Standards-driven health data interoperability can directly support improved patient care coordination (a key early premise of the ACA) and importantly, also a contributor to real-time Real-world evidence (RWE)-based research programs for overall improvements to health. Hence, the importance of Northwell Health, a major U.S. health system, and its’ SMART on FHIR application that aggregates, normalizes and stores patient data to better track progress across the care continuum for at risk premature birth patients. Northwell Health leveraged an innovative integration model developed by Boston Children’s Hospital and the FHIR standard for health data interoperability to evolve its Electronic Health Record (EHR) to improve care coordination for premature birth patients. The model discussed has broad applicability not only for direct health care coordination scenarios but also as an enabler for the creation of richer, deeper and more meaningful data, consumable for AI algorithms, in support of Real-World Evidence (RWE)-based research.
Northwell Health Background
New York’s largest private employer (68,000) and health care provider, the system includes 23 hospitals and more than 750 outpatient facilities.
A nonprofit integrated healthcare network, the system is also home to extensive research via the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, and The Feinstein Institutes for Medical Research not to mention urgent care centers, kidney dialysis centers, acute inpatient rehabilitation, sub-acute rehabilitation and skilled-nursing facilities, a home care network, a hospice network and other services. It was formerly called the North Shore-Long Island Jewish Health System and renamed in 2015. Its flagship hospitals include North Shore University Hospital and Long Island Jewish Medical Center.
The health care provider delivers over 39,000 babies annually. An estimated 15 million babies are born prematurely every year, according to the World Health Organization (WHO).
Northwell implemented a technology solution to support the mission of improved care coordination and “Whole Patient Care” for premature birth patients via the SMART on FHIR application and their Electronic Health Record (EHR). Built on a technology called “HeathShare” from electronic health record vendor InterSystems—and by leveraging the Boston Children’s Hospital SMART on FHIR application—Northwell has offered its caregivers a more effective way ro track a premature baby’s development with minimal disruption to internal workflow. So, for those pediatricians who have access to this new growth chart, according to Northwell’s press release, they are only two clicks away from the electronic medical record (EMR) home screen. Better, faster access to the right information at the right time for this vulnerable patient population represents an important advancement and actually an intention of the Affordable Care Act (ACA) that probably failed miserably at this goal.
App Details: How does it Help the Care Givers?
The app features a graphing function to monitor key health indicators such as weight and height over time and across different caregivers and facilities. As an example, when a baby is born prematurely, the initial care provided at the hospital represents one track in the overall care continuum for the patient, and the next visit at an outpatient office represents a separate workflow in addition to any other subsequent appointments or hospital stays. Importantly, the new SMART on FHIR application consolidates all of the data from these visits into a single, longitudinal view of the patient, empowering physicians with a more complete picture of the patent’s care history.
Again, for purposes of the TrialSite News broader focus on research, the implications of this type of application for real-world evidence (RWE) initiative as well as how such technology advances can support clinical research as care options—are compelling. Such applications produce more timely and nuanced data that in the age of cloud computing, Big Data and AI—can be tapped into, harnessed and utilized for RWE-based research.
Background on the Technology Apps and Players
To improve care coordination for its premature patient population, Northwell Health A) employed a system integrator called J2 Interactive; B) looked to a peer for standards (e.g. Boston Children’s Hospital’s SMART on FHIR application); and C) worked with its existing Electronic Health Record (EHR) vendor, InterSystems, to leverage its HealthShare unified care record to improve upon patient-centric care coordination for an extremely important and vulnerable population–premature patients.
The app leveraged interoperability standards developed by Boston Children’s Hospital Innovation & Digital Health Accelerator, an innovative unit within this provider to continuously shape the future of health care and extend Boston Children’s pediatric leadership leveraging new systems, processes and collaborations with industry via the deployment of a comprehensive digital health platform.
The Boston Children’s Innovation & Digital Health Accelerator is directly contributing to advancements in healthIT for a vulnerable population, to encourage scalable, interoperable solutions leveraging the FHIR standards where applicable. Hence, the design, development and deployment of scalable interoperable solutions including FHIR (Fast Healthcare Interoperability Resources) enabled Application Programming Interfaces (APIs) for exchanging Electronic Health Record data. By combining FHIR standards with the SMART (Substitutable Medical Applications and Reusable Technologies) protocol created by Harvard Medical School and Boston Children’s Hospital to support the creation of applications that can be integrated into any Electronic Health Record system, Northwell was able to progress its’ premature patient care coordination capability.
CIO Impressed with Results
Deborah Mensch, MD, chief information officer at Cohen’s Children’s Medical Center (Northwell member) in New Hyde Park, NY, reports that “The addition of the growth chart into the health information exchange has been invaluable for our clinicians, particularly in the Neonatal ICU. The ability to have appropriate growth parameters for all infants has minimized the need to use multiple websites and paper documentation for these babies.” Emphasizing the critical nature of premature infant care, “Monitoring growth in premature infants is critical to their care, and this tool has eased the burden on our front-line clinicians.”
Don Woodlock, VP of HealthShare, communicated, “It’s imperative to have accurate, up-to-date information about every patient, but particularly for the premature population where a patient’s growth can change in a matter of hours or days.”
Broad Applicability If…
The press release conveys that the application was designed for a specific intent—care coordination for premature patients; however, the application could be used for patients of any age. The ability to leverage the core Electronic Health Record (EHR) represents a fundamental imperative in provider organizations. In this specific case, Northwell has InterSystems’ HealthShare but other health systems can leverage their EHRs whether it be Epic or Cerner, etc. The integrator, J2 Interactive, was employed to use existing APIs and web services to develop connectors based on the Boston Children’s model and the FHIR interoperability standard, to improve care coordination.
Again, with the advent of Real-world evidence (RWE)-based research combined with the movement for clinical research as a care option, standards-driven care coordination initiatives can produce extremely valuable data generation capability if research is considered not as an add-on but a fundamental ongoing underpinning—a continuous improvement agenda—of the healthcare system.
Whole patient care, that is—a form of patient-centric care coordination—reflects the direction of healthcare markets in the United States and many other places. The ability to more easily, efficiently and effortlessly coordinate the care of the patient represents a fundamental mission of healthcare systems and payers moving forward. Whole Patient Care is on the top of many executive’s minds. Evolving existing systems to produce improved patient care coordination and in the process, generate richer real time and actionable data, can contribute to emerging AI-driven outcomes and ongoing Real-world evidence-based research initiatives for ongoing continuous improvement to the healthcare system.