Geisinger Health System in Pennsylvania has been engaged in population health management data analytics for some time, using clinical data from its core Epic electronic health records system and claims data from its health plan.
To expand its population health capabilities, Geisinger has turned to Epic’s core competitor, Cerner Corp., for its HealtheIntent population health management analytics platform. Geisinger remains an Epic shop, says Alistair Erskine, M.D., chief clinical informatics officer. It’s just that Cerner adds a cloud-based Big Data platform that can handle a broad variety of structured and unstructured data in near real-time, according to Erskine.
The Cerner product capabilities add value beyond traditional data warehouses that organize data into data models, rows and columns. HealtheIntent is better suited to accommodate unstructured clinical notes, streaming data from social network sites like Facebook and Twitter, as well as geographic information data from the federal government, such as assessing the walkability of a particular neighborhood, Erskine explains.
Non-healthcare data is becoming more relevant to patient care in the population health management era; physicians, for instance, need to know if their patients have difficulty getting to a doctor or pharmacy. HealtheIntent also has a process to standardize nomenclature from several different EHR vendors—including standardizing lab test names—and a master patient index supporting records from different information systems.
“Epic provides a very effective way to move transactional data into a data warehouse and turn the corresponding analytics back into the clinical workflow,” Erskine says. “At the same time, by simultaneously sending clinical data to the Cerner cloud, we can take advantage of the strength of both Cerner and Epic platforms.”
The bottom line: HealtheIntent generates a population health management record of the patient, he adds, independent of the EHR vendors or source of the data. “It’s about time the healthcare industry takes advantage of a hybrid of structured and unstructured data to learn what’s going on inside and outside of the hospital.”
Geisinger has already demonstrated in proof of concept that it can take advantage of the emerging FHIR interoperability standard from Health Level Seven to exchange in real-time data between Geisinger developed apps and Epic, Cerner and Athenahealth information systems. Now, working with FHIR vendor xG Health Solutions, Cerner and Geisinger will use additional FHIR application programming interfaces to better manage patient populations and exchange data among health systems, and return these insights back into the clinical workflow.
Erskine also is looking forward to real-time HealtheIntent capabilities that Cerner is developing, particularly subsets of perishable data that is only valuable if provided in near real-time. “If an ICU dashboard is fed blood pressure data that is one day old, that is not helpful. On the other hand, being able to collect, normalize, analyze and return blood pressure measurements in near real-time, within 15 minutes, becomes much more useful.”
Geisinger has emphasized to both Epic and Cerner that it plans to take advantage of the capabilities of both vendors in an agnostic manner, Erskine says. “Clinical data does not belong to the vendors, or even Geisinger. It belongs to the patient and should be unconstrained and readily available to improve patient experience and optimize quality of care.”
The industry, Erskine believes will have to untangle what is proprietary to one vendor and what is clinical information to the patient, or risk being categorized as information blockers. “We are seeing information blocking play out on the physician and hospital sides, motivated by business models that impede the flow of clinical information to the detriment of the patient.”
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