Health Gorilla Data Exchange

So today we’re chatting about Health Gorilla and how it’s used at your company. Before we jump into that, could you give a brief overview of the company and your role there?

We offer primary care and wrap services mainly to Medicaid and dual patients. We take on the responsibility for healthcare outcomes, so we’re similar to an ACO provider or a health plan partner in that sense. When it comes to primary care, we usually have a contract that’s based on risk for healthcare outcomes rather than the traditional fee-for-service or provider models. Our main goal is to improve the overall cost of care and health outcomes for our members. In my role, I’ve been in charge of our EHR and revenue cycle systems, quality and risk scoring elements, and product strategy. I’ve also made decisions regarding vendor selection and implementation of our platform technologies.

How long have you been using Health Gorilla?

About two and a half years.

What drove you to look for a product like Health Gorilla?

We have a large member population that we’re responsible for managing. Sometimes we serve as the primary care provider, but other times the member already has a primary care provider. In the value-based care context, we typically only interact with a segment of our members or see them for a fraction of their overall healthcare interactions. However, we are interested in understanding their entire care experience and long-term outcomes.

The challenge is that our electronic health record (EHR) only has access to the notes and activities that occur during our providers’ interactions with the members. We need to be able to gather data on what happens during other primary care visits, or when members interact with specialists or inpatient facilities. That’s where Health Gorilla comes in. Their API integration and technology tools allow us to not just use the information available in their portal, but also power our analytics with insights from clinical visit notes and other activities in the member’s record that Health Gorilla collects from the health information exchanges (HIEs) they work with.

Health Gorilla works with Carequality and CommonWell (two nationwide HIEs) and can extract the text from clinical notes, which we refer to as external provider visits. These are interactions with providers who are not part of our organization but have treated the patient and made notes in their own EHR. With Health Gorilla, we can access that text and apply natural language processing, machine learning, and various algorithms to identify likely diseases, diagnoses, or treatments those external providers have assigned or evaluated when seeing our members. This allows us to supplement our records, address any gaps, or update the member’s information based on the insights we gain from these external clinical notes.

Do you know what key requirements your company used when evaluating solutions in this space?

As with any product, we evaluated price and time to implement. Those were both favorable for Health Gorilla. Factors specific to our needs included the extent of network coverage. We wanted to know how much data we could gather on our members. Another important requirement was the use of healthcare standards, such as the FHIR protocol, as well as the degree of API access. We didn’t want to solely rely on the vendor to provide a portal and analytics to fulfill all of our needs. Instead, we wanted to be able to retrieve data from the vendor and work with it in-house. Health Gorilla has met these requirements, and they have been a good partner for most of our use cases.

What are your use cases for Health Gorilla?

We have two main use cases. The first is when providers and wrap care team members utilize the Health Gorilla portal to search for external medical records. This allows them to gather a comprehensive overview of a member’s healthcare history and current health status before they engage with the member in more detail. This information is easily accessed through the user interface of the web portal.

The second main use case involves the API connections we establish with Health Gorilla. Through these connections, we retrieve the same information that is available through the portal. However, we can use this data to create structured data that supplements the claims data we already have on members. By analyzing this data, we can then provide suggestions and insights on the best course of care for the member.

What are some of Health Gorilla’s strengths and weaknesses?

The technology integration is solid, and we haven’t experienced performance issues. Furthermore, the Health Gorilla engineering and customer support teams have been extremely collaborative when we were working on our solution and technical integration with the Health Gorilla API platform. It meets most of our use cases within the parameters that we designed. However, one area we’d like to see supplemented is that not all providers participate in the HIEs offered by Health Gorilla. We are actively looking for other sources of information to fill in the gaps in coverage. There are several inpatient facilities, in particular, that do not share their data with HIEs, or at least not through Health Gorilla. Depending on the complexity of the customer’s use case, there is still a need for more data on some patients to avoid gaps in the health record.

How is the quality of their integrations and APIs?

They’ve performed well. We haven’t encountered any issues so far, and the data connections have been stable. We’re able to bring in the data in a standard format that is usable for us. As long as the information is available, Health Gorilla is able to access it without any problems. Overall, our integration has been pretty successful and the support provided by Health Gorilla has been very strong

How is the quality of the portal itself?

I’d say it has been good overall. The only point of friction is that it’s an additional tool and portal to use which requires some effort from the user to comb through patient data in order to reach the relevant information; potentially the portal user experience could be improved with better organization of the patient data and improved search functionality in the front-end experience. Occasionally the portal does present performance issues for our users with slow rendering and outages.

There are many different tools, and clinicians don’t want to log into multiple systems. However, that isn’t just a problem with Health Gorilla, it’s the whole healthcare industry. In terms of what they offer, it seems to work well, and users usually don’t have any problems with it and can get to the information they need to understand a patient’s history and to provide high quality patient care.

Is there any ability to pull data into your EHR or CRM?

Yes, their API connections allow for that, but it ultimately depends on the EHR system. For instance, athenahealth doesn’t use Health Gorilla. athenahealth also relies on CommonWell and Carequality as their HIE, so in theory they have access to the same data for their members. However, athenahealth’s EHR doesn’t provide the ability to query the HIE in the same way as Health Gorilla does and the athenahealth HIE connections are not searchable. So while athenahealth receives the same data, they do it in a different manner. We also use Elation, and we created our own tool to display the searchable Health Gorilla data within that EHR. So from a technological flexibility standpoint, we were capable of meeting multiple use cases with Health Gorilla’s API connections.

So the reason you would stay with Health Gorilla now that you’re using athenahealth is because you can’t ingest the data directly via athenahealth?

Yes, that’s right. With athenahealth, you can only retrieve information from the HIE for patients that you have scheduled a visit with or are manually interacting with. athenahealth will then suggest possible matches from the records on the HIE and ask for user confirmation to add it to the patient’s record. This information becomes a part of the patient’s record that you can modify and use as needed. However, this process only applies to one patient at a time that we manually interact with.

This manual interaction doesn’t help when we need to determine which patients we should schedule visits with, especially if we have 10,000 patients and limited capacity. In order to identify patients with unaddressed needs, we need to query data across multiple records or HIE sources. Unfortunately, this is not possible with athenahealth in a programmatic way, but we can with Health Gorilla.

How would you characterize the developer experience and experience with their APIs?

The connections have been solid and the engineering support provided by the Health Gorilla team has been very good. Overall, I’d say they have met our needs, so the developer experience has generally been pretty positive.

How has their support been?

They’ve been responsive for us, and we have a good relationship with them. We have an assigned account manager who we can communicate with whenever we need them, and they proactively involve us in their governance councils and long-term strategy discussions. With other vendors, it’s a different story, as I or someone on the team often has to deal with SLA issues and downtime. But with Health Gorilla, we haven’t had to do that. So that’s a good indicator of the strength of their infrastructure. Our partnership has been mainly focused on future capabilities and details of our API integration or their data structures.

Do you feel like your company made the right decision in choosing Health Gorilla?

Yeah, I think so. We haven’t had any regrets or major issues to deal with. We’ve mainly been considering whether the coverage provided needs any additional supplements. There’s a high likelihood (around 90%) that we’ll renew, but there’s a small chance that we might look for something that not only complements our current coverage but also offers broader coverage. In that case, we would consider replacing it. Overall, our experience has been positive. Our users frequently use the product through the portal on the provider side, and they generally have a good experience. The technology integration and access to data that we wanted within the available coverage have also worked well.

What is a growth area you see for Health Gorilla?

I think they’re well aware of coverage issues and are actively trying to expand their coverage. That’s the entire purpose of their business model. They understand the importance of going beyond just the coverage provided by CommonWell and Carequality. It’s definitely a key element of their product strategy and future plans. They’re closely following national trends, regulatory standards, and new legislation, and exploring new opportunities.

Any advice for buyers who are evaluating this type of product?

I think there are a number of good solutions out there. The most important thing is to have a clear understanding of how you intend to use the data. You’ll want to make sure to choose a vendor that can provide the necessary coverage for your needs. In our case, Health Gorilla has been quite effective in meeting our intended use cases.