The new health economy is a network of different stakeholders with a patient in the centre. It is comprised of the patients, physicians, carers, family, social environment, healthcare facilities, insurance companies, and many others. Each small piece of the whole ecosystem generates different data that can be valuable: EHRs, clinical notes, demographics, family history, risk scores, prescriptions, and drugs; data from wearables and even social media posts. Combining all of them, we could do so much more to improve the quality of care, prevention, and to strengthen healthcare systems.

Hiliary Critchley, Managing Director at Manifest MedEx, describes the situation clearly: “The problem is that information that community medical and healthcare organisations need has not usually been available to them. They either have to follow up directly with the hospital, or the hospital has to follow up with them.”

First step: Make the data liquid

So how do we break the silos to profit from comprehensive data? IT infrastructure, including HIS, is not enough. In the technical report 'Making IT work: harnessing the power of health information technology to improve care in England', Bob Wachter suggests that implementing health IT today – which consists of technical and adaptive change – is one of the most demanding shifts in the history of healthcare. “Adaptive change involves substantial and long-lasting engagement between the leaders implementing the changes and the individuals on the front lines who are tasked with making them work,” writes Watcher. 

On the way towards the data-driven ecosystem, it’s necessary to understand what the difference is between “data liquidity” and “interoperability”. David Hancock, Client Engagement Director at InterSystems, explains that while data liquidity means the ability of data to flow throughout the healthcare system easily, quickly and securely, “interoperability” is the ability for information to be exchanged between systems and for the receiving system to reason with that data. Data liquidity is predicated on interoperability – even interoperable data can be stuck in silos. The art of adaptive change is to make data flow.

Here are some tips on how to do it:

• Strengthen trust, even where there is natural distrust.
• Using incentives and regulations, overcome a stalemate situation where theoretically everybody could profit from cooperation, but conflicting interests between individuals block joint action (“Collective Action Dilemmas”).
• Normalise variability through robust, open standards.
• Drive adoption and engagement by delivering value and simplifying the difficult.
• Never lose sight of the human factor.
• Plan for success. It never happens by chance.

The Greater Houston Healthconnect is an excellent example of how to implement these principles into practice. To ensure a care continuum, Healthconnect integrates disparate electronic health record systems from 24 counties, 15+ million patients, and 1025+ care venues, like hospitals, labs, pharmacies, clinics, specialists, PCPs, radiology centers, and accountable care organisations. This creates unified records across all venues of care.

Deliver value. Simplify the difficult

Enabling the exchange of clinical information seems at first sight like an impossible mission that requires the engagement of many resources, overwhelming the capacity of a healthcare organisation. One highly successful approach is to build incremental value, suggests Kathleen Aller, global healthcare market strategy lead at InterSystems. For example, starting with a small set of high-value information, and collecting it consistently, can build trust, leading to a greater willingness to share additional data. Dr James Reed, CCIO and consultant forensic psychiatrist at Birmingham and Solihull Mental Health NHS Foundation Trust, gave an example of this. He and his team have created a unified care record for mental health care, but the participating organisations were at varying levels of digital maturity. However, by sharing a few simple data elements, such as patient demographics and the care manager, they are able to improve care for patients in crisis significantly.

Building a value based on data liquidity in healthcare settings takes time. However, it’s worth the effort – the goal is to strengthen the quality of care.

“If you have the impression that it exceeds the capacity of your organisation, implement the strategy of small steps, and simplify what seems to be difficult,” advised Hancock. Follow these guidelines:

• Present all the relevant information in clinical workflows.
• Eliminate “seek and sift” in different ecosystems.
• Identify the patients dynamically in high-risk cohorts for intervention.
• Streamline the care organisation process.
• Automate quality measurement data collection.
• Deliver actionable information in a timely fashion.

Let’s go back to the case study of the Greater Houston Healthconnect. Connecting the venues of care enables not only the exchange of the information, but also reduces healthcare costs, supports disease prevention, enhances research, and value-based care. Through better information, unnecessary hospital admissions or duplication of laboratory tests and imaging can be avoided. Healthconnect's integrated care model enables monitoring of health risks and conditions. Real-time alerts for patients admissions and discharges improve the workflow. Consistent data from different sources accelerate and speed up health analytics and research that is necessary for health population management.

Another example is Northwell Health, one of the largest private health systems in the US. Using the unified health record, Northwell has created a healthcare database holding over one billion data points from the disparate EMRs and other clinical systems across its 23 hospitals, 655 outpatient facilities, and more than 18,500 affiliated physicians. It’s an excellent foundation for innovation in care, risk management, and care coordination. 

Northwell used the unified care record as the foundation for a care management application they built called 'Care Tool'. This has resulted in 6% fewer readmissions for cardiac valve replacement patients, 18% to 28% more patients discharged to home instead of a skilled nursing facility, lowered risk of infections, up to 56% greater use of in-network home care, enabling better quality control and greater patient satisfaction. Jim Heiman, AVP for Clinical Information Systems at Northwell Health, says: “Our ability to share data between the acute and ambulatory care settings is pivotal to support transitions of care and care coordination between providers across disparate systems of record.”

The InterSystems’ workshop at the HIMSS & Health 2.0 European Conference encouraged participants to connect diffused data into one consistent unified care record that helps improve care coordination and powers the digital health economy.