ACO wrangles data from 45 different EHRs for real-time analytics
Beth Israel Deaconess Care Organization is a value-based network comprising eight hospitals and about 2600 providers in eastern Massachusetts.
It's grown and changed quite a bit over from its early days as Beth Israel Deaconess Physician Organization, says its chief information officer Bill Gillis. Over the past decade-plus or so, it has evolved into a joint hospital-physician venture, with each side having equal ownership of its governance.
In 2011, BIDCO signed on as a Pioneer ACO, with all the shared risk that entails, and quickly became one of its top performers. It's build on that success through similar ventures with commercial plans, MassHealth ACO, Medicare Shared Savings Program and others.
When it comes to value-based contracts, "we really believe that having a true picture of real-time clinical data is one of the cornerstones," said Gillis.
That's easier said than done, of course, even for a longtime technology leader such as BIDCO, where 100 percent of its network has an EHR, and most providers have been using them since long before meaningful use.
The challenge of that, is that in organically growing, BIDCO is "a mish-mash of a lot of different systems," he said. "In our network, we have 45 different vendors that we deal with. But the reality of that is we have about 150-plus installs of different versions, so it gets to be a bit of a crazy game."
Early on, said Gillis, "I'll be the first to admit: It was my naiveté that I thought, 'We're in the meaningful use program, and meaningful use requires all EHR systems to be interoperable, so if we just allow people into the network and just say they have to be on an MU-certified EHR, boom, we'll have interoperability, right?' Well, we all know how that really works out."
Still, BIDCO managed, with with great effort, to wrangle all those different data streams into something usable.
"We started doing what we call our QDC, or quality data center, which is provided and hosted by the Massachusetts eHealth Collaborative. We began working with that in 2010, to seed a system of raw clinical data out of EHRs, as a way to say let's get all of this data in one place and figure out a way we can aggregate it and normalize it.
"As we started to grow into these programs we were looking at the reality of getting data out of all of these systems and how to really do something with it – make it usable," he added. "That's where the real challenge started to come in. An analogy I use a lot is we went out in the community, we connected all the pipes, and then we turned on the water, but the water wasn't really drinkable at that point."
BIDCO had five or six different data repositories from which it tried to pull different information, normalize it and "use it in a way that we could sort of tell a story," said Gillis. "But by its nature it was prone to inaccuracies and not really in a place were we could distribute it out to our members and say with confidence, here's your data – here's how you're doing on quality, here's how you're doing with utilization. We needed to come up with a different way to do that."
With the rollout this summer of a population health platform from Arcadia Healthcare Solutions, BIDCO has helped solve many of its most pressing data management challenges.
The tool enables easier aggregation and analytics, validating, normalizing and integrating disparate data – EHR, lab, imaging, claims – which are combined into reports delivered to BIDCO's pop health teams and providers, helping them assess their performance, spot high risk patients in need of complex care management and better address prevention and wellness.
"It gave us the opportunity to centralize this information, pull it all into one place and take advantage of all this massive amount of data that everyone is generating now," he said. "It's been normalized, it's been aggregated, it's been validated for accuracy. All of the data elements are mapped, so when we're talking NDC code or RxNorm code, we're talking about the same drug. That was a vision we had, and that's where we are now."
Of course, implementing such a large enterprise system is a big undertaking, and BIDCO chose to do it on a shorter timeline than it otherwise might have. So beyond the technology challenges, effective change management processes were key.
But Gillis says the system is now at a place where providers are much more confident in the platform: "As they see the data – an example is we're able to pull in data elements like ADT information from across our network – they take advantage of it now," he said.
"Our goal is to get to a place where, with a lot of analytics, the power of big data will be for our end users," he added. "Our docs, our care managers, the practice managers and the staff to go right in and run whatever report they want, or take a report we've built for them and drill down into any level they want to get it to. To make it as self-service as possible. That's our goal. I'd say we'll probably be there around Q2 of next year. But it is live now, and people are using it, and for the most part very happy with it."
Still, in a perfect world none of this would have had to be this challenging, said Gillis,
"If we want to look at value-based care and contracting – really looking at reducing cost and better health – we have to come up with better standards for all of these systems to interoperate and communicate, as well as having the payers developing metrics where we can deliver information on them to show how we're performing in contracts," he said.
"We have seven different risk contracts and seven different sets of quality measures we have to deliver on," Gillis explained. "While they're all generally based on HEDIS, a hemoglobin A1c compliance from one payer to another can be slightly different. An EHR vendor isn't going to do that. They're not going to show, this is your Blue Cross data and this is your Tufts data. They're just going to give you data on A1c. And then we have to take that to see if it meets the measure or not.
"It would be great to get to a place – this is my Christmas wish – where maybe there's 100 or 200 measures that all the payers agree on: CMS, Blue Cross, Harvard Pilgrim, they all agree that these are the 200, and then those payers can pick the ones that represent the population that they're wanting us to manage for them," he said.
"And then vendors can build their systems to be able to report on that data in a way that's standardized, instead of us getting data from 45 different EHRs, validating it, normalizing it and then generating reports representing how our providers are doing with different payers."
That's a tall order, Gillis admits. But it's better than what's often the status quo. "It's a big burden that right now is put on BIDCO – but I think could be distributed in a way that makes it more manageable for everybody."