EPIC Health Research Network: Pandemic-inspired innovation in medical outcomes research

Early announcements of the Epic Health Research Network (EHRN) this past spring didn’t grab my attention the way they should have. But a recent article by John Lynn in HealthcareITToday caught my eye, in large part because of the way he described EHRN as a “near real-time medical journal”.

Epic’s announcement of the EHRN described it as a network for bringing together “healthcare professionals, researchers, and data scientists to publish early data-driven observations” and included the following quote from Judy Faulkner:

“We have a tremendous opportunity to help healthcare professionals and researchers share their discoveries with the world,” said Judy Faulkner, CEO of Epic. “We have been interested in creating this site for years to share new knowledge. With the COVID-19 crisis, the need for fast dissemination of knowledge has become critical.”

On the EHRN.org website, EHRN is further described as follows:

EHRN is a journal for the 21st century, designed for rapid sharing of knowledge with researchers, healthcare professionals, and learners to help solve medical problems.

Electronic health record data collected over decades, spanning millions of patients, could provide clues to help solve medical problems.

EHRN reports are reviewed internally and externally prior to publication. To expedite information sharing, they are published without traditional peer review. It’s important that good data be available sooner, rather than perfect data be available too late—especially in times of public health crisis.

EHRN is where you’ll find our reports. We invite others to contribute as well, from health systems and higher learning institutions to government agencies.

Our goal is for EHRN to light the way for fast, collaborative research.

[EHRN.org/About-Us]

Value of Outcomes Data

Unleashing the value of data stored in EHRs has been at the center of my interest in health IT from the time I first started attending HIMSS conferences over a decade ago. However, in retrospect, I realize that the health IT community had little-to-no experience in conceiving new applications for EHR data or in developing complex data products.

Furthermore, patient privacy concerns and data sharing roadblocks curtailed investment in platforms for sharing research derived from outcomes data. The EHRN doesn’t solve these problems, although it may serve as a catalyst for knocking down some of the obstacles across institutions, especially institutions that use EPIC systems (with some help from the ONC’s Cures Act).

Comparison to Usage of Real World Evidence in Life Sciences Research

The life sciences sector has been quicker to develop platforms for including outcomes data, which they refer to as “real world evidence” (RWE) or “real world data” (RWD). Three notable players in this space, TriNetX, Datavant and Medidata, recently announced a partnership to leverage the technology and data assets of the trio to accelerate advances in clinical trial research. It would behoove medical professionals involved in developing evidence-based decision support tools to study the progress made, and methods used, in clinical trial research.

Future for Medical Journals

Under the scenario where outcomes data research platforms gain momentum and become a primary channel for disseminating research, reputable journal publishers can continue to play an important role in amplifying new research developments and putting new evidence in context. However, traditional publishers need to be aware of the new digital research platforms and consider the impact that research networks like EHRN will have on legacy publishers’ role in the research workflow.

With flat or declining budgets from their traditional library market and a push to adopt open access business models, which constrain publisher revenue, medical journal publishers face a dismal future if they fail to recognize the disruption that is occurring and fail to respond by creating—or partnering to create—innovative methods of adding value to the research workflow and implementation process.

Secondary Data Usage in Healthcare

I was guest speaker at the March 22, 2012 “Let’s Talk HIT” series hosted by Scratch Marketing & Media in Cambridge, MA. The topic I chose was Secondary Data Publishing in Health. Health Content Advisor’s parent company, InfoCommerce Group, has a long history of guiding business media companies in constructing data products, but increasingly we are finding interesting examples of secondary data products that develop as a by-product of technology companies. Electronic Health Records (EHRs) represents one of the more compelling examples of information technology that has the potential to spawn a new generation of data products.

Scratch Marketing has posted the video of the talk, which was structured as an interactive group discussion, in 8 parts. See their YouTube page for the list of segments: http://bit.ly/H9Wjk9.

See the event recap by Lizzie McQuillan at Scratch Marketing here:

http://scratchmm.com/2012/03/event-recap-let%E2%80%99s-talk-hit-with-janice-mccallum/

Also, for a provocative view, read Marya Zilberberg, MD, MPH’s takeaway from the evening’s discussion:

http://evimedgroup.blogspot.com/2012/03/how-our-healthcare-spending-is-like.html

Thanks again to Scratch and the many Boston-area (stretching all the way out to the Berkshires!) health IT, public health, healthcare publishing, entrepreneurs, and marketing experts who attended and participated in the discussion. Scratch Marketing added Twitter handles to the video, which helps tremendously in identifying each speaker.

Look to Payers for Innovation in Health Information

So much attention has been focused on the adoption of EHRs by provider organizations—largely because of ARRA HITECH funding—that one could be led to believe that most health IT advances are occurring on the clinical side of healthcare.  In reality, the business side has been quicker to adopt IT systems that add efficiency to the workflow of the participants. Practice management software and revenue cycle management solutions are two examples.

However, the exchange of data between stakeholder groups remains the stumbling block in improving the efficiency of our healthcare system.  On the provider side, it has been evident from the start that one of the most “meaningful” uses of a patient’s electronic record is the ability to make the information available where, when and to whom it is needed.  But, the pathway to meaningful health information exchange (HIE) is a bumpy one—not just because of technical issues, rather because of the regional nature of healthcare laws and regulations that has led to a very fragmented healthcare market.  I overheard someone from a hospital system in Florida at HIMSS say that a Florida-wide exchange may be a good thing, but it doesn’t solve his real problem of the snowbirds who come to Florida in winter but whose primary healthcare providers are in the Northeast. 

But once again, payers are leading the way in “meaningful” exchange of patient data between providers and payers.  The infrastructure created for revenue cycle management applications—eligibility checks, claims submissions, etc.—already exists, so why not build upon it?

In March, I attended the grand opening of NaviNet’s new headquarters in Boston.  I knew that NaviNet provided a communications platform for payers to exchange information with providers and that they were actively expanding their portfolio of services, so I wanted to know more about them.  I left that evening thinking that NaviNet’s existing platform that already connects 470,000 physicians in 128,000 offices to a growing number of large health care plans could be leveraged for exchanging clinical data. 

This week I had a follow-on conversation with Kimberly Labow, Chief Marketing Officer at NaviNet.  Kim confirmed that NaviNet recognizes the opportunity to leverage their existing network to become a single point of contact for business and clinical communications. 

At this point, NaviNet has already expanded to offer practice management and EMR applications to provider clients and has recently launched a mobile eprescribing application in Florida in conjunction with Aetna.  It’s interesting to note that Availity is also part of this strategic partnership because they were working with Aetna and Prematics prior to NaviNet’s involvement.  NaviNet subsequently acquired Prematics, which led to this multi-factorial “coopetition”.  [Note: Aetna has recently acquired Medicity, a health information exchange vendor, which makes the level of coopetition even more multi-dimensional.] However, this level of cooperation is not an anomaly; I see it is a sign of things to come as our healthcare system undergoes periods of consolidation within and across stakeholder groups. 

Given the existing structure of our healthcare system, the payer segment— unlike the providers—has clear incentives to use information to increase efficiency in business and clinical areas.  Payers recognize the benefits of working with patients to encourage more healthful behavior and are taking an active role in creating care plans and follow-on communication with patients.   At the recent Patient-Centered Computing and eHealth: Transforming Healthcare Quality course, Blackford Middleton suggested that in an alternate future, if providers don’t respond to the challenges of adopting health IT and learning how to use and analyze data, they will be disrupted and the insurers will become our healthcare coaches. 

I doubt that many patients, physicians or hospital groups want health insurance plans to become the primary source of health advice and care management.  However, we are moving toward a more integrated payer-provider model with ACOs and we have witnessed the success of integrated delivery networks like Kaiser Permanente. Convergence is occurring from all directions: providers are merging with physician groups, providers are consolidating, payers are consolidating, and payers are also diversifying into healthcare delivery.  A recent Wall St. Journal article described the payer diversification efforts as including: “acquisitions and partnerships that will allow the [health insurers] to employ doctors directly, delivery health information technologies, and participate in new hospital-doctor groups known and accountable-care organizations”. 

With alliances and acquisitions occurring within and across stakeholder lines, it is becoming a challenge to coordinate standards efforts and for analysts like me to try to diagram an industry that’s in flux.

NaviNet is trying to make a contribution toward coordinating efforts with the Unified Patient Information Management (UPIM) platform they are supporting. For my part, I rely on variations of the convergence diagram below that I created some time ago, which attempts to illustrate the clinical information market in an EHR-centric world. The initial version had payers outside of the inner circle. After writing this post, I think it’s time for another updated illustration that more closely aligns providers and payers!

 

Clinical Information Flows in an EHR-Centric World