InterSystems' Bizzarro discusses strategic interoperability

Interoperable systems, patient-centric data to support continuity of care
By InterSystems
03:03 PM
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(SPONSORED) Dominick Bizzarro, RPh, Managing Director, leads the development and implementation of business strategies for InterSystems’ HealthShare offerings. In these efforts, he is focused on providing connected care solutions to an array of clients, including state-level health information exchange, integrated delivery networks and other regional/national entities. He works collaboratively with customers to define and deliver strategies that provide clinical and economic value while fostering long-term sustainability.

Prior to joining InterSystems, Bizzarro was the CEO of the Healthcare Information Xchange of NY (HIXNY), an operational health information exchange. He was a NY eHealth Collaborative board member, Policy and Operations Council member, Collaborative Care workgroup member and Co-Chair of the Sustainability workgroup. He is a graduate of the Albany College of Pharmacy and received his MBA in health systems from Union Graduate College.

Q: Today’s healthcare organizations typically have multiple IT systems that often span multiple care settings and providers. As demands for greater accountability and continuity of care increase, how will these organizations have to evolve from a technology perspective to meet these demands?

A: Evolve is an appropriate word as healthcare organizations must leverage and extend the investments they made in core systems, and invest in technology that helps them tie it all together. It is both a challenging and exciting time, and IT has a truly strategic role in a healthcare organization’s success.

Fundamentally, continuity of care relies on interoperable systems and patient-centric data. This calls for three core capabilities: 1) aggregating all the data in a comprehensive patient record, 2) making sure providers are all connected to that record, and 3) making the data available at both a population level for analysis, and individual patient level to drive action.

Interoperability is at the heart of the matter, and is the fundamental underpinning of an IT strategy to meet an evolving set of demands. We are seeing progressive organizations defining interoperability as much more than message passing from one application to another. Rather than solely relying on connecting to a single, comprehensive electronic health record (EHR), they want unifying technology that provides the capability to take advantage of comprehensive, patient-centric records populated by clinical data the moment it is available to drive actions through a community of connected providers, caregivers and the patients themselves.

Technology platforms of the future must be interoperable, as it will be a large determinant of success in new care delivery models. It is about getting value from data. After years of working with customers around the world, we think that this type of technology is best referred to as a strategic informatics platform.

Q: We are starting to hear more about Big Data across multiple industries, but what does that mean in healthcare? Is it all hype?

A: I have seen more than a few sets of eyes roll when someone speaks about Big Data in healthcare. For those who are steeped in the daily challenges of delivering quality care to patients, they live the reality and the only hype is the amount of attention it has been receiving recently. They offer that a more appropriate term might be “Real World Data.” We have seen good progress on capturing, sharing and analyzing healthcare data that is structured and fits into rows and columns. But so much healthcare data is present in other forms, such as free-text patient notes, device generated data, images and others with even more on the way in the form of social media content, text messages and the impact of genomics. The most immediate challenge and opportunity lie in taking advantage of the unstructured text.  Capturing the lab result and using it analytically is simple enough. However, some of the most valuable data is in the clinician’s text note where she conveys impressions, learning from the patient interview, the reason for ordering the text, what conclusions were drawn and what the next steps should be. In most settings, these invaluable notes comprise a large portion of the patient record. These notes are readily available, but they are rarely analyzed.

Customers should expect that their healthcare technology platform is able to tap the value of this Real World Data in an achievable manner. To explore this textual data, there should not be a need to build ontology. These are helpful, but should not be required. Analysts with appropriate permissions should be able to access this data in an unguided style, and without the requirement of sitting beside an IT expert.

Imagine that a patient presents in an emergency department. If the clinicians must act quickly, there is likely no time to review the entire patient record, especially on complex patients. Their desire is to have a summary that reveals the important aspects related to the patient. Have they experienced chest pain prior to this event? If they have done so twice in the past, what were the treating clinician’s conclusions and treatment approach? Was the treatment plan followed? Did the patient note side effects to the newly prescribed medications? The ability to quickly access the entire record (structured and unstructured) can significantly contribute to superior clinical, satisfaction and economic outcomes.

Q: Healthcare IT “Nirvana” for many organizations might be complete, enterprise-wide access to all data, qualitative analytics that can leverage user knowledge, full patient engagement and closed-loop delivery of care. What will it take to get there?

A: Step one is to embrace the notion that this is a high-priority goal. Given the many changes in the U.S. healthcare over the last three years, this is likely the case in many markets now, and likely all of them in the next three years as the care delivery models evolve. Having access to “all the data” is foundational and enables many possibilities to improve care. But it is not enough to just have access to comprehensive data. What is truly needed is the ability to understand it, derive knowledge, add value and drive the right actions. Healthcare organizations recognize that it is too much to ask any single application to deliver on all of this promise. It calls for a new approach – an informatics platform – to tie together the aggregation, analysis and actions needed.

I have a physician colleague who sums it up well by referring to this as the Five Rights of Interoperability:

1. The Right Data in

2. The Right Amount to

3. The Right Person at

4. The Right Time to drive

5. The Right Action

That seems like a good start in the pursuit of Healthcare IT “Nirvana.”

Q: Many healthcare organizations across the U.S. are transitioning to become Accountable Care Organizations (ACOs), or entering into an accountable care model. How will these organizations need to evolve their IT infrastructures to provide the connectivity and access needed to support this transition?

A: It seems like one of those questions on a multiple-choice test best answered by “e) all of the above,” since what we discussed earlier all applies. It is clear that no single application or vendor can meet all of an ACO’s needs for managing risk, insurance payments, provider networks, informatics, care coordination and more. It requires a platform approach that both delivers solutions and enables solutions.

Intrinsically, ACOs and other similarly purposed entities are seeking to identify and manage clinical and economic risk, then close the gaps on that risk. The key competencies to closing these gaps are the ability to manage the health of a population and to coordinate the delivery of care. Like high-performing organizations in other industries, healthcare providers will have a heightened focus on quality measurement and continuous improvement. The right healthcare technology platform is a cornerstone.

For many, managing the health of populations is a marked shift in mindset, but there are progressive organizations that have embraced and extended their health information technology assets to address some of the riskiest populations. For example, North Shore-LIJ, a large and leading health system in Long Island, NY, is interested in managing its population of patients they serve, including those at high risk. They identified a clear need to improve the clinical, satisfaction, and economic outcomes for high-risk obstetric patients. To do this, North Shore-LIJ needed to connect more than 100 providers who use three different outpatient EHR implementations, two different inpatient EHRs and two prenatal imaging centers with their own ultrasound reporting systems.

When a high-risk expectant mother is admitted to an emergency room, the system automatically notifies her obstetrician and primary care doctor, while providing the emergency room physicians with instant access to her aggregated medical history. If lab results indicate a problem for mother or baby, the admitting physician will receive an alert. North Shore-LIJ created the interoperable foundation and tools to automatically detect and notify providers of gaps in care or clinical changes even when the patient is not present.

By identifying a high-risk population and enabling the coordination of care, the community surrounding that patient shares complete and up-to-date information, increasing safety and satisfaction for all concerned.

What is strategic interoperability & why do you need it?
Strategic interoperability enables you to aggregate, normalize, and integrate data about every patient, from every care setting, so that clinicians and administrators can make decisions based on complete records and insight from real-time analytics.

Be sure to visit the InterSystems booth at HIMSS14, Booth 2741, Hall B to see presentations from North Shore-LIJ, RICOH, Seattle Children’s Hospital, Dr. Mark Blatt from Intel and more. You’ll also have the opportunity to bring your questions and comments to a variety of educational and networking events supported by InterSystems. Visit www.InterSystems.com/HIMSS14 for more information.

About InterSystems: InterSystems is a global leader in software for connected care, with headquarters in Cambridge, Massachusetts, and offices in 25 countries. InterSystems HealthShare® is a health informatics platform that enables strategic interoperability and analytics for action across a hospital network, community, region or nation. InterSystems’ products are used by thousands of hospitals and laboratories worldwide, including all of the top 15 hospitals on the Honor Roll of America’s Best Hospitals as rated by U.S. News and World Report. For more information, visit InterSystems.com.