Interoperability and Population Health: Key Excerpts
The Tegria Blog Apr 05, 2021
By Stephanie Ngo, Managing Director, Payer and Provider Integration Solutions, Tegria
As mergers and acquisitions continue in the healthcare industry, an increasing number of healthcare organizations (HCOs) are being left with multi-EHR operations. This can result in siloed data and workflows, making it difficult for HCOs to provide seamless communication and delivery of care as they embark on their population health journeys.
This blog will dive into some of the population health challenges HCOs face as they merge with community practices using different EHRs, and what can be done to mitigate these challenges.
Healthcare has become more competitive as new entrants raise the expectations of patients with innovations in convenience and access. Additionally, as Centers for Medicare & Medicaid Services (CMS) looks for ways to cut costs and reimagine reimbursement, HCOs are forced to rely on their market share to negotiate higher reimbursement rates with commercial payers to stay afloat. Meanwhile, many smaller organizations, especially those in rural areas already struggling to survive and further devastated by the COVID-19 pandemic, have been forced to merge or shut down entirely, leaving their communities without convenient care options.
According to Healthcare Finance, “In 2021, 31% of CFOs plan to acquire physician practices, 30% want to join a clinically integrated network, 28% expect to merge with another organization, 24% plan to enter into a joint venture, 20% may need to sell to another organization and 17% expect to acquire another organization.”
Although there are many financial and operational challenges associated with acquisitions, mergers, and partnerships, we will focus on the population health strategy and interoperability challenges related to multiple EHRs.
Regardless of the type of relationship formed in these transactions, one challenge is always present: How do you get everyone using the same EHR or, at least, sharing clinical data between systems to allow for seamless care delivery? Even when the organizations and practices involved in the relationship use the same EHR vendor, this remains a problem, because customizations make it difficult to effectively share data and standardize workflows across the newly formed system. This leads to the question: Why not all be on the same EHR instance?
There are a variety of reasons why these organizations remain on different EHRs, but they can all be boiled down to cost, resources, culture, and change management concerns. Let’s break it down:
The COVID-19 pandemic has positioned population health and value-based care at the forefront of every healthcare leader’s mind. Since the main pillars of population health are data analytics, streamlined workflows, and patient engagement, having access to consistent and reliable data is key. The lack of a shared EHR and an effective data exchange mechanism can stand in the way of this goal for the following reasons:
Although the end goal may be to get the entire health system on the same EHR, the reality is that this may not be immediately feasible, so it’s important to find solutions for the here and now. However, this is a very complex issue involving entities that often vary greatly in terms of their financial and technical ability and cultural identities.
There is no out-of-the-box solution that will work for everyone. The selection process resembles more of a buffet where providers can pick and choose through a spectrum of options to find a sustainable working solution. The most successful strategies will include some mixture of technical and operational components.
Some of these options are outlined below, using a hospital with the Epic EHR as the example:
The consolidation of HCOs shows no signs of slowing down, which means the number of organizations facing the multi-EHR problem will continue to grow. With population health and value-based care at the forefront of healthcare, don’t get left behind. Start exploring your options to stop the frustration and deliver seamless care across your health system.
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