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The business case for interoperability: A Q&A with Salim Kizaraly, Founder and SVP, Stella Technology

mark stevens

Mark W. Stevens, Contributing Editor

Health Information Exchange – Past, the present and future

Health Information Exchange (HIE) allows healthcare professionals and patients to appropriately access and securely share a patient’s vital medical information electronically, according to the definition identified by the Office of the National Coordinator for Health Information Technology (ONC).

Efforts to establish HIE has been underway for the past two decades, beginning with similar initiatives – known as Community Health Information Networks (CHINs) – that began in the mid-1990s. In the past ten years, more progress and “buzz” has surrounded HIE in part to the Health Information Technology for Economic and Clinical Health Act (HITECH Act), part of the American Recovery and Reinvestment Act of 2009 (ARRA) that was signed into law, and designed to accelerate the adoption and assist healthcare providers to obtain meaningful use of health information technology (HIT), including electronic health records (EHRs) and care coordination through HIE through funding incentives for the adoption of these tools.

The goal for HIE is to bring together a large array of healthcare information and records about the patient from across the entire continuum of care, and to improve the quality and coordination of care for patients while reducing healthcare costs. Those records include lab results, medications, allergies, conditions and various reports that are generated by physicians, hospitals, and specialists at the time of care. HIE brings together all the patient information and clinical records from a variety of disparate systems in a complete, timely and accurate record – in order to provide a comprehensive and collaborative care over time.

Today, the overall operational maturity of HIE initiatives continues to evolve, according to the eHealth Initiative 2014 HIE Annual Survey. While electronic exchange of health data appears to be on the rise, survey results show that HIEs continue to face technical challenges and financial constraints. These challenges remain to be the biggest barriers to interoperability. Managing relationships with participants, sustainability, and interoperability remain the key barriers to widespread data exchange. Per the report, as in 2013, respondents continue to struggle with interface development as they work to stitch together disparate systems.

“Stella has been called the most important interoperability company no one has ever heard of…”

– Salim Kizaraly, Stella Technology Founder

Stevens: How are Stella’s interoperability services enabling healthcare organizations to better communicate, collaborate and share clinical information? In other words: Why Stella?

Salim Kizaraly_Stella Technology

Salim Kizaraly, Founder, Senior Vice President, Stella Technology

Kizaraly: Stella has been called the most important interoperability company no one has ever heard of, but the Stella Technology team has been building clinical data integration software solutions for over 17 years, starting with our work with the Axolotl HIE platform back in 1998. We truly understand the challenges associated with deploying an integrated network which, if implemented well, allows a team of providers to communicate, collaborate and improve patient care. 

An example of our expertise can be found in the work we did for the New York eHealth Collaborative (NYeC). On behalf of the Interoperability Workgroup (IWG), NYeC engaged Stella to design and build the IWG Testing Tool, a modular, extensible and comprehensive testing platform which allows HIE and EHR vendors to certify their compliance with IWG interoperability standards. Now known as the Interoperability Testing tool (ITT), the technology is  used by the new ConCert by HIMSS vendor interoperability certification program, the ITT is advancing the interoperability of EHR vendors such as Cerner and Medfx, two of the more than a dozen vendors participating in the ConCert pilot program which concludes in December, 2015.

In addition to its work with HIMSS and at the national level, at the state and regional levels, Stella has worked with the State of New York in implementing the Statewide Health Information Network of New York (SHIN-NY) – the largest health information interconnectivity project in the U.S. – helping design and build out its core infrastructure (which had its first “Go-Live” this summer).  Stella has also worked with Michigan, Nebraska, Utah, Idaho, Tennessee and California in defining their interoperability standards and platforms, as well as deployed multiple regional HIEs in those states and elsewhere in the Country.

Clinical information exists in multiple HIEs and systems within healthcare systems. The first challenge we need to solve is connecting and bringing together the information from the disparate systems, and to be able to connect the information highway across a community, region or statewide HIE for complete interoperability, so that physicians can collaborate on patient care.

The next critical HIE step is the need to clean, de-duplicate, standardize and aggregate the data, and there are number of technologies and solutions that currently exist and are able to do that today. 

Since its founding, Stella Technology has been focused on its mission to build technologies for the next generation, “healthcare-connected” network for providers, payers and healthcare stakeholders to access meaningful data, such that informed clinical, administrative or financial decisions can be made at the right place, at the right time, and most important in a fully collaborative and coordinated fashion. They include:

The Integration Toolkit is the connected network’s foundation and infrastructure. It allows the extraction, validation and collection of clinical, administrative and financial information from a host of disparate systems. 

The Clinical Staging Database is the “holder” of the data aggregated by the Toolkit. By unlocking the data that organizations have in their various systems and making it openly available to them is a significant benefit. Because all the aggregated data is one place, an HIE, health system or ACO can conduct either care management initiatives or analytics to identify the population of diabetic patients that are in their community to manage their care prior hospitalization.  

Caredination is an innovative medical communication and collaboration platform, which focuses on ensuring that the care team is always informed of patient/member events as he/she navigates the complex healthcare system. Critical information is never lost during transitions of care, as Caredination facilitates multi-directional dialogue among providers and payers by incorporating collaborative elements of social networking.

Healthcare organizations now have a unique tool to measure the quality of clinical data in a quick, efficient and automated way. Developed in partnership with Buffalo, NY HIE HEALTHeLINK, iQHD (Quality Profiler for Healthcare Data) “measures” the quality of data from various source systems based on configurable validation rules. Organizations can work collaboratively with their partners and stakeholders to improve the overall quality of the clinical healthcare data in their community, and save a substantial amount of time, resources and costs in collecting, analyzing and leveraging data for integration projects and population health management initiatives.

Stevens: Looking through your crystal ball, what does the future look like for Interoperability?

Kizaraly: As we look ahead, we predict that care provision will be even more centered on the patient. A shift towards new technologies, tools and models of care will be the next frontier for interoperability, which will seamlessly include inpatient devices, remote patient monitoring solutions, and wearable device technologies. The patient-consumer will be more involved and engaged in their own healthcare.

As the healthcare world becomes interconnected, the need to scale the infrastructure will be critical, as more and more data will flow in and out of more systems and devices, in a more real time fashion as ever before. While Big Data has been present in some areas of healthcare (e.g. biotech or genomics), we are, as an industry, just starting to scratch the surface of how to process, make sense and optimally utilize the vast amount of information coming our way.

Lastly, telehealth is another big trend that is much talked about, especially following the Centers for Medicare and Medicaid Services (CMS) new funding and reimbursement model for telemedicine services for 2015. Health systems will be able to integrate new telemedicine solutions and technologies to decrease hospitalizations and re-admissions for their patients with chronic illness or diseases, and in the long run improve the experience and quality of healthcare for their patients, while significantly reducing healthcare costs. 

Stevens:  And in conclusion…

Kizaraly: OK, so in closing, and based on our own experience and what we have seen over the past 17 years, the sharing of clinical information is more than ever vital and necessary. If someone is in the business of providing care, it is a matter of survival, because without collaboration and sharing of information, your organization may not be around to compete in the new healthcare marketplace.

We also need to remember that no matter how excited we get about technology, people and process are equally critical to making your interoperability business case successful, so make sure to make them an integral part of your organization’s healthcare transformation journey.


Case studies of interoperability in action

The following are three (3) brief use cases from some of the most successful HIEs around the country that are utilizing a wide range of services and solutions to meet their  interoperability needs.

  • Interoperability – Critical to real-time business and clinical analytics

HEALTHeLINK, the Western New York (WNY) Clinical Information Exchange and one of the leading clinical information exchanges in the country, is a collaborative effort among various health care organizations to share clinical information in efficient and meaningful ways to improve the delivery of care, enhance outcomes, and help control health care costs.  HEALTHeLINK was in need of an ease-of-use solution to access and store patient, provider, clinical results and other medical/administrative information in a simplified process for provisioning data for future analysis. 

HEALTHeLINK implemented the Clinical Staging Database, an extensible relational store which contains a general purpose, canonical clinical data model – that can used by a variety of applications for functions such as reporting, analytics, and operations management. Once fully deployed, the Clinical Staging Database will provide HEALTHeLINK simplified access to 3.9 million patient administrative records, as well as 118 million clinical results.

According to Daniel E. Porreca, executive director of HEALTHeLINK, “It’s critical for us to have secure and efficient access to data in order to perform operational functions, security audits and partition clinical data to better support doctors and their staff enabling better treatment.”

HEALTHeLINK is able to extract previously hard to access data in a much more automated, scalable fashion, and use it outside of the existing system without compromising its meaning, relationships and integrity. The Clinical Staging Database solves the issue through a set of intelligent extraction routines and open interfaces to subsequently feed the data into HEALTHeLINK’s analytics platform for quality improvement measures.

An example to having access to the data is that organizations can create registries relating to patients with chronic medical conditions, to effectively manage their communities and improve the care of their patients.

For instance, the Western NY Beacon community, established by HEALTHeLINK and the recipient of one of 17 Beacon Communities nationwide, is facilitating the use and access to the data registries to better track, manage and improve the transitions of care for diabetic patients.  The success of the project has resulted in a significant reduction in the number of hospitalizations, a savings of approximately $600 per diabetic patient per year, and an estimated reduction of hospital charges of $18M per year in Western NY.

The full online report which highlights and provides an overview of the health IT milestones that were achieved over the course of the three-year project can be viewed here.

  • Readmission reduction and notification encounters for improved transitions of care

Digital Collaboration Solutions (DCS), a consulting and services firm for healthcare provider and patient engagement and care management, and Hahnemann University Hospital, a 496-bed academic medical center in Philadelphia, PA and the largest provider in the Tenet Healthcare chain, conducted a joint pilot program to improve care coordination and care management by ensuring heart failure patients receive post-discharge follow-up through enhanced electronic notification to family and friends.

The pilot included a readmissions assessment, industry benchmarking, clinical workflow reengineering, and the implementation of a cloud-based, mobile technology appointment reminder solution powered by Caredination. As of January 30, 2015, the pilot improved the readmission rate by 40 percent over the baseline rate at the beginning of the pilot project with a projected return on investment of more than 100 percent.

As one the leading and most innovative HIEs in the country, the Rochester Regional Health Information Organization (RHIO), a Stella client, has helped emergency departments reduce hospital admissions. Patients whose medical histories could be accessed by their physicians at the point of care were more than 30 percent less likely to be re-admitted to a hospital, avoiding an estimated $357,552 in costs over a six-month period, per a study by Weill Cornell Medical College. 

  • Interoperability – critical component for streamlining the business of healthcare

Systems involved in a laboratory ordering workflow have specific requirements around having the right identifiers in the right place before messages can be processed. Lab Information Systems (LIS) need to have registered patients with the proper Medical Record Numbers (MRNs) before they can accept an order from an EMR system. EMR systems, in turn, need to have the correct order number (or visit number) in the returning lab result so that it can be reconciled with the correct order.

The East TN Health Information Network (etHIN), a non-profit, regional Health Information Organization (HIO) that facilitates the electronic exchange of health information in a primary Community of Care covering a 17-county area of middle East Tennessee, recently deployed the Orders Results Matching Service (ORMS), a lab ordering and resulting application to reconcile orders generating from EMR systems with results sent by Lab Information Systems (LIS).

As a network connecting disparate systems within a healthcare community, a solution such as the ORMS allows etHIN to provide a much-needed value-added service to its stakeholders by leveraging its existing HIE infrastructure.

The ORMS, with the help of other HIE solution components such as the Master Patient Index, acts as a mediation tool between all the different systems in the ecosystem.

Automating the entire process provides increased efficiency and reduction in administrative costs. By cross-referencing patient identifiers, provider identifiers and order/visit numbers, the ORMS saves caregivers significant time in linking orders and results with the appropriate patient, encounter and provider, thereby reducing medical errors and limiting manual entry (please see the ONC HIE ROI calculator in the supporting resources section to determine potential savings provided by your HIE).


Supporting resources

Other industry programs and initiatives supporting interoperability

  • Argonaut Project – A project with the purpose to develop a first-generation FHIR-based API and Core Data Services specification to enable expanded information sharing for EHRs and other health IT based on Internet standards and architectural patterns and styles.
  • The Sequoia Project – A non-profit, public-private collaborative to expand trusted, secure and interoperable exchange of health information across the nation by fostering cross-industry collaboration and by providing shared governance and necessary shared service to public and private organizations who wish to interconnect as a network of networks.
  • EHR/HIE Interoperability Workgroup (IWG), HIMSS and Integrating the Healthcare Enterprise (IHE) USA – A strategic relationship to streamline the process for achieving connectivity between EHR and HIE systems. As mentioned earlier, the new IWG Testing Tool, developed by Stella, is the platform for IWG Pilot Testing Program.
  • ConCert by HIMSS  – The comprehensive interoperability testing and certification program governed by HIMSS and built on the work of the EHR | HIE Interoperability Workgroup and IHE USA.
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