Healthcare organizations (HCO) have historically invested in health information exchange (HIE) technology expecting that access to a patient’s longitudinal record can help clinicians deliver better care.

In the not-too-distant future, HIE objectives will be far more complex than they are currently. An HCO’s success will depend on effective and efficient care processes in venues that the HCO does not control but nevertheless must understand and influence.
HCOs need new capabilities, including better visibility into the clinical processes of other HCOs, if they are to manage their risk and optimize care processes no matter where their patients seek care across the continuum. 
HCOs will require a new level of distributed intelligence to extract value from clinically integrated networks.

Beyond driving referrals and accessing a patient’s record, HCOs will need to ensure that all clinicians with whom they share risk have access to tools and are receiving the information they need to meet contract-based clinical quality and financial metrics.


THE MIGRATION TO CLINICIAN NETWORK MANAGEMENT

Chilmark Research calls this new and necessary level of distributed intelligence Clinician Network Management (CNM). Given that HIEs imperfectly meet HCOs’ data-sharing needs, the term CNM reflects both what providers need and the direction we see vendors heading in their product roadmaps. Within a CNM construct, HCOs provide their care partners with the information they need to successfully manage care across organizational boundaries.

Going well beyond patient record look-up and document exchange, CNM can help clinicians in every care setting:

  • Understand which of their patients are at risk
  • Identify care gaps in their patient panels
  • Interact in real time with other clinicians on a patient’s care team
  • Reduce wasteful practice variability

With CNM, physicians and other clinicians receive relevant and timely guidance on appropriate care protocols, have a view of their contractual obligations to other providers, stay abreast of how their progress and quality
performance measures compares to others, and can see how attribution rules apportion their contributions to patient care and the wider community. CNM enables HCOs to reduce process variations that drive higher
costs and overutilization. Rather than simply serving up patient data, CNM will reinforce the processes and workflow needed for the transition to value-based care.

Orion Health’s comprehensive CNM offering – now called Orion Health Healthier Populations – is based on its clinical data repository, clinician and patient portals, and the Rhapsody integration engine.

This foundational offering has been enhanced over the last year. Healthier Populations includes analytics and care coordination functionality, both of which the company launched or enhanced in the last year. Its notifications solutions supports a variety of delivery options and the ability to send documents to the EHR. Supported events include new lab results, ADT or encounter events, new patient, or new diagnosis.

It is customizable by the facility or by end user. If a message or event is accessible to Rhapsody, it can be used for a notification. For customers seeking to attest for VDT, it also certified its patient portal under the 2014 rules. It also offers a feature called DSM Direct which, for certain EHRs, integrates data from attached CDAs upon receipt into the patient record, eliminating the need for clinicians to use the EHR and a portal-based inbox.

Read the Orion Health Excerpt below.