Moving From EHR Integration to HIE Integration
CareAlign, an application developed several years ago at Penn Medicine, is a mobile collaborative workspace used by clinicians for efficient rounding, handovers, and clinical documentation. Now in addition to integrating with the user’s electronic health record, the application is bringing data from the HealthShare Exchange (HSX) health information exchange to the point of care.
During a recent webinar put on by HSX, officials from Penn Medicine and HSX discussed the value of using application programming interfaces to open up HIE data sets to application developers.
HSX has current and longitudinal medical information on more than 8.5 million people in the Greater Philadelphia/Delaware Valley service region. Its MarketStreet platform uses open application programming interfaces to facilitates secure data transfer to companies and entrepreneurs to drive new products and services meant to improve health and healthcare.
Subha Airan-Javia, M.D., founder and CEO of CareAlign, and an associate professor at Penn Medicine, said that CareAlign does a few important things that the EHR doesn't do very well, including team and task management. CareAlign has shared electronic task lists for not just the primary team, but consulting teams, all other clinicians, interdisciplinary groups for nurses, therapists, and pharmacists, to be able to work together on what needs to happen for a patient, she said. It also offers the ability to make standardized templates and checklists, so that you can make sure that you're implementing standardized care across your services.
The other thing it does, she added, is power informed decision making at the point of care. “We do that by integrating with the EHR and other data sets like Market Street, where we can bring data in and show vitals, labs and meds in real time, and in a clinically oriented way where we see it really drive decision-making.”
“HSX data will bring patient lists and demographic data into CareAlign,” Airan-Javia said. “When you are managing your patients and your lists, even without any EHR integration, because of MarketStreet, we can actually query the database, find patient information, and bring in things like the patient emergency contact information, their allergies, all the important information that we'd have to otherwise manually enter in.” It also shows the data provenance for every single data item: when where, what was the source of that data, what was the date of the record, so that clinicians have all the information they need to interpret it appropriately. The names of care team members also flow in, she added.
“The vitals, labs, medications, and diagnoses are a huge part of that informed decision making, which we can also power now with the CCDAs and other data that's being sent to HSX, Airan-Javia said. “Whatever is being sent to HSX, we can pipe it in and leverage the interface that we've already created.”
Srinath Adusumalli, M.D., assistant chief medical information officer for Connected Health Strategy and Applications at Penn Medicine, noted that CareAlign “has been adopted by 159 of its inpatient services, and essentially all of our of our primary medical and surgical services, in various ways, are using CareAlign. It’s in use in all inpatient units, as well as post-acute care units.”
He described the value to the clinicians. “You can go into CareAlign and see the medications the patient is currently on, was previously on and then also when doses were administered or missed just with a couple of taps. And for us, that's, that's been incredibly helpful to all members of the care team on top of the data visualization. And really, this is the, again, one of the core functions of Carolina is that there's a simple handoff and tasks list. And the handoff is guided by having a one-liner, a summary about a patient to orient any member of the clinical care team.”
The MarketStreet platform itself is a two-sided platform that enables apps and partners secure access to the health information that HSX has captured throughout the number of years through the HIE, explained Alice Vuong, manager of IT engineering for HSX. “The way that we do healthcare exchange today, it's been very clunky. So we hope that MarketStreet provides an avenue for real-time, precise data to help the clinicians with care and treatment of the patients,” she said. “Instead of creating different point-to-point connections with different sources of information, MarketStreet members such as CareAlign can make one connection to HSX. Then they will have data from all of the different HSX members that we have connections to for encounters, problems, meds — all that clinical information that we've collected through the years.”
Epic’s Care Everywhere also brings in outside data, but mostly from other Epic sites, Airan-Javia said. “Now, in our area, there are a lot of Epic sites, but what the HIE connection gives us is data from the non-Epic sites. For instance, there are a ton of post-acute care sites. I know a lot of members of HSX are nursing homes, skilled nursing facilities, home care companies, and there is a lot of information about our patients that is relevant to how we practice that happens in these non-acute care settings,” she said. “So bringing all of that information in and making it accessible for us at the point of care is what is really different. I tend to think of what we get from the HIE as not necessarily really deep information in one encounter, but a broad set of information across all of the different encounters. It's so essential to have that holistic view of patient history so that we can make better decisions.”
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