When a "Health System" is Defined by Data, Not by Buildings: North Shore-LIJ's Interoperability Investment

A detailed look at the strategy behind North Shore-LIJ's $25M investment in interoperability.

North Shore-Long Island Jewish Health System, based in Great Neck, N.Y., has aggressively expanded its network in the past few years. Today, it includes 17 hospitals, some 400 ambulatory facilities and physician practices and three skilled nursing facilities. For CIO John Bosco, the system's expansion has been exciting — as it means access to even more data — but challenging — since much of the data has yet to be integrated into a single, shared record.

"As we take on, whether it's through ownership or alliances, new and different entities, we need a way to provide integrated care and exchange clinical data," he says. Previously, the system hasn't had an easy way to do this. North Shore-LIJ currently uses Allscripts for the majority of its inpatient and ambulatory sites, and Mr. Bosco refers to Allscripts as the system's "corporate EHR."

"We have not done a good job as an industry, and the government has certainly not done a good job, of setting interoperability standards," he says. "The systems don't talk very easily."
This is a problem, because as the health system moves further into risk-based contracting and population health management, it's imperative its providers have access to a complete history of each patient and the tools to provide the best care.

"The main driver behind our investment in interoperability is around a recognition that we are shifting to new models of care with a focus around integrated delivery and continuity of care," says Mr. Bosco. Without EMRs that are able to "talk," information remains in silos. To be successful providing coordinated care throughout the continuum, every provider across that continuum needs access to an aggregated, normalized, comprehensive patient record and an event-processing engine.

"We need to get rid of the silos of information so providers can share the information they need to take the best care of the patient," he says. "Each provider needs full access to the data that is pertinent to the care they are providing."

To achieve this, North Shore-LIJ will invest roughly $25 million in its interoperability efforts.

For future ambulatory centers and physician practices that may join the health system, who have implemented EMRs already, switching them all to Allscripts may not be financially wise, or respectful of the new workflows these providers adopt.

"At some point it would be nice to think we'll move them onto the corporate EMR, but connecting them via the interoperability platform is a quicker and less expensive way to integrate them into the health system," Mr. Bosco explains. "We're in a position where we cant say we need them to come onto the same system. We need a way, where if they've made an investment in technology, they can continue to realize the benefits of that investment."

In order to seamlessly share data among providers, and create a single, comprehensive patient record for each patient — which could be accessed by any provider at any time — North Shore-LIJ worked with InterSystems, a maker of interoperability software, and implementation partner J2 Interactive, to develop the IT infrastructure needed for interoperable, comprehensive patient records, and data mobility.

Now, nearly a year into the efforts, Mr. Bosco says the majority of the group's work has been around building out that comprehensive record. It also recently launched several major functions: alerts to primary care providers when certain patients present to the emergency room; matching of risk cohorts for patients in certain managed care contracts; and basic clinical profiling of patients in new managed care contracts.

Next, IT leaders plan to roll out more advanced capabilities such as real-time active analytics and more complex business process orchestration. The implementation team is currently evaluating a list of at least 30 "uses cases" — different business requirements that interoperability can address.

"Healthcare transformation presents new IT requirements and a lot of new and different entities and users, and we're in process of prioritizing those and understanding where to best put the resources initially," says Mr. Bosco.

The long-term goal of the efforts isn't just to provide physicians with comprehensive patient health information, but using real-time analytics and clinical event notifications to help get physicians better information to guide patient treatment.

Having a shared foundation of information across the North Shore-LIJ is critical to its functioning as a truly integrated system. Without interoperable EMRs and a shared information system, the coordination of care — and the improved outcomes and savings that result — would be impossible.

"I remember, I hate to say how many years ago, when wide-area networking came about and you could begin to connect a company and their buildings together…the network became the system; that became the IT foundation for the company," he explains. "I view the interoperability platform in that same regard. I think the interoperability platform will become the system."

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