The Health Collaborative Developing FHIR-Enabled Enterprise Data Warehouse

March 30, 2020
Cincinnati-based HIE breaking down silos between its own data stacks

A year ago, when the Cincinnati-area nonprofit health improvement organization The Health Collaborative (THC) sought to merge clinical, claims and other data in an enterprise data warehouse, its IT leaders chose to embrace the FHIR standard for a more interoperable healthcare system.

In a recent interview, Alex Vaillancourt, CIO and senior vice president of informatics at The Health Collaborative, gave some background information to explain why the FHIR standard and application programming interfaces (APIs) made sense to the organization, which also runs a regional health information exchange. It works with 58 hospitals, 1,222 practices, and more than 17,000 physicians, who treat more than 8 million patients.

 Vaillancourt joined THC a little over a year ago. “We were a typical organization where claims data and analytics was in its own technology stack, and our HIE work was in its own stack, social determinant work and data was in its own stack,” he said. “And yet we saw the opportunity to bring those data sets together. “We started on a vendor selection process and landed on Information Builders as a solution that would help us bring all that under one roof.”

THC is involved in a voluntary All Claims Payer Database in Ohio. “We have great access to claims data, but, as you would expect, that has some age to it,” Vaillancourt explained, “so we are trying to merge in the clinical data sets. We do gaps-in-care reporting. Rather than having data that is three or four months old and telling a nurse or doctor here are the recommended patients to follow up on, we are looking at how we use the clinical data set to change that. Did someone actually have an A1c test done more recently than three months ago? Then they don’t have to make phone calls needlessly.”

 One of the reasons THC chose to begin work on deploying Information Builders’ Omni-HealthData platform is to align with new interoperability rules from the Office of the National Coordinator for Health IT and CMS. “The draft regulations had already been released last year, and we knew FHIR APIs were probably going to stay in the final regulations,” Vaillancourt said. “With Information Builders moving into that FHIR world, we want to be a data platform and not have to build every app you can imagine. We want to open our platform up to developers and partners and hospital systems so to have standard APIs and not have to customize every instance of data sharing was a world of difference.”

 One use case he described involved admission, discharge and transfer (ADT) event notifications, which will be required in six months by the new rules.  The new interoperability regulations are going to force a little more standardization and open sharing, he said. A hospital system sends THC clinical data to share with the rest of the community. The idea is that when the hospital sends an ADT, THC can use the discharge as a trigger to FHIR-query against the hospital’s Epic system and pull that patient data rather than the hospital having to send it. “So rather than a push of data, can we pull the data from the hospital as we need it? That starts to open up a lot more possibilities for the providers and all the various EHRs in every market,” Vaillancourt said. That will require some programming work in EHRs, even with standard APIs. “There are some things we are trying to work through,” he said.  Most of our hospitals are on Epic or Cerner and they are FHIR-ready for most of the USCDI of the data set, but by default those are turned off. So we are working with the hospital systems on how you turn those on, and how that FHIR query would work.”

 The good news for THC on ADTs is that it has been doing them for a few years. “Now, we have fine-tuning to do,” Vaillancourt said. “Everybody gives us ADTs but there is a lot of technical variation in terms of what hospitals and data providers put in those. “As a case in point, there are conversations around COVID-19 and what data from the ADTs we can extract.” THC is working with the departments of health, on what data it gets in real time to  supplement their data sets. “If we have high-risk patients around Ohio who have upper respiratory issues, COPD, and other chronic conditions, can we flag them, and then when there is an ADT that they have landed in the ED, on in an in-patinet setting, can we set off bells and whistles?”

 THC also is trying to do more work on ADTs in the ambulatory space. Some physician practices are getting more granular in terms of what they want from the HIE in terms of ADTs, he added. “They say don't just tell me admissions, but only if they end up in the ED more than once and are diabetic. Or if the patient lands in ED and is diabetic and has transportation and food issues. So how do we link all those data sets together and get more sophisticated in alerts capabilities?”

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