Value of Massive Scale Data Modernization for an HIE

The Client

A Canadian provincial HIE (health information exchange) responsible for delivering, overseeing and validating high quality and timely care delivery for 15.5 million citizens. The agency collects and manages data systems from over 200 hospitals, 4,300 pharmacies, private labs, drug repositories, community and specialty care clinics.

The Issues

The provincial agency collects data from multiple disparate repositories and EHR (electronic health record) systems across the continuum of care in both physical (paper-based) and digital formats. These legacy systems lack true interoperability resulting in incomplete, inaccessible data, inefficient workflows and incompatible security and authorization protocols. Accessing records in a timely manner is a complex and burdensome task, often riddled with delays and gaps in information. The provincial system does not receive source data from primary care facilities, which provide 80% of care delivery to the population. This combination of siloed data and incompatible processes has contributed to increased risks and costs, delays and gaps in care management, an inability to scale best practices across the continuum of care, and health inequity across the province. The effort to make data complete and comprehensive requires high manual effort—considerable time spent by care teams to gather relevant data, ensure it is up-to-date, usable, without errors and duplication—and substantial burden on resources and funding allocation.

The Objectives

The client’s goal was to create a province-wide unified EHR (electronic health record) system that compiled complete and longitudinal health records for each citizen. They needed their new unified system to facilitate seamless and interoperable health data exchange from a diverse collection of applications and sources—imaging, drug, community care, primary and long-term care—to facilitate timely, accurate and appropriate care provision. They knew that achieving this goal would reduce clinical and operational burdens and costs across the network, enhance coordinated quality care delivery, and improve health equity across the population. To achieve this goal, the client had to first consolidate their technologies, policies and business workflows and create a modern interoperable health data ecosystem. They searched for a solution that could:

• Consolidate and standardize data from all fragmented systems into a single source-of-truth health repository that could collect, aggregate and analyze, across multiple cloud platforms.
• Reduce operational and administrative burdens and process complexities of data exchange by using the HL7? FHIR? implementation standard for data interoperability and exchange.
• Manage and comply with provincial policies and procedures around data exchange, risk, vulnerability, ethics, authorization, privacy, security and patient access.
• Create a province-wide clean, quality data repository (complete, matched, de-duplicated records), to eventually support specific use cases such as clinical reasoning capabilities, medication dispensing records (for Opioid management etc.), population health trends, etc.
• Comply with provincial quality guidelines to ensure health equity across underserved populations like Indigenous, rural and low-literacy communities.

The Solution?

Smile’s Health Data Platform (HDP)—a cloud-based enterprise-level data exchange and interoperability platform, built on the HL7 FHIR standard—is a modern solution with no vendor lock-in. It was evaluated by the client in an open bid against competing market solutions. Smile was awarded the bid due to the wide-range of capabilities demonstrated, including:?

• Compatibility with all HL7 FHIR resources to simplify the data ingestion and standardization process from multiple disparate sources, including legacy third party vendor applications and systems.
• Extendibility and support across multiple cloud platforms—including Microsoft Azure and AWS—to unify data management and sharing across environments, and optimize care delivery and cost.
• Modular architecture with specific features that can be turned on and off, on demand—like MDM (master data management) and RTE (real-time export)—providing both flexibility and ownership of IT infrastructure.
• Performance and scalability demonstrated by exceeding the client’s minimum requirements: over 40 million transactions exchanged per day, more than 1TB of data managed each week, and storage of near-infinite data volumes.
• Industry leadership with over 160 successful enterprise-level implementations globally and leading over 31 Working Groups that create IGs (Implementation Guides) for technical deployments.

A dedicated team at Smile delivers continuous operational maintenance, and technical support services. The team leverages Microsoft Azure's managed service capabilities to provide both application operations (AO) and infrastructure operations (IO) support. This frees the client’s in-house IT resources to focus on their business operations, as opposed to IT management.?

Time to Value

Within 18 months of implementation, the client achieved:?

• A FHIR-based Clinical Data Foundation (CDF) was established to ingest, store and share health data, complete with seamless, automated integrations to existing provincial registries, systems and services.
• Multiple implementations of FHIR-powered analytical solutions—the first ever by the provincial agency in the Microsoft Azure cloud—which reports on centralized waitlist management, mental health and addictions, surgical efficiency and cardiac care metrics.
• A Primary Care information exchange for patient information, such as current conditions, prescriptions, allergies, vaccinations, etc. which contributes to a complete, scalable and shareable Patient Summary (PS).
• Closed data-contribution gaps across repositories like long-term, acute care, lab, drug, medication dispensing and imaging, by standardizing both data and processes, in and out of systems. This has simplified and harmonized hundreds of business and system requirements across the network. For medication dispensing, data is now collectable from community pharmacies and hospital administrators.
• Launch of Innovation & Vendor Acceleration (IVA) environments to enable development within areas of acute, community and primary care as well as medication data domains using FHIR IGs. This accelerates timelines to implement new data exchanges within these sectors.
• Harmonizing IGs and clinical terminology to provide richer clinical and historical context to build better clinical decision support tools, and understand health inequities through data-driven analytics

Though the implementation with the client is still ongoing, the above benefits fulfilled their key objectives, while also lowering the total cost curve of care management and delivery across time.

Strategic Value

With a completely modernized, cloud-based Health Data Platform, the client can continually run and refine analytics and insights to enhance digital services, virtual care, and lower health equity barriers while optimizing costs. Improved and timely care delivery can be scaled to emergency care, recalls and safety alerts and medication reconciliation across all points-of-care. The modernization benefits include analysis of data for both primary (e.g.: treatment plans) and secondary use (eg: research data). As comprehensive and rich data continues to be contributed to the data platform, new possibilities are unleashed, such as integrated assessment records, long term care management, and predictive analytics on patient and population trends, to name a few.? Bring massive scale data modernization to your HIE so that you can create more value, serve growing population needs better and more efficiently. Contact us today.

*The original use case is published on the Smile Digital Health website at: https://go.smiledigitalhealth.com/l/1028393/2024-07-16/25zzg