Disrupting Outdated Healthcare Technology Solutions with Workflows, Decision Support, Case and Knowledge Management: Trisotech

The Silicon Review

“Organizations can create their own automatable models, but Trisotech has developed evidence-based CPG workflow and decision models that are human-readable, machine automatable, and embeddable in most medical encounter systems.”

Modern healthcare innovation is more than developing better medical devices, diagnostics, therapeutics and clinical practices. One of the most impactful areas of current healthcare innovation is in healthcare information technology. Just as the digital transformation wave is changing business practices everywhere, it is also changing healthcare, albeit at a slower pace.

Currently, digital transformation in the healthcare field is most prominent in the sharing of healthcare information, managing healthcare knowledge, clinical decision support, regulatory compliance, and Clinical Practice Guidelines (CPG). Barriers to adoption have included competing standards, vendor proprietary lock-ins and the slow-going adoption of evidence-based practices.

Trisotech (https://www.trisotech.com/), a Montreal-based company, has risen to become a global leader in enterprise software and has been a driving force in international business process management (BPM) standards. The company’s healthcare clientele includes international and U.S. acute care hospitals, healthcare insurance organizations, government health services, and healthcare professional societies. Recently, Trisotech has bundled together product features and standards-based models into a specialized set of its Digital Enterprise Suite (DES) software capabilities - the Healthcare Feature Set (HFS).

“Healthcare subject matter experts (SMEs) and clinicians constantly work with IT to translate large volumes of regulatory, therapeutic and procedural information into organizational policy. Moving to evidence-based practices is very desirable for healthcare organizations, but also difficult,” explains Denis Gagné, CEO and CTO of Trisotech. Gagné is also a founding member of the BPM+ Health Community of Practice (https://www.bpm-plus.org/) where he currently leads the Ambassador Program and sits on the Steering Committee.

Sharing of Healthcare Information

Healthcare organizations must be able to quickly set guidelines and policies associated with their data and tailored to their respective delivery systems and business models. The FHIR^® (HL-7^®) standard support in Trisotech’s DES allows for data storage, retrieval, and patient data exchange both at the population level and for individual patients. Trisotech also supports CQL (HL-7^®) Clinical Quality Language execution in its automation capabilities.

“FHIR and CQL support is enabled through visual modeling by SMEs, often provider and IT teams, who can reflect industry changes quickly. These models can then become automated processes, cases, and decisions with the click of a single button,” says Gagné. “Once automated, clinical best practices, care pathways, and back-office workflows create common standards against which quality of service, cost containment, and patient satisfaction can be directly measured and continuously improved.”

Trisotech HFS resources to accelerate information sharing include:

FHIR Terminology Server connection
Built-in FHIR Data types
FHIR Accelerator - predefined FHIR Resource structures as FEEL data types
FEEL FHIR Accessors
SMART on FHIR apps
CQL Automation Engine (optional)

Managing Healthcare Knowledge

Managing knowledge requires clear unambiguous communications across the healthcare organization and secure software to standardize and centralize workflows and decision making. Healthcare has more varied data than most industries due to the numerous coding schemes for encounters, billing, regulatory reporting, etc. The Trisotech Knowledge Entity Modeler (KEM) is a DES component that allows organizations to create and define Terms and Business Rules. Using KEM, providers, business, and IT users can jointly specify vocabularies (healthcare and other) containing terms along with their exact definition and coding schemes they commonly use. As such, healthcare organizations can standardize and automate their use of terms in data entry (autocomplete), clinical decision support, and clinical practice guidelines ensuring standardization across their various departments and associated businesses entities.

Trisotech HFS knowledge management components include:

A Healthcare tab that allows addition of codes (Coding system, Code and Display name) and valuesets from the Terminology server.
300 pre-defined FHIR Observations in KEM
300 pre-defined FHIR Conditions in KEM

Clinical Decision Support

According to HealthIT.gov, “Clinical decision support (CDS) provides clinicians, staff, patients or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and healthcare. This typically results in improved quality of care and health outcomes, avoidance of errors and adverse events, and better efficiency, cost-benefits, and provider and patient satisfaction.”

CDS Hooks™ is one of the most common ways to provide CDS automation in a clinician’s workflow. When an EHR system notifies external services that a specific activity has occurred within an EHR user session, a CDS service can gather needed data elements through FHIR services and return information to the clinician in the form of a “card.” Trisotech’s decision modeling and automation, in conjunction with CDS Hooks support, delivers real-time clinical decision support during patient encounters allowing providers to consider alternative diagnoses, treatments, and potential cost-saving measures for their patients.

Trisotech HFS resources to support clinical decision support components include:

CDS Hooks Server
CDS Card Data types
CDS Hooks Customizable Cards (Info, Warning and Critical cards for Patient View and more)
CDS Card Accelerator

Regulatory Compliance

In the U.S., CMS and ONC have used the 21st Century Cures Act to implement new rules for improving healthcare interoperability. CMS requires its programs to make patient claims and other health information available to patients through third-party applications and developers. ONC requires that FHIR must be the standard by which health IT developers certify their APIs. An additional interoperability rule will likely go into effect in 2023 and require payers to provide patient’s prior authorizations information as part of a patient access API, giving patients a better understanding of how the prior authorization process impacts their care.

Beyond compliance requirements, back-office tasks such as pre-authorization and medical necessity determinations are time-consuming, expensive, and have a huge impact on patient experiences. Automation of determination activities expedites decisions for waiting patients, allows services to be rendered sooner, and increases ROI improving both perceived and real quality of service.

Trisotech HFS resources to support regulatory compliance components include:

FHIR Terminology Server connection
Built in FHIR Data types
FHIR Accelerator

Clinical Practice Guidelines (CPG)

CPGs define a sound, transparent methodology that translates best evidence into frameworks for clinical decisions and supporting best practices that improved patient outcomes. Evidence-based CPGs are a key aspect of patient-centered care informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options. CPGs can be directly modeled using Trisotech’s Digital Modeling Suite (DMS).

Organizations can create their own automatable models, but Trisotech has developed evidence-based CPG workflow and decision models that are human-readable, machine automatable, and embeddable in most medical encounter systems. Models like these typically require multiple decisions, often needing specific patient data. One size does not fit all, so the models must be well-documented and easy to change to reflect changing policies and local conditions.

Trisotech HFS CPG components include:

Pre-built models including nearly 1,000 free customizable care pathways, clinical guidelines, and healthcare decision calculators in the BPM+ Health standard.
An on-line course explaining the CPG BPM+ automation process.

Summary

Trisotech is disrupting outdated healthcare technology solutions with workflows, decision support, case and knowledge management that is interoperable with existing software systems in any healthcare setting.

HL7^®, and FHIR^® are the registered trademarks of Health Level Seven International and the use of these trademarks does not constitute an endorsement by HL7.