Northwell Health Drives Innovation: Employing Interoperability and Rapid Application Development

By John Bosco, Senior Vice President and CIO, Northwell Health

John Bosco, SVP and CIO, Northwell Health
John Bosco, SVP and CIO, Northwell Health
Northwell Health, based in Long Island, New York is the state’s largest health care provider and private employer with 66,000+ employees, 23 hospitals and nearly 700 outpatient facilities. The system’s rapid growth through acquisitions and partnerships with other healthcare organizations, and the adoption of new care delivery models, has driven the need to collate and organize segmented patient data.
To drive towards achieving a “central repository,” Northwell invested a great deal of time and resources, and leveraged the technology of the InterSystems HealthShare product in building its own internal health information exchange (HIE). Over the past 5 years the Northwell HIE has served as the backbone for interoperability and has evolved into a platform for the acceleration of innovation. Today the platform supports the aggregation, integration and use of information from disparate electronic medical records (EMRs), ancillary clinical systems, and billing systems from across our numerous hospitals, outpatient facilities, as well as more than 18,500 affiliated physicians.
“One of the key successes to the advancement of the HIE has been the availability of a unified patient record for nearly 8 million patients, that spans over a 1 billion unique data elements connecting hundreds of millions of diagnoses, observations, results, and other distinctive information” said John Bosco, senior vice president and chief information officer. “The data in the HIE has been consumed by caregivers to improve the overall quality of care delivery, through facilitating the coordination of care, improving outcomes, and enhancing business performance.” The Northwell HIE also connects with the NY State RHIO – SHINY (State Health Information Network of New York) which provides clinical data from across New York State for consented patients.
From Pilot to System Wide Care Coordination
Northwell started its journey to provide access to patient information across the continuum through a New York State funded initiative known as HEAL-10 grants. The project tested the premise that shared health information could improve care coordination and outcomes for women with high-risk pregnancies. It required the sharing of obstetrics information across a community of more than 100 providers using three distinct outpatient EMR instances, two different inpatient EMRs, and two prenatal imaging centers with their own ultrasound reporting systems. In the end, the program was deemed successful in several aspects. Most importantly, critical information followed the patient wherever she encountered the healthcare system, allowing clinicians access to vital information from varying care providers.
Building on the success of this project, Northwell made a committed investment to ensure that key clinical information from hundreds of varying systems across the continuum would be easily accessible and digestible to clinicians at their fingertips. Early on, when standards like CCD and FHIR (Continuity of Care Document and Fast Healthcare Interoperability Resource) were evolving, Northwell focused on the integration of clinical information into a clinicians’ daily workflow using the HIE Clinical Viewer – a tool for clinicians to view aggregated patient data across the health system. The HIE would push information directly into the EMRs using timed triggers, allowing the clinician viewing capabilities through the Clinical Viewer. For example, when a patient is admitted to the hospital, clinical records from the outpatient settings are made accessible in the inpatient EMR using a set of complex interfaces and APIs (application programming interfaces). The integration with the HIE Clinical Viewer also provides specialized views that ensure that clinicians get information tailored to their scope of practice.
With Northwell’s expansion into newer care delivery venues, one of the more recent innovative integrations includes the ability of a Clinical Call Center agent to access needed data in a patient record almost instantly. The HIE is integrated with the call center software Avaya to leverage caller ID, thus accelerating the search for a patients’ record, and allowing the agent to easily see what follow-up care is needed for that patient.
As Northwell continues its rapid growth, the HIE has also been pivotal in the onboarding of newly acquired organizations. As a commitment to delivering fast integration, the entities are initially provided with clinical viewing capabilities, and within a couple of months progress to more complex integrations.
Rapid Application Development to drive Innovation Efficiency
With the successes from various interoperability initiatives of the pilot project, Northwell pivoted to leveraging the vast real time information infrastructure of the HIE to build numerous applications in support of the rapidly changing field of population health management. Northwell has adopted a “data first” approach to care management and has built its own care management application called the “Care Tool.” The Care Tool identifies high-risk patients, assesses needs, shares care plans across providers and locations, supports efficient workflows, and provides quality metrics for continuous improvement.
Building on the Care Tool, Northwell has invested in multiple technologies to simplify the creation of custom applications. Many of these “apps” are built into the EMRs as extensions to aid the build of workflows that have emerged as a result of changing healthcare business models. One of these apps that is internally referred to as the “ListApp,” leverages a rules engine to apply complex rules on real time data flowing through the HIE to create various cohorts of patients. For example, the ListApp triages patients who have recently been discharged into high, medium and low risk of readmission based on rules executed on available data. Another application then allows clinicians and administrative staff to complete follow up workflows. These follow up workflows include tasks like making follow up calls to engage care management services who can then track and engage with the patient after they have completed their visit. The utilization of the ListApp has resulted in a reduction of readmission rates and increased patient engagement. There are dozens of these mini apps that Northwell has created with a small development team. The key to their success has been the adoption of tools that have enabled business focused teams who are less technical, to easily use the applications to improve business processes.
Recently, Northwell has partnered with Microsoft to leverage their PowerApps platform to accelerate application development. As an example, one of the PowerApps is being used to facilitate interdisciplinary rounding at the hospitals. Leveraging advanced technologies including FHIR-based APIs and intelligent bots it can deliver real-time information to the clinical staff. With the goal of safely discharging the patient in a timely manner, daily interdisciplinary rounds now include the review of the industry length of stay for a specific diagnosis, outstanding orders, and gaps in care coordination (i.e., immunizations).
Northwell continuously promotes IT innovation through its Center for Health Information Technology and Innovation (Innovation Center). Established to help shape the future and raise the standard of healthcare, the Innovation Center brings together clinicians, technologists and entrepreneurs to collaborate on solving some of healthcare’s most challenging problems. At the foundation is Northwell’s technological infrastructure, equipped with wired and wireless networks, cloud storage, 3D printers, TeleHealth equipment, and access to simulation sandboxes resembling real world scenarios in the health system hospitals and doctors’ offices.