consent regulations)
• Putting forth a large data normalization tool to ensure that ‘system to system’ and ‘system to community’ exchanges have a standard set of clinical data architecture
• Integrating an internal provider identification credentialing process across the entire RRH system
• Handling referrals internally and externally with their partners through standard Epic tools
• Implementing a set of governance advisory councils and groups to guide their internal perspective and represent patients

The resulting interoperability infrastructure has provided the basis for:

• Transitions of Care – Clinicians, working in their native EHR, have a longitudinal patient record view, have a much more complete view of a patient’s encounter activity across the entire community, and not just as their native EHR views the patient.  This insures consistency in clinical data access from ambulatory, to inpatient, to post-acute, to home care.
• Business Intelligence – The collection, aggregation, and normalization of key clinical domains across its private and public HIE clinical data repository…including problems, allergies, medications, immunizations, procedures, vitals, lab results, radiology reports, and clinical documents…feeds a robust, normalized enterprise data warehouse, supporting many of RRH’s business and clinical intelligence initiatives.
• Gaps in Care – An EHR’s view of “Gaps in Care” is typically from its own clinical data repository.  However, a clinically integrated, HIE, combining the enterprise and community view of the patient, insures a more realistic view of a patient’s care needs, while reducing unnecessary, redundant, laboratory testing and imaging studies.
• Patient Engagement – The patient-provider relationship is a more productive conversation when the provider has a broad, longitudinal view of a patient’s medical record, focusing the path forward to better, comprehensive care planning.

As they move from the traditional volume-based economy to a value-based economy, RRH would like to create a value proposition and are strategically focusing on areas such as:

• Network development: Reach their communities through a vast network of touch points for all their care needs
• Patient experience: Build and deliver a signature experience for patients anywhere in their system. Patients need an experience where they are part of their own healthcare
• Operational excellence & Integration:  Strive to make the organization better, knowing that when RRH thrives, their patients thrive
• Innovation & Population Health: Improve the health and wellness of the people in their region through innovation

As the healthcare industry experiences a digital health revolution, RRH recommends the following considerations for success for turning innovation into something meaningful for the healthcare industry:

• Learn from peers and other industries outside of healthcare who are successful and leading the way
• Form new relationships at the local, state, and federal level to synch strategies
• Empower patients and clinicians
• Develop a purpose-driven approach that includes understanding the problem, engaging end-users early in the process, and tailoring the approach to fit the workflow
• Do not design technology until an organization has understood the problem, listened to customers, and thought about the workflow

These best practices and considerations for success were discussed as part of a presentation by Rochester Regional Health during eHealth Initiative’s September 2018 Technology & Analytics Workgroup meeting.