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Readying EHR Technology for Population Health Management

"Cerner for me is my main street, but I'll go off of main street until my large provider has a solution that becomes minimally successful or adequate to replace and then I'll modularly move back on to main street piece by piece."

By Kyle Murphy, PhD

- The path forward to population health management isn't a straight one for EHR technology which must adapt to new forms of clinical quality reporting and value-based payment.

EHR technology for population health management

While clinically integrated networks go a long way toward coordinating the care of patient populations, they also add complexity according to Christiana Care Health System CIO and Senior Vice President Innovation and Strategic Development Randy Gaboriault, MS.

"The build of these networks — they aren't all in our environment exclusively employed networks, which creates complexity," he tells EHRIntelligence.com. "A practice may have deployed Allscripts, NextGen, or some other EHR. That's where we have to overlay a reporting capability."

Bridging this technology gaps represents an important milestone in the formation of a risk-based models of care delivery which accompanies agreements about the measures and objectives participants must complete in order to receive compensation.

"As we take on risk pools, like a Medicaid or ACO population, there is the piece where the organization has to develop the clinical network in order to be able to agree to participate to deliver care under this sort of model and our objective there is to inject the best known science in to that care pathway," Gaboriault reveals.

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Reporting in a value-based world, however, is a different animal when compared to traditional fee-for-service, one that participants need to wrap their heads around first.

"In terms of current metrics, think of reporting things like parts or events per thousand and then figuring out global policy and changes you need to implement  in order to move your organization to best in class," Gaboriault explains. "In a movement to outcomes-based medicine, it creates a very different approach to reporting because you are now focused on answering a very different question."

That "very different question" requires providers to look within a patient population, identify similarities among individuals, and develop patient engagement tools for helping patients address conditions or behaviors affecting the quality of their health.

From the provider's perspective, actionable data takes the form of information about at-risk patients coupled with methods for addressing those risk both effectively and economically.


Christiana Care Health System takes a flexible approach to EHR technology

"We would give them data that says how many of their folks are out of control," says Gaboriault. "You start with the target objective on average and what's the denominator as well, so helping them understand how they're performing on a granular basis as well as the cost perspective as a patient comes in and we have to hold the whole network accountable for the total cost of a patient."

Under risk-based agreements, providers all have a responsibility of positively influence patient outcomes and the cost of care. Being accountable requires that they have insight into how their individual care decisions impact the patient's care as a whole.

EHR technology as the backbone of population health

Enabling what Gaboriault calls a supply chain of information requires not one but many technologies all due to how the population health management marketplace for technology is maturing.

"There are a lot of people in the market solving either from their existing positions of strength or there are disrupters who are trying to solve a piece of it, which still then would require an organization like mine to be an assembler," he claims.

Christiana Care Health System is Cerner shop, but its needs to achieving certain population health management goals can sometimes move at a pace that its EHR technology platform is able to keep up with.

"I have Cerner or somebody might have Epic as a backbone platform," Gaboriault explains. "They certainly will not move as fast as the individual disrupters in the market to create solutions and they will not be as comprehensive necessarily as mean going to the market and buying all the solutions and organizing it."

A recognition of this reality has led Gaboriault to the conclusion that his organization must develop a core competency for selecting the technologies best suited to complementing its backbone EHR technology and organizing them effectively. It represents a modular approach to health IT vendor selection.

"I will go to the market and purchase solutions that fit with the longer-term intention," he asserts. "Cerner for me is my main street, but I'll go off of main street until my large provider has a solution that becomes minimally successful or adequate to replace and then I'll modularly move back on to main street piece by piece."

That willingness to take the road less traveled, however, comes about only after building a strong case for it, generally one of necessity.

"The things that live off of main street really have to be things that can't be solved from my larger platform of players, the things that create that maybe create a real unique differentiation in solving a particular problem now that we have," Gaboriault adds.

Christiana Care Health System is in its fourth year of employing this strategy.  And it's one that is likely to stay in place to keep pace with the dynamics of population health management.

"You'll never have every piece fully on main street — that's for sure," Gaboriault says.

Image Credits: Christiana Care Health System



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