Through a pilot project, Six East Bay hospitals are collaborating on the use of a data analytics tool that enables emergency departments at disparate health systems to share real-time patient data to improve care coordination for complex patients, such as homeless individuals who are often high utilizers of emergency care.
The six hospitals—four are part of the Sacramento-based Sutter Health system and two are part of Oakland-based Alameda Health System—have deployed PreManageED, a technology platform that serves as a virtual safety net to help providers facilitate collaborative care coordination for patients who turn to emergency rooms as the first point of contact for healthcare, sometimes as frequently as three times per week or more. Often, many of these high utilizer patients may not have the resources to navigate the healthcare system due to housing insecurity and other social barriers.
The data-sharing platform, designed by Sandy, Utah-based Collective Medical Technologies, enables ED providers and their teams at six hospitals in the East Bay area of Northern California to securely share health records, care plans and other relevant patient data between emergency rooms in real time.
According to Arthur Sorrell, M.D., physician informaticist at Sutter Health and physician chair of the Sutter Emergency Department Leadership Council, the technology is closing a communication gap that typically exists in emergency rooms across the country with the goal of ultimately closing gaps in care.
Patients who are high utilizers of emergency room care pose a significant challenge to hospitals and healthcare systems. Often, these vulnerable patients, such as homeless individuals, will frequently visit emergency rooms at several different hospitals and at different health systems in a geographic region, such as the East Bay, but ED providers often do not have easy access to other hospitals and health systems’ patient records to understand what care was provided to the patient.
“These patients typically utilize the ER because, one, it’s their only access to the healthcare system, and two, they don’t have a medical home and don’t benefit from care coordination. Some of the may have complex medical conditions that are purely medical issues and some have psycho-social issues. We don’t have a good way of either identifying the population that is the most frequent utilizers and identifying those that would most benefit from interventions so we know where to target our limited resources,” Sorrell says.
Participating hospitals in this collaborative initiative are Alta Bates Summit Medical Center - Summit Campus in Oakland, Alta Bates Summit Medical Center - Ashby Campus in Berkeley, Sutter Delta Medical Center in Antioch and Eden Medical Center in Castro Valley, all within the Sutter Health system as well as Highland Hospital in Oakland and San Leandro Hospital in San Leandro, which are part of the Alameda Health System.
According to Chris Klomp, CEO of Collective Medical Technologies, the health IT vendor partner, the idea for the collaborative technology partnership was conceived when health leaders across the Bay Area, including Better Health East Bay, Sutter Health’s philanthropic foundation partner in the East Bay as well as Sutter’s Research, Development and Dissemination (RD&D) division, came together to discuss how to best care for complex patients. “We were talking about it less from a pure interoperability perspective and more about how do we actually start a collaboration across providers in order to not only identify complex patients via high utilizers or individuals suffering from other complexities, but then also enable providers to interact with one collective effort, irrespective of their provider organization, to make sure the needs of the patients are met,” Klomp says.
In addition to the patient care challenges, on a national basis, the overuse of emergency rooms results in $38 billion in unnecessary expense annually, according to data from the New England Healthcare Institute.
The data-sharing platform fills a niche in the expanding world of interoperability, Sorrell says, as the data analytics tool enables providers to target, in real-time, the high frequency ER utilizers. “So that I, as a provider, can see right away that a patient has been not only at our ER recently, but other hospitals’ ERs in our geographic vicinity, where they might be frequent utilizers there as well, and the data tells me what happened during those visits.”
The data-sharing platform specifically caters to the needs of emergency care providers by fitting into ED physicians' workflow and providing data for care coordination in an efficient way, according to Sorrell. Typically, when Sorrell requests a patient’s health record from another hospital, he will receive 20 to 50 faxed pages. “Buried in there is one page that is going to answer my question,” he says.
The technology platform utilizes a basic provider-level tool, Health Level Seven (HL7) Admission, Discharge and Transfer (ADT) messages. The PreManage ED system extracts ADT data, aggregates it and applies real-time analytics to identify risk patterns and high-risk patients and pushes a flag into the ADT tracking board of each hospital’s respective electronic health record (EHR) system. Essentially, according to Sorrell, the data-sharing platform gets ED providers across different hospitals and health systems “on the same page” to provide patients with a consistent set of care interventions to treat their needs.
“The way it looks, it’s similar to health information exchange data, but it’s not really a full-fledged HIE, in that it’s not exchanging what we call a CCD or another part of the health record. But what it does is provide a really focused, valuable structured report that is made up from the ADT feed, so it gives you demographic information, visit history, patient identification information. And, the way we’ve got it integrated it into our Epic EHR system, it puts that information right in the sights of the providers who are seeing that patient when they register in the emergency department. So, it complements our current capabilities for health information exchange very well,” Sorrell says.
Sorrell adds, “So if a patient comes into me and they’ve been to three other hospitals, if I don’t have a current health information exchange with those hospitals, or even for the hospitals where we do have the Epic CareEverywhere platform, it will put in front of me the visit history so I’ll know that, literally two hours ago, the patient was discharged from an ED visit. And that, to me, is very valuable.”
The virtual safety net technology being deployed at the six East Bay hospitals addresses a significant patient safety issue, especially as patients with significant psycho-social issues are particularly vulnerable and not able to effectively articulate what care they received at another hospital. “If I’ve got a patient who just came from Highland Hospital, and when the patient was at Highland, the patient told the physicians they were having chest pains, so the physicians did an extensive work-up, including a CT scan, which is a full-on dose of radiation to their chest. And, then the patient came to me and complained of chest pains, but I didn’t know about their previous ED visit or what was done, and I want to do the right thing for them, so I might do a CT scan as well, so that’s two CT scans in the past 12 hours. Without that previous visit history information, I might perform tests the patient doesn’t need and I might not be serving that patient's needs,” Sorrell says.
Collective Medical Technologies provided early data from the technology collaboration between the emergency departments at Sutter Health’s Alta Bates Summit Medical Center and Alameda Health System’s Highland Hospital, for the first 60 days that the pilot project came online. The data provides a snapshot of the patient cross-over that occurs between the two emergency departments and highlights the need for efficient, real-time data sharing.
Since coming online with the technology platform on March 31 and through May 31, emergency departments at Alta Bates Summit Medical Center, including both campuses, registered 20,799 encounters, and an encounter could mean simply a patient showing up at the emergency room, or any time that patient touches the system. Of this 20,799, 16,119 were individual patients, and of those, approximately 2,000 had also been to Highland Hospital’s emergency room since that hospital came online with the system on April 29. So, that's 2,000 shared patients between just two hospitals, in two different health systems, in the EAst Bay area.
A breakdown of that data indicates that of those 16,119 patients seen at Alta Bates Summit Medical Center’s ED, in the prior 12 months, 4,191 patients had three or more ED visits, 2,685 patients had four or more ED visits, 1,802 patients had five or more ED visits and 1,297 patients had six or more ED visits.
Further, the data-sharing capabilities of the PreManage ED system has enabled the two health systems to identify the high utilizers, and perhaps most vulnerable patients. According to the data, of the 2,000 shared patients between Alta Bates Summit Medical Center and Highland Hospital, in the prior 12 months, 1,448 patients had three or more ED visits between both hospitals, 1,127 patients had four more ED visits and 900 patients had five or more ED visits. In addition, 730 patients had six or more ED visits between both hospitals.
In addition, of those patients with three or more ED visits in the prior 12 months, almost 250 had indicated that they were homeless.
In addition to improving care coordination at the point of care, the data-sharing platform enables providers to better coordinate with case managers and social services as well.
Highland Hospital officials shared the story of a particular patient at the Highland ED, who was referred to Highland’s Complex Care Management (CCM) program because her primary care physician was worried about her neuroendocrine tumor and un-healing wounds. Because of the use of the data-sharing technology platform, a Highland care provider was able to learn that the patient was homeless, as she was living in a tent, and had a case manager at Summit. When the patient was admitted to the Highland ED, the care provider was able to contact the patient’s case manager at Summit, who was then able to visit the patient at Highland. As a result the relationship between the provider and patient was strengthened, which can often be difficult with ED patients, and the case manager also was able to initiate a referral to a transitional housing program.
“The promise of health information exchange, and having electronic health records across the country, wasn’t just to make people into data clerks and save paper, but really the primary purpose was to be able to have your record follow you wherever you go, instead of the record being cooped up in the silo, in order to help standardize care and develop best practices,” Sorrell says. “Whether a patient is in a rural area and or in a large city, the patient should get the same quality of care. And being able to disseminate best practices and standards of care also applies to non-medical care to ensure that we are all on the same page and doing what we all agree is the best to help patients in a psycho-social environment. So it’s not only helping to coordinate care, it’s also helping to disseminate the concept of doing the best practices and standards of care for everyone.”
While systems like this have been implemented in other states, the goal with the Alameda County initiative is to extend the PreManage ED data-sharing platform beyond hospitals to include primary care physicians, clinics, social services agencies and other community partners to deliver comprehensive care and improve patient access to a full range of services.
“One of the things that’s unique, innovative and exciting about this initiative in the Alameda County and East Bay area is that it started with the ED because that’s a front line of defense, and it’s a clearinghouse for most patients, given a variety of reasons, including low barriers to care. But if you want to really drive a healthy community, you have to go beyond the ED. The next phase of where we’re headed with this project is how do we move far beyond hospitals and bring healthcare providers together, as well as community partners across the county, so that you’re delivering a consistent collaborative and cohesive set of care paradigms for patients who don’t have the resources to appropriately access the continuum of healthcare resources. So, we’re laying the foundation with ER and we’re working on the next phase and integrating the right partners and the right participants,” Klomp says.
Sorrell adds, “The promise of this type of system is that as more institutions subscribe to the service, you get a much fuller picture and the value of the information increases because now you’re going to see the other places where that patient has visited.”
