A change for exchange

By Mike Miliard
11:58 AM
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Intersystems retools its HealthShare, targeting IDNs

CAMBRIDGE, MA – When Farzad Mostashari, MD, the national coordinator for health IT, thinks about health information exchange (HIE), he's also thinking about grammar and parts of speech.

"Our goal is to advance exchange as a verb to support meaningful use and improve care coordination, not to support a particular model of exchange or organization type," he has written. "One of ONC’s key goals is to reduce the cost and complexity of exchange by putting in place the building-block standards, services and policies that are needed regardless of the exchange model."

That's a way of thinking that's shared by InterSystems, the developer of integration and information systems technology. In May, the firm launched the latest version of HealthShare, its informatics platform, which enables interoperability and active analytics.

While HealthShare was conceived initially to serve public health information exchanges at the regional, state and national level, this new version has been retooled to deliver the more robust functionalities needed by integrated delivery networks (IDNs).

"Health information exchange," says Paul Grabscheid, InterSystem's vice president of strategic planning, is "a phrase that I think really sells the technology short."

HIE is evolving from "low-level transactional data transmission to much higher-level aggregation of patient information into comprehensive cross-episode records," he says. "HealthShare was re-architected with this in mind, enabling a new generation of patient records to be used for point-of-care and population health solutions."

Grabscheid notes how an IDN "can be much more targeted in its use of technology, using HealthShare to deliver information within the organization’s existing applications where it can be a natural part of the clinician’s workflow. IDNs are also better positioned to make immediate use of analytics as part of their efforts to improve outcomes and quality of care."

Moreover, he says, "because the needs of IDNs are quite varied and many view HealthShare as a platform on which to build and deploy unique solutions, we have created a more modular component-based structure that enables each IDN to select the HealthShare functions that most directly address their needs."

With ACOs and patient-centered medical homes demanding that patient data flow easily among care teams, payers and the government, he adds, there's no shortage of decision-makers, using any number of EHR systems and sharing information via a patchwork of different HIE systems. The fact that most clinical data is unstructured only complicates things.

With the new HealthShare, Grabscheid says InterSystem focused on three strategic areas aimed at IDNs: "intelligent aggregation, so that we can effectively normalize and combine all data for patients, no matter where it originates on the continuum of care; knowledge delivery, so that providers can make much better use of the huge amounts of text and other unstructured data in patient records; and active analytics designed to empower clinicians to make better care decisions."

So far, the technology has been deployed in regional and national projects, everywhere from Missouri to Denmark, and in several new IDNs.

"We began selling to IDNs in the summer of 2011 and have more than 25 new customers already," says Grabscheid, who notes that the IDNs are using the technology to create patient records for portals, using analytics to reduce readmissions, streamlining administrative transactions across payers, helping improve the referral process among primary care, specialists and acute sites, automating public health communications and linking to regional exchanges.

One such IDN is Beaumont Health System, in Royal Oak, Mich. Officials there say the HealthShare implementation replaced a legacy integration engine that was lacking in its monitoring and alert capabilities.

“In addition, we wanted more built-in interfaces and more advanced communications capabilities than were available in the legacy software,” says Subra Sripada, Beaumont's executive vice president and chief administrative and information officer in a statement.

David Whitlinger, executive director of the New York eHealth Collaborative, notes that "the public and private infrastructure layer of HIE solutions, including comprehensive database and integration technologies and coupled with a robust privacy and security backbone," is crucial to delivering patient-centric care.

HealthShare, he says, "combines those infrastructure technologies and the ability to access critically important clinical data to provide a comprehensive platform upon which innovative healthcare solutions can be built and run."

InterSystems recently announced the growth of its collaboration with Ridgefield, Conn.-based Apelon, which develops terminology and data interoperability solutions. One goal of this partnership will be to help care providers meet the standardized reporting requirements for meaningful use and ACOs.

Apelon’s technology, focused on data aggregation, normalization, and analytics, provides access terminology standards, such as SNOMED-CT, ICD-10-CM and LOINC, within the HealthShare environment, and supports the mapping of local data sets and code catalogs to these standards. “Apelon is enthusiastically committed to assisting organizations to realize interoperability of their clinical data,” says the firm's president and CEO Stephen Coady.

"Strong support for clinical terminology – both standard and non-standard – is key to achieving data interoperability and we have worked with Apelon in this area for a number of years. Apelon’s recent development initiatives increase the speed and reduce the cost for utilizing Apelon’s content and services with HealthShare."

Grabscheid has likened the HIE space to something akin to the Wild West.

"From the standpoint of product offerings, this is still very much a market under development," he says. "Healthcare providers see myriad needs, but they are not certain how to address them or what sorts of technology solutions will provide lasting value. The result is a confused marketplace in which vendors approach customer needs from different directions and customers often struggle to sort out the alternatives.”

He adds that, "What I hear most often from clinicians is, 'Find a way to deliver the information I need – and only the information I need – when, where and how I want it.' The challenge is to have easy, secure access to the latest, most complete view of the patient and to deliver real information-based insights efficiently and in-context. This is the focus of our technology investments and we’re making real progress, but it’s not something that will get done overnight."