Fine-tuning the health system orchestra

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Jun 12, 2019

I’ve spent the last few months talking to health systems around the country, and reconciling the harmony between real or perceived health IT needs and clinical goals inevitably emerges. Assessing a real population health management approach intertwined with value-based care models is a common refrain within the big picture as well.


As a nurse, I have spent more than 30 years in healthcare in roles. I have spent the last 25 of these years in leadership roles that included inpatient and outpatient settings, and building quality programs.


Most recently, I was the president of a medical group in southwest Michigan, and prior to that the vice president responsible for population health. I have seen all sides of the equation before taking on my current more consultative role.


At a recent Becker’s Healthcare conference, I staffed a panel with two very esteemed clinicians from the Trinity and Cleveland Clinic systems. Our appearance was titled, “Using Health IT to Improve Care Transitions and Communications.” What it turned out to be was a dominant discussion on the challenges today of communication and being able to see the entirety of a patient within the multiple platforms we do our work in.


Both panel partners supported the merits of a single-system EHR as the step to take towards improvement. This is what is commonly referred to as a rip and replace scenario. Challenging and very expensive. But it is a point of view that has ebbed and flowed historically since the days of meaningful use, when building an EHR or health IT system was about adoption and compliance more than envisioning a patient-centered ecosystem, and those challenges still remain.

Patient data outside any EHR

I understand the desire and the benefits of a single system EHR. I came from an organization with one integrated record. It was great to see the emergency room notes and specialist notes in the record. Although it is a more complete record, it can give one the false security that you are seeing all of the patient information. In fact, you are seeing only the patient information for the activity that the patient did within the system. How can this be?


  • Patients do not access care based on who has their EHR. They see who their insurance allows them to see. They see who their best friend or neighbor recommend. And they see who makes it most convenient for them to get in. The EHR is just not at the top of this priority list.
  • Not all health systems provide all services. Transplant care, oncology, even inpatient pediatrics will take a patient away from their health system to seek care.
  • Many services are independent of the healthcare system. Behavioral health and chiropractors continue to be largely independent practices. And yet, when one thinks about the amount of back pain treated by a chiropractor, the primary care provider needs to have access to this vital information.


And then we get into the practicality of changing over EHRs. We have all invested far too much in our EHR solutions to just unplug and acquire a new one. That costs millions to do! The reality is that we live in an environment in which health systems continue to bring in new medical groups, bring on independent hospitals, combine with other systems, or even have one clinically integrated network work with another. Each CIN has invested in an EHR that works for them. How does one CIN collaborate with another if they are on different systems? And how does one measure the outcomes of this collaborative work? In my experience, one integrated record is not the total answer.


Instead of focusing on which EHR is the solution, let’s focus on the ability to combine all this disparate data to provide a more complete view of the patient. We do this by utilizing an agnostic analytics platform that is able to interface with any of the existing EHRs in a health system and bring in external data sources, such as skilled nursing, regional labs and health plan data. It can than normalize it, risk stratify it, and segment the population. It doesn’t replace the EHR, but enhances the EHR by providing vital data to manage quality, improve care coordination and with analytics allow organizations to manage risk. More recently it’s being oversold that a single EHR platform can mirror those functions, let alone track utilization, risk and PMPM quality and costs.

The regulated patient data era

Right now we are in a patient-centric era where interfacing, exchanging and making normalized patient data and health plan data – clinical and claims – available to the patient and all caregivers is not just a desire but a necessity.


If you are following the ONC data blocking and the companion CMS interoperability rulemaking, you know that regulation and conditions of participation with the patient at the forefront are on pace to become realities next year.


The necessity is creating a connected care ecosystem well beyond an EHR’s internal communication prompts that instead aligns with other systems and other health plans toward a complete patient view. (And soon all of that internal/external data will need to be made available at the patient’s request.)

Bring on the orchestra

So where does this orchestra fit in? I like to use that analogy in talking to health systems toward integrating data and managing populations.


At the outset, health systems need some internal connective tissue, like the sheet music, that acts as a roadmap or translator between the internal IT and clinical teams. Clinical relevancy meets technology. The goal of course is to build an orchestra on the same notes from the ground up that supports the patient and the clinical team right up to the provider, with everyone playing at the top of their license. As you build you don’t leave out the patient along the way. The patient is part of that team, and health IT is merely one player, not the conductor.

About the author

Cindy Gaines

Cindy Gaines,
Chief Nursing Officer


Cindy Gaines has over 28 years of healthcare experience, splitting this time between quality and operations across the continuum. During her esteemed career, Cindy has led the integration of patient care across the care continuum and integrated program requirements of third-party payers including pay-for-performance criteria to maximize clinical, operational, and financial initiatives.

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