The long-awaited road to true healthcare IT system interoperability is being implemented at Good Samaritan in Indiana, enabling the 232-bed community healthcare facility to better deliver on its commitment to providing exceptional patient care. The system will also enable the hospital to substantially increase its revenue while containing healthcare system integration costs.
“We strive to be the first choice for healthcare in the communities that we serve and to be the regional center of excellence for health and wellness,” says Rob McLin, President and CEO, Good Samaritan. “We are proud to be the first hospital in the country to implement this great integrated health record system that will allow us to provide a much higher level of continuity of care for our patients, as they are our top priority.”
The integration is made possible with Zoeticx’s Patient-Clarity interoperability platform, which will integrate WellTrackONE’s Annual Wellness Visit (AWV) patient reports with Indiana’s health information exchange (HIE) and the hospital’s Allscripts EHR. Indiana is the largest HIE in the country, serving 30,000 physicians in 90 hospitals – or six million patients in 17 states.
WellTrackONE and Zoeticx will enable patients’ AWV data to flow from the application to the Allscripts EHR and the Indiana HIE system. With Zoeticx’s Patient-Clarity platform and WellTrackONE’s software, the healthcare IT integration passes on increased revenue from the Centers for Medicare & Medicaid Services (CMS) and decreased IT costs for medical facilities.
Medicare pays medical facilities $164.84 for each initial patient visit under the AWV program and $116.16 for each additional yearly visit. With the AWV integration in place, the hospital is now able to meet CMS’ stringent requirements for patient reimbursements.
It is estimated that the Good Samaritan will be able to generate $500 to $1,200 per AWV patient from follow-up appointments for additional testing and referrals for approximately 80 percent of the Medicare patients that are flagged by the AWV for testing, imaging, and specialty referrals within the hospital.
This subscriber number is expected to trend upward into 2050 and will create billions in new revenue in the United States as the population ages. The hospital is not charged any costs for the system until it is reimbursed by CMS.
Overcoming healthcare system limitations
The hospital began offering Medicare’s AWVs a few years ago, but had to develop its own tracking protocols, which impacted their budget and staff resources. The system they created also operated poorly, allowing them to only view about 10 to 15 percent of their patient data.
Good Samaritan medical teams were also constrained by interoperability, spending valuable patient face time trying to find specific patient data buried in the EHR system. They also had all of the data contained in WellTrackONE and the Allscripts system, but no way to integrate the two, let alone achieve that integration with the Indiana HIE.
“Our systems were working fine, independently of each other,” says Traci French, Director of Business Development and Revenue Integrity, Good Samaritan. “But we could not achieve true interoperability between the two systems. The best we could do was basically reshuffling PDF documents. The next challenge was to integrate that data with the exchange. We needed to get data to providers where they needed it, when they needed it.“
Searching for a solution
The facility turned to Robert Storch, Founder, National Medical Reps, who identified three goals when asked to find an interoperability solution for the hospital’s AWV integration.
“We wanted to have the ability to seamlessly integrate with any EMR product, but we also saw another specific need that no one in the market had addressed – the inclusion of integration with health information exchanges. It was the best way we could help keep costs down for our customers and allow them to share that information across the HIE’s multiple providers and facilities to provide a better continuity of care to AWV participants,” says Storch.
“First, I set out to find the best companies we could to integrate the AWV, provide interoperability across all EMRs, and include seamless integration into the chronic care management side of the equation,” says Storch. “WellTrackONE was already implemented, but finding Zoeticx was a bit more complicated. Everyone complains about lack of interoperability, but Zoeticx appears to be one of the few companies doing anything about it.”
Storch discovered that not only did Zoeticx solve interoperability, but it had identified the steps needed to connect the dots of the long-elusive CMS stringent requirements for its Chronic Care Management (CCM) patients.
“It appears that Zoeticx is the first medical facility EHR integrator to access this multibillion-dollar aging population market. This technology breakthrough enables providers to electronically invoice Medicare and Medicaid with a new billing code number, creating a new medical facility profit center and substantially impacting caregiver revenue for the approximate 15 million patients who have two chronic diseases and qualify for CCM care,” says Storch.
Connecting data points
WellTrackONE gathers and processes 280 patient data points, identifying potential catastrophic and chronic medical conditions. Once the assessment is complete, those conditions are outlined for review by a medical provider, flagging potential for current risks and chronic conditions in multiple categories, such as functional capacity, safety, cognitive, mental, vision, and other areas.
Current and potential catastrophic and chronic conditions that meet CMS’ AWV guidelines are outlined by category, subcategory, and severity and include suggestions for clinical testing and referrals to specialists. The clinical triggers provide medically necessary information for follow-up visits, lab, and other testing as well as referrals of the patient to specialists to ensure the patient is obtaining the best possible care to minimize the risk of hugely expensive catastrophic events.
Addressing all challenges associated with the lack of interoperability
To begin addressing the integration of these data-laden reports and overcoming their previous interoperability challenges, Zoeticx’s Patient-Clarity server used its powerful data switch to “push” WellTrackONE’s reports into both of the hospital’s Allscripts EHRs and the Indiana HIE system. This was done using Zoeticx’s middleware-driven application program interface (API) to translate the data.
The middleware design approach addresses multiple challenges relating to the lack of EHR interoperability. First, WellTrackONE’s solution becomes agnostic to any EHR infrastructure, opening up to more opportunities to address care provider needs for AWV. Second, healthcare IT addresses the challenges of integration where patient medical information flow is now integrated between EHRs and the Indiana HIE. The reports are available to all Indiana HIE patients and participating facilities to provide a much higher level of continuity of care for the patient.
Fast implementation was also required from Zoeticx as the hospital was preparing to place an additional Allscripts EHR online. It needed interoperability for the hospital’s two Allscripts EHR systems, one for the clinical side and one for the rest of the hospital, but also its connected facilities.
In addition to speed and seamless integration, the hospital required customization for its billing capability. It had to be able to invoice the AWV under specific physicians while reports from patient assessments were custom routed to the attending physicians via Zoeticx’s platform.
Additional customization was also needed to ensure that the hospital’s laboratories and on-site specialists were included in the referral process by integrating the labs and specialists to the referral links within WellTrackONE. This would enable ease of use and ensure the referrals were going to the right lab, testing facility, or specialist.
“The whole integration took no time, and we were up and running with a newly integrated system. Our expectations were perfectly met, and we now have more efficient providers who can better treat patients, their primary goal,” says French. “We also had no out-of-pocket costs and were able to generate substantial revenue for the hospital and its providers, and achieve healthcare IT integration between EHR and Indiana HIE at the same time.”
Proactively looking ahead
The next step for Good Samaritan is to add its seamless Chronic Care Management program to the equation. It will provide the hospital with a complete, end-to-end solution that will give providers the latest up-to-date information to manage their patients’ chronic and catastrophic illnesses and provide them with the best care possible. The challenge will be supporting the chronic care documents available to care providers within and outside the healthcare network.
Looking to the future, Good Samaritan is also aware of the trend in which hospitals in particular have been purchasing physician and specialty clinics. Physician offices and specialty clinics often have their own EHR systems, and they are never upgraded under a single EHR vendor, which results in disparity of EHRs. Similar interoperability problems occur when a hospital system makes a purchase, but the complexities are even more pronounced. Different areas within the hospital usually operate a version of the EHR system used by the whole facility.
“Whether we need to integrate additional EHRs for our healthcare IT system or through acquisition, with Zoeticx’s interoperability, we are well positioned for any possible future expansion,” French says.
