Ken Terry

April 13, 2015

UPDATED April 15, 2015 // CHICAGO — Geisinger Health System, through its xG Health Solutions spinoff, has introduced a new approach for transferring the best practices it has developed for treating multiple health conditions to other healthcare organizations, using software apps on an advanced interoperability platform. The Danville, Pennsylvania–based healthcare system made the announcement April 13 here at the annual meeting of the Healthcare Information and Management Systems Society (HIMSS).

Geisinger executives said their EnrG solution is using a technology that will increase interoperability among different electronic health records (EHRs). The solution could reduce the EHR documentation burden on physicians by up to 90%, they said.

In addition to being integrated with Geisinger's extensively modified Epic system, the EnrG software can also be used with Epic EHRs customized by other providers, as well as Cerner and athenahealth EHRs. Senior executives of all three companies were present at the launch conference here, along with other top health information technology leaders.

The breakthrough in the ability to transfer the EHR workflows that Geisinger has developed over the last 15 years to other organizations results from the use of Fast Healthcare Interoperability Resources (FHIR), a new HL7 draft standard. FHIR can be used to access specific data elements in an EHR, and an Internet platform known as SMART can be used to display the information. Together with a security standard called Oauth, SMART and FHIR can be used to integrate apps with disparate EHRs, so that the apps have to be written only once. The SMART on FHIR platform, a hot topic in health information technology circles, was developed by researchers at Harvard Medical School, Boston Children's Hospital, and Intermountain Healthcare.

Other companies have shown the feasibility of using FHIR-based application programming interfaces to connect apps to disparate EHRs as part of the Argonaut Project, Aneesh Chopra, the former chief technology officer of the United States, told Medscape Medical News. The Argonaut Project is a loose affiliation of stakeholders, including Epic, Cerner, McKesson, athenahealth, and the Advisory Board Co, aided by outside developers that include Geisinger and xG. The project has developed and tested a set of FHIR profiles, including medications, allergies, and patient names and demographics, that will be voted on next month by HL7 members, he said.

But among these companies, Geisinger's use of FHIR to transfer its workflows to other organizations is unique, Chopra said.

"Geisinger's ability to commercialize its EHR workflows via FHIR to a growing number of FHIR-enabled EHR platforms is pioneering and will usher in a new era of provider and patient-focused applications to more effectively deliver care," he added.

According to an xG marketing document, "Our apps can exchange information in real time with any FHIR-enabled EHR…. They extract and analyze data, then reorganize it and present it in a user-friendly way along with clinical decision support. Results of analyses of data — that reside inside or outside the EHR — are integrated directly into the workflow."

Among the outside data supplied to the app is information from patient questionnaires, which is edited by nurses and integrated into the EHR. Geisinger has developed graphical methods to make it easier for physicians and patients to grasp the meaning of the longitudinal data.

Focus on the Patient

EnrG apps focus on common procedures and chronic diseases, including coronary artery bypass surgery, coronary angioplasty, total hip replacement, lumbar spine surgery, rheumatoid arthritis, hip fracture, congestive heart failure, chronic obstructive pulmonary disease, asthma, diabetes, and oncology.

The rheumatology app, which has been in use at Geisinger for 4 years, is the subject of a study published in Arthritis Care & Research. In the study, "the software integrated and reassembled information from the patient (via a touchscreen questionnaire), nurse, physician, and EHR into a series of actionable views." The researchers found "a strong correlation" between use of the software and disease control, as well as "a relative increase in patients with low disease activity."

Eric D. Newman, MD, a coauthor of the study, noted at the launch conference that this approach accelerates the acquisition of patient information during an encounter. After reviewing the patient supplied details, patients and physicians can go right into problem-solving mode, he said, and achieve more during the visit.

By integrating the preanalyzed, patient-entered data into the note, he added, "we can auto-create 90% of the patient note. So doctors can focus on the assessment and plan."

Earl Steinberg, MD, chief executive officer (CEO) of xG Health Solutions and a nationally known quality expert, said that a "supernote" designed for primary care is now in beta testing. The app has been shown to help automate documentation, he said. Moreover, it increases the accuracy of problem lists and prompts clinicians to provide appropriate care.

The rheumatology app will be beta-tested at non-Geisinger sites this summer, and is expected to be generally available by the fall. xG also plans to bring half a dozen additional apps to market in the next 18 months.

In addition, xG will market a host of other Geisinger-developed applications for population health management, care manager training, and analytics, along with its ProvenCare evidence-based medicine approach to hospital care. Geisinger is partnering with the American College of Cardiology to disseminate xG products to its members, said Glenn Steele, MD, PhD, Geisinger's president and CEO.

Other apps are being developed for discharge planning, management of patients in the emergency room, and the integration of genomics into clinical practice. Geisinger is currently sequencing the genomes of 250,000 patients, Dr Steele noted.

At the launch meeting, Stanley Huff, MD, from Intermountain, and chair of HL7, pointed out that the FHIR standard can achieve full interoperability among disparate EHRs only if they use standardized data profiles, including unified nomenclature. If Geisinger and Intermountain develop different profiles, the systems will not be able to communicate with each other. Steinberg agreed that the stakeholders need to work together to build common profiles.

While Geisinger has been "optimizing" its Epic EHR for many years, other organizations need not change their EHRs "to the same degree" to take advantage of Geisinger's workflow apps, noted Alistair Erskine, MD, chief clinical informatics officer at Geisinger. It was not immediately clear how much customization might have to be done to use the EnrG apps.

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