Q&A: Geisinger builds on HIE for Keystone Beacon Community
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James Walker, MD, chief health information officer of Geisinger Health System, recently spoke with CMIO about Geisinger’s plans for the Keystone Beacon Community.
How will Keystone Beacon Community demonstrate those improved patient outcomes?
We were already using an integrated EHR-networked patient health record and HIE altogether to support coordinated care. What we proposed for the Keystone Beacon Community is that we would take those skills in care coordination and supporting care coordination with health IT and extend them, provide them in a non-Geisinger form, to all of the hospitals, clinics, long-term care facilities [and] home health facilities in a five-county region.
The HHS expectations for the Beacon Community projects seem ambitious, no?
It’s an accelerated timeframe. [However,] we have been doing what I think of as outreach health IT for over a decade. [For example,] we provide pediatric echocardiograms in 25 locations in our region that otherwise would not have it... We have telestroke, we support remote lab services for hospitals that couldn’t afford to have a lab pathologist present, we do radiology.
For KeyHIE…we’ve been working with community and regional hospitals’ practices, home healthcare [to] understand their needs to develop low-cost, high-impact services for the past five years.
What [Keystone Beacon Community] really gives us the opportunity to do is take bits and pieces that we have already executed somewhere and put them into an integrated system that includes everybody in the community in care coordination and health IT. Our conviction, based on our own internal experience, is that by doing that, we can improve patient outcomes across that community--some in a pretty short period of time, some will take longer.
Can you talk about the IT systems involved in this effort?
Our core principle is that it has to be very low-cost, very simple, off-the-shelf, reliable technology, and we cannot assume or require any level of IT sophistication on the part of IT participants. Starting from that, we asked: ‘What do clinicians really need to take care of patients?’
While it would be nice if it were semantically interoperable, if you can just give doctors lab/ra/pharm--problem lists, allergies, recent test results, discharge summaries, high-value documents--if you can just provide those to clinicians in a timely way, you get enormous improvements in care quality and efficiency.
What KeyHIE systems are being used in the Keystone Beacon Community?
KeyHIE is based on a [GE Centricity] repository, where documents as simple as Word documents are categorized according to CCD [Continuity of Care Document standards], so it’ll just be labeled ‘office visit’ or ‘hospital discharge’ or ‘EKG trace.’ The rest of it is often a simple image or a blob of text. The document repository is fronted by a patient index of about 3 million patients, then by a record locator service, so when I identify a patient I’m taking care of, I can see where they’ve been seen, and whether they’ve consented to have their information shared—and 400,000 patients have—then I can open up whichever one of those documents seems to me to be relevant to the patient’s need right now.
Both from a usability standpoint on the user side and also [in terms of] cost and simplicity of technology on the technology side, we found that document store is a useful way for us to start. We do translate lab results into LOINC, so there is some semantic interoperability in the exchange, and certainly our goal over time is to make the information more and more semantically interoperable.
The other important feature of the exchange [that] we’re repurposing for the Keystone Beacon Community is a notification system. One of the reasons that patients end up being readmitted to the hospital when it could have been avoided is that the sickest, who are the most likely to get readmitted, their case manager often doesn’t find out that they’ve been discharged from a regional hospital until they’re readmitted three weeks later. If the case manager knew when the patient was discharged, they could get them back to their primary care physician, follow up, and usually those re-admissions can be prevented. [Now] people will get automatic notification if a patient has been seen in the emergency department, and then they can go into the EHR to look at the discharge document, see that they’ve been admitted, and they’ve been discharged.
That automatic notification will make a remarkably large difference in how quickly and well patient care is continued from inpatient to outpatient, from nursing home to emergency department, and so forth.