Data integration and interoperability enable greater capabilities to capture and share patient information, supporting new models like value-based care management.
Access to disparate data sources can streamline and improve the quality of information used in care planning and intervention. Integrated data from educational or evidence-based clinical sources supports accurate and timely patient engagement.
Lastly, pushing data back out from systems enables broader team-based care, quality reporting, and communication.
However, care management doesn’t require interoperability to be effective. Most ThoroughCare clients start with no data exchange. As we’ll see, many seek more extensive data exchange capabilities as their care management programs mature or when needs evolve.
What’s the difference between data integration and interoperability?
These terms are used so interchangeably that they lose their meaning. However, there are essential distinctions when assessing your needs and vetting care management solutions.
Healthcare data used for care management can be viewed this way: Data integration translates information to be used across digital systems, and interoperability is the ability of those systems to speak to and share with each other.
Specifically, as a care coordination platform, ThoroughCare’s integrations pull data from various sources, and interoperability relates to how information is shared digitally.
For example, ThoroughCare integrates seamlessly with Honor My Decisions so that their Advance Care Planning workflow and modules display within our software. Also, evidence-based educational information is integrated directly from HealthWise.
Care management data integration and interoperability continuum
The amount of data integration and interoperability your care management program may need will depend on factors, including:
- Type of care management program
- Programmatic objectives
- Interventional tactics implemented
- Current risk- or value-based contract requirements
- Desired trackable or reportable quality measures and scores
- Cost saving goals
- Patient and provider needs and preferences
Larger organizations and broad care teams tend to use ThoroughCare’s electronic health records (EHR) integration and our open API capabilities for bi-directional data exchange.
Clients can manage their own API credentials using the developer portal, lending to a more seamless data exchange experience
Figure 1 shows the data interoperability continuum available to clients—from none to bidirectional. Each client’s needs are different, and each use case has unique requirements.
Because ThoroughCare is a cloud-based software platform, it enables integrated connectivity with top EHRs, data exchanges, 400+ remote monitoring devices, and mobile applications. Combined, they create an inclusive patient view throughout their care management journey.
This flexibility ensures that care teams can work toward specific goals and address challenges, enabling integrated and interoperable data as needed.
Meeting care management input and output needs
Figure 2 highlights how various types of data can flow into ThoroughCare and how the platform can generate and share data.
As you review your care management program goals, answer these questions:
What activities and interventions do we want to implement?
e.g., export billing information like time logs, email patients, send physician reminders, etc.
What types of reporting do we need to create?
e.g., compliance, billing, quality, operations, financial, etc.
What types of patient materials do we need to create?
e.g., care plans, educational materials, letters, legal documents, etc.
Specific needs will determine how data integration and interoperability can support your program.
When do you need data integration and interoperability?
As illustrated earlier, your care management goals, strategies, and tactics will dictate whether you need integration or interoperability now or in the future.
However, certain care management programs inherently lend themselves to specific inputs or outputs, indicating possible data-sharing scenarios.
As shown in Figure 3, programs like Remote Patient Monitoring generate data that alerts providers when patient physiological readings are out of normal bounds and timely intervention is required.
Transitional Care Management focuses on the critical time when a patient is discharged from a hospital and returns to a home or communal setting. Data flowing from a hospital into ThroughCare enables a provider to support the patient in the days after discharge to ensure they stay healthy and are not readmitted.
Advance Care Planning documents can be created when a clinician or care manager facilitates an end-of-life planning discussion with a patient. Key decisions can be recorded in ThoroughCare and documents can be shared with the patient, their family, and other physicians or providers.
Creating diagrams like those in Figure 3 can help outline specific data inputs and outputs. This can help ensure that your care management program effectively uses patient information.
Integration supports a comprehensive patient picture
As your care management program evolves, here are some things you can do with ThoroughCare’s more advanced data integration and sharing capabilities.
EHR integration
- Launch ThoroughCare and import patients directly from EHR
- Populate clinical data into ThoroughCare: conditions, ICD-10 codes, allergies, medications, labs,
- and vitals
- Upload care plans into the EHR and facilitate claims submission
Remote Patient Monitoring
- Analyze patient data remotely, increase patient engagement timeliness, and proactively manage patient health
- Vitals collected may include weight, blood pressure, blood glucose, oxygen saturation, temperature, respiratory rate, sleep activity, heart rate, and more
- Enhance patient interaction with automated SMS text reminders for appointments
- Quickly bill and submit accurate time and device claims to maximize revenue
Advance Care Planning
- Enable patients to complete, share, and update an advance care plan within a single care coordination platform
- Individual plans can be accessed 24/7 by scanning the QR code on the wallet card, clicking a link stored within the EHR, or received via an email shared by the plan owner
- Includes all elements needed to honor a person’s wishes: emergency contacts, healthcare decision-maker, treatment preferences, legal documentation, end-of-life values, and video living will
Health Information Exchange access
- Access patient health information from multiple sources
- Utilize ThoroughCare’s API for direct HIE feed via HL7 ADT messaging
- Help patients share care plans and make critical care decisions with a holistic view
- Analyze and trend data to enhance value-based care delivery across populations
- Share data with HIEs
ThoroughCare enables scalable, flexible data integration and interoperability for care management
