With more than 20 hospitals and 250 clinics in more than 80 communities on the West Coast and in Hawaii, Adventist Health has a pressing need to share information with Cerner and non-Cerner health information technology (IT) systems.
The faith-based, nonprofit health system began solving this problem in 2019 by implementing Cerner Health Information Exchange (HIE). Not long after, the Cerner ITWorks℠ client became the first Cerner client to connect to Carequality via CommonWell Health Alliance®—two nationwide networks that allow for data exchange across different IT vendors—after this functionality became generally available.
Implementing the Cerner HIE took Adventist Health from one-way data sharing to “true interoperability.” Through the Cerner HIE, clinicians can access external records, reports and results in the electronic health record (EHR). The portal provides Adventist Health patient data to the provider community by gathering information from other external sources connected to CommonWell and Carequality, as well as other health entities. Connecting to CommonWell gives clinicians the ability to access data from more than 22,000 provider sites; the connection to Carequality extends that reach to a total of 50,000 provider sites nationwide.
“Using Cerner HIE, we enabled data exchange between Adventist Health and around 340 health systems,” said Dana Zanone, MD, vice president and health informatics officer.
The exchange is an important part of patient care in the communities Adventist Health serves. End users have retrieved more than 44 million documents from other health systems, and physicians from those same health systems retrieved nearly 7.92 million documents from Adventist Health.1
The system presents data in end-user workflows for ease of access and use. The HIE also acts as Adventist Health’s provider web portal, serving more than 1,000 community offices and more than 5,000 users.
Over a 10-month period ending in October 2020, the monthly number of times web portal users looked at the HIE community view—the comprehensive picture of a patient’s medical history—more than doubled, increasing from 47,764 to 110,559.1
“This information gives providers a more holistic view of their patients,” said Rakhal Reddy, MD, medical director, informatics.
“We provisioned about 127 positions within our Cerner environment, between both providers and staff,” Reddy said. “We continue to refine our external data, validating CommonWell and Carequality data with our Cerner ITWorks partners, and rectifying any issues that come up from our end users, especially physician champions.”
To further its HIE and other care delivery strategies, Adventist Health entered a strategic alignment with Cerner ITWorks in 2018. Cerner has day-to-day responsibility for the organization’s clinical applications IT staff.
Two roles in clinical workflow
In the HIE relaunch, two new roles, data preparer and data reviewer, were defined for ambulatory, emergency room and inpatient venues to help with ingesting external data into the patient’s chart.
Data preparers support integrity and timeliness by confirming patients are enrolled in CommonWell and re-caching CommonWell data to ensure the most recent information from outside sources has been retrieved.
Within the native workflow, data reviewers reconcile outside problems, allergies, medications, immunizations and procedures to the patient’s chart to provide clinicians the latest and greatest view of the patient’s medical history.
Once data has been verified, it appears in a patient's chart, where providers can access it through Quick View or the Outside Records MPage®. Providers can reference outside records before ordering new tests.
“With this relaunch, we found great benefits and avoided some of the duplication of studies,” Zanone said. “This helps reduce cost of care, but also helps us avoid harm with our patients, especially in the use of X-rays and CT scans.”
Improving medication reconciliation
With the relaunch of the HIE, staff members began seeing improved medication reconciliation and adherence, and clinicians said they could better understand the value of viewing and reconciling data.
“Because they've seen value in it, they're doing it more often, and I believe it really is helping them improve their care decisions,” Zanone said.
Relying on a team approach
Zanone said the ITWorks team has done “wonderful” work with the organization’s clinical informaticists.
“When we work with the clinicians, the payers, and ultimately the patient, to give feedback to our ITWorks partners, they've gone out and worked with Cerner to implement it,” she said.
Data for this story was pulled utilizing Cerner Lights On Network®.
For more information, check out our Health Information Exchange Model Experience page.
1 Comparing January 2020 to October 2020