SUTTER HEALTH: A HEALTH DATA SHARING CASE STUDY Session 58, March 6, 2018 Steven Lane, MD, MPH Clinical Informatics Director, Privacy, Information Security & Interoperability, Sutter Health Dave Cassel Vice President of Carequality, The Sequoia Project 1
Conflict of Interest Steven Lane serves as a member of the Azuba Advisory Board. Dave Cassel has no real or apparent conflicts of interest to report. 2
Agenda Sutter Health: A Case Study Carequality: A Case Study Developing A Strategy For Exchange 3
Learning Objectives Demonstrate the real world application of a national interoperability framework Design an onboarding plan that incorporates lessons learned during pilot use Adapt a health data sharing strategy that incorporates multiple national-level approaches 4
Sutter Health: A Case Study 5
Not-for-profit health system with headquarters in Northern California Serving over 3 million patients across more than 100 communities Supports: 5,500 physicians 24 acute care hospitals Regional home health, hospice and occupational health networks Medical research, education and training 6
Why Exchange Matters To Sutter Health Northern California Mobile, tech savvy population Early adopter of health IT First EMR in California, 1999 First PHR in the US, 2001 Competitive healthcare market Patients regularly move between healthcare systems, physician practices Consolidating market Providers joining larger systems with need to integrate historic medical record data 7
Multi-Platform Interoperability Approach Sutter Health Leverages Many Types of Connectivity Epic Care Everywhere ehealth Exchange Santa Cruz Health Information Exchange Direct messaging via Surescripts HISP Carequality Surescripts NRLS 8
Monthly Patient Records Exchanged 4,000,000 3,500,000 3,000,000 Sutter has exchanged with organizations spanning 25 states Sutter has exchanged with organizations in every state Surescripts NRLS Go-Live 2,500,000 2,000,000 1,500,000 1,000,000 500,000 ehealth Exchange Go-Live Went live with Surescripts HISP First CA Regional User Group Meeting 9 VA Go-Live DoD Go-Live SSA Go- Live Carequality Go-Live Began sending Direct messages to PCPs automatically from EDs Enabled Advanced Record Location 0 Dec '10 Jun '11 Dec '11 Jun '12 Dec '12 Jun '13 Dec '13 Jun '14 Dec '14 Jun '15 Dec '15 Jun '16 Dec '16 Jun '17 Dec '17
Linked Organizations per Patient Unique Sutter Patients 2,000,000 1,500,000 1,000,000 500,000 0 1,863,583 1,032,453 557,657 265,983 173,915 1 2 3 4 5+ Linked Organizations 10
Cumulative Sutter Health Patient Links Total Links Unique Patients 8,000,000 Carequality Go-Live 7,000,000 6,000,000 5,000,000 4,000,000 3,000,000 2,000,000 1,000,000 0 Dec '10 Dec '11 Dec '12 Dec '13 Dec '14 Dec '15 Dec '16 Dec '17 11
Top Trading Partners by Patient Links KP N Cal Surescripts NRLS Stanford Health Care UCSF Medical Center Dignity Health Stanford Children's Health John Muir Health UC Davis Health System El Camino Hospital Hill Physicians Medical Group Practices Using athenahealth Veterans Affairs 370,711 317,417 275,149 244,471 219,941 196,562 152,673 479,557 617,301 847,346 1,154,728 1,315,941 Epic Carequality ehealth Exchange 12
Patient Link Sources (in thousands of patients) 1,155 1,017 298 64 27 10 5,163 197 Epic Surescripts NRLS Non-Epic, non-carequality Carequality 13 athenahealth NextGen SCHIE eclinicalworks
Carequality in California Go-Live Jul 2016 HIMSS 2017 Feb 2017 HIMSS 2018 Mar 2018 Sutter Health Facility Other 14Health System Live on Carequality
Nationwide Exchange Sutter has exchanged with 41 states via Carequality 15
Top Carequality Trading Partners by Implementer athenahealth live since July, 2016 190 unique sites eclinicalworks live since August, 2016 165 unique sites Santa Cruz HIE live since August, 2017 NextGen live since April, 2017 Sent Documents 69,431 Received Documents 232,707 216,360 461,164 Factors Leading to Imbalanced Exchange Automated queries Opt in vs. opt out 16 Patient matching Reuse of patient IDs
70,000 Monthly Documents Exchanged via Carequality 60,000 50,000 40,000 30,000 20,000 athenahealth eclinicalworks NextGen SCHIE 10,000 0 Jun '16 Sep '16 Dec '16 Mar '17 Jun '17 Sep '17 Dec '17 17
88% Availability of External Data at Time of Encounter 83% 76% 89% 41% 47% 48% 55% Ambulatory ED Inpatient Hosp Outpt Encounters with ANY ext data 18 Encounters with NEW ext data
Sutter Emergency Departments July, 2017 47% Of patients with new external documents available 1 in 25 Patients 1 had an interaction alert 2 fired based on reconciled data 30% Of clinicians acted on these alerts 3 1 Patients with new external documents available 2 Drug-drug interaction or drug-allergen interaction 3 Actions include modifying or cancelling the order 19
Carequality: A Case Study 20
Introduction to Carequality A standardized, national-level interoperability framework to link all data sharing networks Common rules of the road: In order for the varied participants to trust each other with health information, everyone needs to have a legal obligation to abide by the same rules. Well-defined technical specs: Shared rules are not enough; clear standards must be laid out in an implementation guide that all implementers can follow. A participant directory: To connect using the common standards, systems must know the addresses and roles of each participant. 21
The Network Effect How do you get nationwide connectivity? Clinic by clinic, hospital by hospital? Data sharing networks have already connected many participants within communities. The connections grow exponentially by connecting these networks. If you connect six clinics, you might reach a few dozen physicians. If you connect six communities, you can reach thousands of physicians. 22
Broadening Interoperability Opportunities Diverse Stakeholders Use Collaborative Process: Physicians Consumers Government Agencies Data Sharing Networks Hospice and Home Care Research Public Health Vendors Collaborative Multi- Stakeholder Open Payers Behavioral Health Acute Care Long Term/ Post-Acute Care Standards Development Orgs. Pharmacies EMS Services Real- World 23
Carequality Evolution 2014 Need to connect disparate local & national networks recognized by by industry 2015 Carequality Interoperability Framework published by stakeholders across the healthcare continuum 2016 Live exchange begins July 1 with Sutter Health (Epic EHR) and an athenahealth provider 2017 Connectivity accelerates as implementers onboard. 50% of all physicians now connected and 2.4M documents exchanged monthly 24
Carequality Members 25
Carequality Live Sites HIMSS 2017 26
Carequality Live Sites HIMSS 2018 27
On Boarding Process Becoming a Carequality Implementer Becoming a Carequality Connection 28
Lessons Learned on Driving Adoption Internally From connecting technologies to connecting people Motivating staff to access new health data How to utilize outside information 29
Looking Ahead Changing Interoperability Landscape Future of Exchange For Clinicians & Patients 30
Questions Steven Lane, MD, MPH LaneS@SutterHealth.org @emrdoc1 Dave Cassel DCassel@SequoiaProject.org @carequalitynet 31
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