When EHRs lack interoperability, investing in big data analytics can help

ORLANDO – Data can be a wonderful means through which health leaders can improve their business performance and boost care quality for their patient populations, and it's a must when transitioning to value-based care. But a high volume of data can get confusing, especially if a health system utilizes multiple electronic health records.

One possible solution for a health system is to invest in a single EHR for all of its campuses. Yet the cost is often so prohibitive that the organization has no choice but to live with disparate EHRs. How do you get them to communicate with each other?

Nathan Riggle, director of analytics at Mercy ACO in Iowa, is something of a historian when it comes to Mercy's efforts to utilize and make sense of data. Speaking to a crowd at HIMSS19 here Wednesday, Riggle traced those efforts to 1995, when Mercy's then-CEO started an Excel spreadsheet to track diabetes patients. Things got complicated in a hurry.

By 1998, the system had evolved to have its own SQL registry. From 2003 to 2012, that morphed into free registries from QIO. In 2012, Mercy partnered with Medventive/McKesson on automated data entry.

"You get Medicare claims data, which is an awesome data source, but you're also responsible for a lot of members, and you want to know as much about those members as possible," said Riggle.

With the implementation of the statewide ACO in 2015, the system needed to invest even further in something that would handle this complex data scenario.

Enter its partnership with Innovaccer.

That marriage would help the system realize some of its strategic priorities – namely managing risk and the total cost of care, lowering network leakage, achieving data-driven care management, identifying growth opportunities and creating value for the patient population.

"Bad delivery systems result in gaps in communication and care, which means a duplication of effort," said Riggle. "You need to look for ways to close that communication gap."

Disparate EHRs, of course, mean a lack of interoperability, and circumventing that can entail thousands of iterations of data analysis, said Riggle. As Mercy joined more and more shared savings arrangements, it wanted to monitor the status of its programs.

Payers will dole out live reports, said Riggle, and they're helpful, but it can be preferable for an organization to do its own reports, and to do them quickly. It was especially important for Mercy, since its patient base encompasses roughly 300,000 members – with automation making it much, much easier to parse the data in meaningful and insightful ways.

"We wanted to be able to analyze the data for strategic insights," said Riggle. By hooking up with Innovaccer, Mercy didn't have to pony up for a new, system-wide EHR; it could instead tap big data technology to achieve a universal view of the EHR – pulling out key clinical components and creating a view for the network so it could track patients across the continuum of care.

Making that data investment set Mercy up for population health, risk management, care coordination, quality reporting and predictive analytics.

The data analytics team does a discovery phase of the analysis, and can then model it and look for insights.

"I want to find the insight first," said Riggle. "Once we have those insights, then I love taking advantage of an automated platform because I don't like to do reporting. Once I find those insights, I say, 'OK, I have this insight, now I want to automate it.'" The platform can then look at those reports and direct them to the system leaders and the care management team.

"We're using our data lake to really paint that full picture and embed that into a timeline and identify any gaps in communication," said Riggle. "Having the timeline helps to minimize those gaps you might encounter."

Mercy's financial performance speaks for itself. In 2012/2013, its shared savings payments were in the range of about $2.5 million. The current projection is somewhere in the vicinity of $18 million.

The system has also achieved a 7 percent reduction in readmissions, a 6.65 percent reduction in emergency department utilization, a 14 percent decrease in primary care services, a 9.15 increase in the annual wellness rate, and a 280 percent increase in total return.

"We need the infrastructure in place to take on more risk and take on more lives," said Riggle.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com