Orlando Health is a $12 billion health system in Central Florida, managing the largest clinically integrated network in the state with more than 9,000 employed and affiliated private practice providers.
The health system recently faced two central challenges. One being that it had significant fragmentation across its data environment, particularly within the context of a large clinically integrated network. The second being the task of being able to deliver meaningful, real-time insights to providers in their native workflows to aid in decision making and clinical support.
As for the former, today the organization manages more than 350,000 value-based covered lives across 9,000 employed and affiliated providers in the CIN. While the health system employed providers work and document in a single electronic health record, from Epic, nearly half of the covered lives are managed by independent practices using upwards of 80 unique EHRs.
A truly major undertaking
Therefore, aggregating this wide array of clinical data combined with payer claims datasets and other third-party data represents a major undertaking. In developing a unified data model, the health system was able to develop a comprehensive view of the patient care journey from all angles, then present this holistic information to the physicians to make the most informed clinical next steps.
“To illustrate this in practice, imagine a primary care physician seeing a frail, elderly patient with congestive heart failure who was recently discharged after a hospitalization,” explained Brandon J. Burket, vice president of value-based care and population health at Orlando Health. “That provider might not have access to recent lab results, discharge notes, medication changes or recent utilization activity because information is buried in multiple EHRs and payer-based claims data.
“Care teams, therefore, lacked visibility into the documentation needed to both perform optimal clinical functions as well as those necessary administrative tasks, such as capturing updated risk adjustment codes, to ensure the patient was well cared for and value-based contract aims were achieved,” he continued. “To do this work absent a point-of-care system, manual reviews across multiple platforms were required, oftentimes taking weeks or months to complete.”
As such, combining this data into usable information, moving away from the classic “data rich, information poor” universe, helped to close more gaps, optimize clinical team time and alleviate physician frustration, he added.
Bending the cost curve
“These tools help us to succeed and keep physicians engaged in our efforts to bend the cost curve and perform better across quality measures for all populations,” he said.
“This also created standardization for us in reporting, moving from a heavy reliance on Excel-based reports or faxed chart documents to a model more predicated on actionable clinical efforts and more near-time reporting on such activities, thereby enabling us to shift to more proactive care delivery, as opposed to the traditional reactive model that has been the norm prior to adoption of advanced point-of-care systems.”
The solution to the problem that Orlando Health envisioned was simple to articulate but complex to achieve.
“In essence, we sought to surface meaningful, near real-time insights to any provider, regardless of their EHR, without disrupting their workflow,” Burket explained. “Our vendor’s proposal was to implement an EHR-agnostic digital assistant embedded within the provider’s native environment. The tool would then act like a co-pilot to pull relevant data from multiple sources into a single, visually aesthetic and intuitive piece of real estate within the physician’s day-to-day clinical view.
“This would then help to synthesize the most pertinent, contract-tailored alerts to the providers, allowing for suggestions on things like care gap and documentation opportunities while the patient was physically in front of them during the encounter,” he added.
What made this vision the most compelling, he noted, was not just the allure of technology enablement but the concept of change management to engage providers while simultaneously easing their workload.
Core pillars of the model
Burket and his team structured the model around several core pillars:
- Connectivity. The tool had to interface into multiple ambulatory systems used by private practices. This was key because affiliated providers are very unlikely to switch platforms or navigate to external third-party or browser-based portals.
- Curation. Providers do not need another cluttered inbox or complicated dashboard filled with metrics. Instead, they want and need to be simply informed of what information they do not have handy in their own EHR and what needs to be done, all in a clean and easy to navigate platform, Burket said.
- Customization. As each practice is unique, Orlando Health recognized the need to be able to tailor the user experience to accommodate different workflows, scheduling philosophies, patient mixes and so forth, as needed to optimize the utilization of the toolset.
“Once we aligned on the vision, we began a phased rollout, starting with a handful of affiliated provider practices,” Burket recalled. “We integrated the point-of-care technology with a wide range of EHRs at the outset, including eClinicalWorks, NextGen and Allscripts, among others. Then, we turned the system on and began to see how providers and teams used the platform, as well as how we could optimize the end-user experience to see increased engagement and actionability.
“In real terms, the system launched insights at the point-of-care whenever an identified patient chart was opened,” he continued. “The InNote system surfaces a sidebar-styled dialogue box with key insights related to cost, utilization, quality and risk coding information, all curated to the specific payer arrangement the given patient is affiliated with through the CIN.”
As such, these are not generic insights, but rather personalized based on the specific contract terms, patient characteristics and needs, and available datasets – for example, claims plus EHR plus ADT plus pharmacy plus SDOH data, and so on, he added.
A click-efficient setting
“A principal effort in the initial deployment was to create a very click-efficient environment, so substantial attention was paid to ensuring providers could easily mark care gaps closed, send and receive referrals, and/or document conditions without leaving their chart,” he said.
“This all coupled with some of our patient outreach tools, which enrich and update the unified dataset, serve to help enhance documentation in advance of and following the clinical encounters, using omnichannel pathways to connect with patients to gather information in ways most conducive to their messaging preferences,” he continued.
As a result of these deployments, Orlando Health saw that these real-time tools helped to drive provider engagement, streamline scheduled visits, and, ultimately, improve care through the closure of significantly more care gaps.
“The reporting to the physicians was complemented by reporting to CIN management, which had an aggregate view of network opportunities, allowing more nimble deployment of critical staff and resources to then drive broader network-wide improvements using this more contemporaneous data sourced right from the practices themselves,” Burket said.
The success story
The health system has reported a variety of successful results working with the technologies.
First, a 28.2% improvement in care gap closures.
“This was one of the most powerful metrics to emerge from our initial evaluation,” Burket reported. “Providers using the InNote tool saw an increase in gap closure rate across tens of thousands of encounters compared to a control group not leveraging the platform during the same period.
“This represented both closures in ‘paper gaps’ – that is, missing documentation – as well as, and more important, in true care gaps, for things like cancer screenings, diabetic management, chronic condition assessments and preventive interventions,” he continued.
And further, $907,000 in value generated through campaigns.
“Using the associated patient outreach toolset, the CIN was able to deliver more than 10,000 messages over two campaigns, one targeted at annual wellness visits and a second at breast cancer screenings,” he said. “Engagement rates for these campaigns were far above industry norms, exceeding 80% for patient interactions with the messaging.
“In total, across these two campaigns, nearly 3,000 gaps were closed leading to $842,000 in incremental visit revenue and an estimated $65,000 in technical and staff workflow savings,” he added.
Advice for his peers
When it comes to using these types of technologies, IT and VBC leaders should listen to the end user to know what they need and when, Burket advised.
“That is, we heard the physicians tell us they had ‘portal fatigue’ and did not have the time, energy or resources to navigate to more places to get the simple information they needed to better manage care,” he explained. “Instead, we needed to build a system that routed that information to them where they needed it: in their own EHR.
“Another piece of advice: Don’t think how technology can be additive, think how it can be transformational,” he continued. “Adding another tool in and of itself won’t make you better, and if it does that may only be marginally better. Rather, think how a tool can truly augment work that is done today and help to rewire workflows, support a culture of improvement and proactivity, and increase the capacity to perform under value-based care.”
Follow Bill’s HIT coverage on LinkedIn: Bill Siwicki
Email him: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.
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