The Impact of Clinical Integration and Interoperability on ED Utilization

Abhinav Shashank
Sat 13 Jan 2018
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Consider a 57-year old diabetic man who missed his past two HbA1c tests. Given that diabetes runs in his family, and that his blood glucose is more than 8.1%, he is quite likely to have a stroke, or worse, a cardiac arrest. Perhaps if someday, that man googles ‘symptoms of stroke’ at 11:30 pm on his phone as the fitness band on his wrist records his escalating heart rate, there’s a good chance that he will end up in the emergency department the next morning.

Wouldn’t it be great if a physician could be aware of these looming complications? It would be a simple way to understand what the gaps are, what could be done, and if all the recent developments could be accessed in a jiffy!

The increasing number of ED visits

The average cost of a visit to the ED is $580 more than the cost of a regular office healthcare visit. That’s how, unnecessary visits to the ED heap a considerable burden on the U.S. healthcare expenditure, yielding a total of $38 billion every year. Plus, out of all these ED visits, no less than 56% of them are preventable.

The traditional emergency department care is not designed for every episode. They are not designed to provide coordinated care- they can provide urgent care, but it may not be the best care. Once the patient is assessed and treated for their episode, they are either admitted or released. And once they leave the facility, there is no way to track or find if their episode will repeat and if they’ll come rushing back to the ED in the imminent future.

A silver lining to find the way- data

Yes, despite the huge expenses that are driven by unnecessary emergency department utilization, there is a silver lining. These ED visits produce valuable data that can be used to gain insights into population health. With every click of the mouse and with every keystroke, EDs are generating actionable data that offers providers an inside view of the health behaviors of patients and communities. It’s not just EHR data or just files received from multiple payers- ED encounters can also offer rich insights about risk scores, social determinants, behavioral health, and network utilization. It’s all about leveraging the right data at the right time!

Predictive analytics and the looming questions

According to a study, there are two questions which need to be answered when it comes to emergency department utilization:

  1. Who is likely to have higher ED utilization?
  2. What can be done for such patients?

The use of predictive big data analytics and risk score modeling can work wonders in identifying patients that could benefit from early interventions or close monitoring. Smart analytics can help understand several causes for ED utilization, especially the avoidable ones, and lead to creating strategies focused around controlling costs and utilization.


Of course, leveraging analytics is a solution that has been around for quite a while now. Even though, there are some challenges that just having good analytics can’t solve:

For one, let’s look at patient behavior. Changing behavior has historically been difficult. If a patient doesn’t know any other way of finding urgent care, or has a long and storied history of rushing off to ED at every event, it’s unlikely their behavior will change.

Another is the healthcare landscape. Often, patients don’t have access to lower-cost, quality care alternatives. Also, reimbursements that reward hospitals for busy EDs have led to many hospitals increasing their utilization by attracting more patients to their EDs. This kind of lack of awareness and unwillingness, is another barrier on the road to reduced ED utilization.

Ultimately, analytics are only the key to unlocking insights. The real outcomes also require actionable engagement.

A solution that marries analytics and engagement

We at Innovaccer are driven by our mission- to drive healthcare efficiency by unleashing the power of data. Innovaccer provides a robust data integration platform that runs smart predictive analytics on acquired data and integrates the insights generated from analysis and engagement together.

Innovaccer’s healthcare data platform integrates the data incoming from various sources and data feeds, ranging from EHRs and CCDA documents to 835/837 files from the payers. This breadth of data helps in creating a comprehensive picture for the population, along with patient risk scores. These records, integrating all the events, help the providers understand the visit volume, patient arrival, readmission events, and a lot many insights like missed visits or screenings, time of arrival of patients in the ED, time of discharge from the ED, length of stay.

Along with this, the platform even integrates social determinants of health as well as behavioral factors that impact a patient’s health. It provides a view of care timelines and the outstanding measures to chase, enhancing patient engagement in a data-driven fashion. We deliver pioneering methods of engaging patients and assist providers in educating patients and changing their behavior. Finally, providers can benchmark the outcomes and measure results- determining what’s working and what’s not and then creating modified, strategic interventions.

Two-way interoperability driving communication

Interoperability is important- I can’t emphasize this more strongly. The reason interoperability is a must, is because care can’t be contained to just the brick-and-mortar structure of hospitals. As care moves away from single physical infrastructures to distributed locations, a clear picture requires all data sets from all over the care continuum to be integrated.

Innovaccer offers a truly two-way interoperable platform, that creates a technology backbone for care teams. Since it’s an agnostic platform, it can support a wide range of data formats and protocols. It doesn’t just relay information back and forth the network, it even pushes the information of care gaps back to the EHRs so that providers are always updated with the latest and the most recent developments of their patients. Post that, it presents crucial information on screen as the care team members look through the EMRs, highlighting the patients in need of immediate attention and the ones who are at high risk of a potential readmission.

The road ahead

There’s no denying the EDs are important- they have an important and a growing role in healthcare. Keeping it connected with other providers across the continuum with updated information can help patients get the treatment they really need. As healthcare evolves to deliver quality at every step of the care continuum, providers have to aim for complete transparency and 100% interoperability. Our journey doesn’t end at optimizing ED utilization; it doesn’t end at reducing the cost of care. If we aim to achieve the healthcare where preventive care outdoes a disease-driven system, it’s high time we switched to a smarter solution that is accurate, capable, and leads us to the healthcare of our dreams.

To learn how the power of analytics can assist you reducing your skyrocketing ED utilization, get a demo.

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Tags: Healthcare, Integration, Interoperability
Abhinav Shashank
The Impact of Clinical Integration and Interoperability on ED Utilization

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