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PA’s Health Information Exchange Awards $674K to Hospitals

PA’s Health Information Exchange Awards $674K to Hospitals | Healthcare and Technology news | Scoop.it

The institution of a health information exchange (HIE) is imperative for the healthcare industry, as it allows for effective data sharing among multiple medical facilities located on opposite sides of the country and coordinates care throughout patient-centered medical homes, accountable care organizations (ACOs), and other healthcare settings.


The Penssylvania e-Health Partnership Authority is one such health information exchange institution, which has recently awarded onboarding grants of more than $674,000.00 to connect multiple hospitals and other healthcare providers including ambulatory care practices to its Pennsylvania Patient & Provider Network (P3N), according to a company press release.


Approximately $67,000 of the awards come from state funding while about $607,000 comes from federal funds. The program’s funding comes from the Centers for Medicare & Medicaid Services (CMS) and is being awarded with the assistance of the Pennsylvania Department of Human Services.
By integrating provider networks to health information organizations (HIOs), the P3N creates a strong system for electronic health information exchange. The release states that $355,000 is being awarded to the HealthShare Exchange of Southeastern Pennsylvania.


“The benefits of eHIE to patients and providers are significant,” Alix Goss, Executive Director of the Authority, stated in the press release. “This grant program is critical to helping providers connect to HIOs, and HIOs connect to the P3N.”


“As more HIOs join the P3N along with their connected providers, more patients will experience better coordination of their care, faster access to their clinical results, and reduced redundancy of medical tests,” Goss continued. “The bottom line for patients, providers, and the healthcare system will be improved patient safety and healthcare quality.”


These onboarding grants are helpful in terms of supporting sustainability among private-sector HIOs and assisting in increasing its membership. Additionally, the program brings about a stronger emphasis on the participation in electronic health information exchange, supporting healthcare reforms, and offering high-quality healthcare services.


The performance period for this grant ends on September 30, 2015 and is part of the Medicaid EHR Incentive Program. The onboarding grant funding itself is covered mostly by CMS while the Authority covers 10 percent of it.


Spreading health information exchange platforms throughout the nation is vital in the industry’s efforts to reduce medical errors, support population health management, improve care coordination, and offer better quality care.


While health information exchange remains vital to improving medical care services, there are certain regions throughout the United States that have not embraced the use of HIE platforms. Rhode Island is one example. Go Local Prov reports that as many as eight out of ten physicians in Rhode Island are not using the state’s health information exchange. Rhode Island Medical Society Government Relations Director Steven DeToy explained some of the reasons for the low numbers of health information exchange adoption.


"First, not every physician has a computer that they use for EHRs," DeToy told the news source. "Second, some of those who do, have a system that isn't CurrentCare compatible as of right now, but hopefully will be. There have been some proprietary issues. Certain EHRs don't allow physicians to prescribe electronically.”

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Are We Getting Closer to the Top of the HIE Mountain?

Are We Getting Closer to the Top of the HIE Mountain? | Healthcare and Technology news | Scoop.it

Two weeks ago, I finally completed the long, enduring process of buying my first home in Hoboken, N.J. The journey, from start to finish, took months to complete, the money put into it was substantial, and the paperwork and effort to try to make sure that everything went smoothly (Does it ever when it comes to real estate?) was rigorous, to put it kindly.


One of the strangest parts about this process, from a personal standpoint, is that I won’t be living in the home! Instead, I see it as an investment opportunity that I hope will pay off in the long run. Will it? It’s hard to say as of right now—the real estate market will dictate how it works out for me in the future, and it might be years and years down the road until I know if it was a savvy move or not.


The quick lesson here: sometimes in life, it takes a really long time to see tangible results for the efforts that we have put in. This couldn’t be more accurate when it comes to health information exchanges (HIE). The investment that our country has put into developing and maintaining HIE platforms has been gigantic, in the form of half a billion dollars, yet many naysayers believe that the return on that investment might never come.


To date, it’s been pretty hard to argue with them. Interestingly enough, I actually blogged about this very issue back in December, referencing a study from the Santa Monica, Calif.-based research organization RAND Corporation which found that due to the lack of evaluation on HIEs in the U.S., simply put, it has been too difficult to determine if they have been successful or not.  It’s too early to judge them, the researchers of that report found. “There are likely other health information exchange organizations in the country that are being used, and some may be having an impact. But, if they exist, they haven't been evaluated,” Robert Rudin, lead author of the study and an associate policy researcher at RAND, said at the time.


Recently, I read another review on HIEs, one that had similar conclusions to the RAND study in terms of early evaluation, although this study had a more optimistic outlook. This latest report, “The benefits of health information exchange platforms: Measuring the returns on a half a billion dollar investment,” from Niam Yaraghi, a fellow in the Washington, D.C.-based Brookings Institution’s Center for Technology Innovation, studied the effects of accessing patient information through an HIE platform on the number of the laboratory tests and radiology examinations performed in two emergency departments in Western New York in 2014, via the region’s HIE, HEALTHeLINK. While Yaraghi readily admits that true HIE benefits won’t be realized until more providers join HIE platforms, and subsequently share data, he sees that there is significant potential.


Yaraghi’s analysis looked at two groups of patients in the ED, one group whose care involved querying HEALTHeLINK’s database of clinically relevant information from a patient’s medical history, and the other group whose care did not involve an HIE query. The study revealed that querying the HIE’s database is associated with significant utilization reduction in ED settings. In the first ED setting, querying the database is associated with respectively, a 25 percent and 26 percent reduction in the estimated number of laboratory tests and radiology examinations. In the second ED setting, querying the HIE’s database is associated with a 47 percent reduction in the estimated number of radiology examinations.


In his conclusion, Yaraghi writes, “The efforts by Congress, patient advocacy groups, and most importantly the shift towards value-based payments promise complete interoperability in the near future. After more than a decade of concerted national efforts, we are now on the verge of realizing the returns on our investments on health IT. HIE platforms have the potential to leverage the national investments on interoperability and radically improve the efficiency of healthcare services.”


Comparatively speaking, the aforementioned RAND study found no evidence showing whether or not health information exchanges are on track as a potential solution to the problem of fragmented healthcare. “It is pretty well established that the U.S. healthcare system is highly fragmented,” RAND’s Rubin said. “Lots of studies over the years, including some recent studies, have shown that a typical patient visits doctors in many different practices. Frequently the doctors don't have the patient's previous medical information. There is no sign of that problem getting better, and in fact it may get worse if medicine continues to become more specialized.”


Indeed, as Yaraghi notes, getting providers on board and increasing the volume of data available on the HIE platform will be the key moving forward. “A RHIO (regional health information organization) without data is an expensive yet empty glass of water,” he writes.  “At the beginning, RHIOs could help physicians have a better understanding of the patients’ condition as much as an empty glass could help them quench their thirst.” Undoubtedly, as HIE organizations look to get providers more involved and willing to share data, the providers themselves are looking for more out of the HIEs. A recent report from NORC at the University of Chicago, funded by the Office of the National Coordinator for Health Information Technology (ONC), found that providers highlight the potential for HIE to ease access to actionable data that integrates data from across the care continuum and provides clinicians with information at the point of care to improve care delivery and care coordination.


At the end of the day, it’s all about value, as with most things in life. If the general public values my condo in Hoboken, and I get renters to pay me to live there, I’m almost certainly going to see a return on my investment. Similarly, if physicians across the U.S. see value in HIEs, the federal government will eventually see a return on their investment as well, in the form of lower healthcare costs and better patient outcomes. As Yaraghi writes, “This is the first study in which access to an HIE platform was provided to all of the patients in a treatment group, while the care of the others in the control group did not include querying an HIE platform.” I hope that this research serves a stepping stone for moreresearch in this area—and down the road, a return on our enormous expenditure into health information exchanges.

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Are We Getting Closer to the Top of the HIE Mountain?

Are We Getting Closer to the Top of the HIE Mountain? | Healthcare and Technology news | Scoop.it

Two weeks ago, I finally completed the long, enduring process of buying my first home in Hoboken, N.J. The journey, from start to finish, took months to complete, the money put into it was substantial, and the paperwork and effort to try to make sure that everything went smoothly (Does it ever when it comes to real estate?) was rigorous, to put it kindly.


One of the strangest parts about this process, from a personal standpoint, is that I won’t be living in the home! Instead, I see it as an investment opportunity that I hope will pay off in the long run. Will it? It’s hard to say as of right now—the real estate market will dictate how it works out for me in the future, and it might be years and years down the road until I know if it was a savvy move or not.


The quick lesson here: sometimes in life, it takes a really long time to see tangible results for the efforts that we have put in. This couldn’t be more accurate when it comes to health information exchanges (HIE). The investment that our country has put into developing and maintaining HIE platforms has been gigantic, in the form of half a billion dollars, yet many naysayers believe that the return on that investment might never come.


To date, it’s been pretty hard to argue with them. Interestingly enough, I actually blogged about this very issue back in December, referencing a study from the Santa Monica, Calif.-based research organization RAND Corporation which found that due to the lack of evaluation on HIEs in the U.S., simply put, it has been too difficult to determine if they have been successful or not.  It’s too early to judge them, the researchers of that report found. “There are likely other health information exchange organizations in the country that are being used, and some may be having an impact. But, if they exist, they haven't been evaluated,” Robert Rudin, lead author of the study and an associate policy researcher at RAND, said at the time.


Recently, I read another review on HIEs, one that had similar conclusions to the RAND study in terms of early evaluation, although this study had a more optimistic outlook. This latest report, “The benefits of health information exchange platforms: Measuring the returns on a half a billion dollar investment,” from Niam Yaraghi, a fellow in the Washington, D.C.-based Brookings Institution’s Center for Technology Innovation, studied the effects of accessing patient information through an HIE platform on the number of the laboratory tests and radiology examinations performed in two emergency departments in Western New York in 2014, via the region’s HIE, HEALTHeLINK. While Yaraghi readily admits that true HIE benefits won’t be realized until more providers join HIE platforms, and subsequently share data, he sees that there is significant potential.

Yaraghi’s analysis looked at two groups of patients in the ED, one group whose care involved querying HEALTHeLINK’s database of clinically relevant information from a patient’s medical history, and the other group whose care did not involve an HIE query. The study revealed that querying the HIE’s database is associated with significant utilization reduction in ED settings. In the first ED setting, querying the database is associated with respectively, a 25 percent and 26 percent reduction in the estimated number of laboratory tests and radiology examinations. In the second ED setting, querying the HIE’s database is associated with a 47 percent reduction in the estimated number of radiology examinations.


In his conclusion, Yaraghi writes, “The efforts by Congress, patient advocacy groups, and most importantly the shift towards value-based payments promise complete interoperability in the near future. After more than a decade of concerted national efforts, we are now on the verge of realizing the returns on our investments on health IT. HIE platforms have the potential to leverage the national investments on interoperability and radically improve the efficiency of healthcare services.”


Comparatively speaking, the aforementioned RAND study found no evidence showing whether or not health information exchanges are on track as a potential solution to the problem of fragmented healthcare. “It is pretty well established that the U.S. healthcare system is highly fragmented,” RAND’s Rubin said. “Lots of studies over the years, including some recent studies, have shown that a typical patient visits doctors in many different practices. Frequently the doctors don't have the patient's previous medical information. There is no sign of that problem getting better, and in fact it may get worse if medicine continues to become more specialized.”


Indeed, as Yaraghi notes, getting providers on board and increasing the volume of data available on the HIE platform will be the key moving forward. “A RHIO (regional health information organization) without data is an expensive yet empty glass of water,” he writes.  “At the beginning, RHIOs could help physicians have a better understanding of the patients’ condition as much as an empty glass could help them quench their thirst.” Undoubtedly, as HIE organizations look to get providers more involved and willing to share data, the providers themselves are looking for more out of the HIEs. A recent report from NORC at the University of Chicago, funded by the Office of the National Coordinator for Health Information Technology (ONC), found that providers highlight the potential for HIE to ease access to actionable data that integrates data from across the care continuum and provides clinicians with information at the point of care to improve care delivery and care coordination.


At the end of the day, it’s all about value, as with most things in life. If the general public values my condo in Hoboken, and I get renters to pay me to live there, I’m almost certainly going to see a return on my investment. Similarly, if physicians across the U.S. see value in HIEs, the federal government will eventually see a return on their investment as well, in the form of lower healthcare costs and better patient outcomes. As Yaraghi writes, “This is the first study in which access to an HIE platform was provided to all of the patients in a treatment group, while the care of the others in the control group did not include querying an HIE platform.” I hope that this research serves a stepping stone for moreresearch in this area—and down the road, a return on our enormous expenditure into health information exchanges.

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New Grant Program Advances Health Information Exchange

New Grant Program Advances Health Information Exchange | Healthcare and Technology news | Scoop.it

The development of health information exchange institutions is aimed at advancing coordinated care, delivering superior quality of medical services, and improving public health outcomes. Certified EHR technology and health IT systems can enhance the communication channels and connections between different coordinated care settings, which is why EHR interoperability and health information exchange is so important.


In Massachusetts, the Massachusetts eHealth Institute at MassTech (MEHI) announced that a new grant program is available to strengthen technologies and communication channels among various medical facilities in varying regions across the state, according to the public entity’s press release.


The grant program called Connected Communities Implementation Grant Program is currently accepting proposals from groups that are working together to develop effective health information exchange and utilize health IT systems in an effort to advance coordinated care. The grant is meant for improving workflows and giving providers an opportunity to solve the many challenges of coordinated care and transitions of care within their communities.


The hopes behind these type of grant programs and healthcare reforms is that it will achieve better patient outcomes, quality of care, and lower healthcare costs through efficient health information exchange.


“The Connected Communities Grant Program provides us with an opportunity to support impactful health IT programs driven by the priorities in individual communities,” Laurance Stuntz, Director of MeHI, stated in the press release. “Through this approach, our hope is to receive proposals that identify region-specific roadblocks to sharing information, engage a broad cross-section of healthcare stakeholders, and address the unique needs of patients in that community through the use of technology.”


The cooperation and coordination among multiple medical facilities remains a key focus of the healthcare industry especially in terms of long-term and acute care as well as behavioral health services. This particular grant program asks for one or more specialty providers in these areas to send a proposal in order to help further strengthen important partnerships.


Those who receive the grant will initially obtain up to $25,000 from MeHI. The grantees will need to develop a strong action plan, detail health information exchange pathways in a diagram, outline a ‘use case,’ and provide a budget for the anticipated costs.


“Finding ways to improve information sharing and real-time data capabilities, while enhancing providers’ ability to treat patients at the community level, will go a long way toward helping the Commonwealth meet its healthcare cost reduction goals,” David Seltz, Executive Director of the Health Policy Commission, said in a public statement. “We look forward to continuing our work with MeHI and other stakeholders to build a stronger healthcare system.”


The grant program is looking to push forward provider access to clinically important data including laboratory results and discharge plans, better healthcare outcomes, and reduced hospital readmissions along with duplicative tests. Massachusetts medical providers and groups who are interested in expanding their health information exchange capabilities would be wise to send a proposal to MeHI in order to advance the quality of their patient care services.

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Reflecting on the Clash of Incentives Around “Information-Blocking” in the Push Towards the New Healthcare

Reflecting on the Clash of Incentives Around “Information-Blocking” in the Push Towards the New Healthcare | Healthcare and Technology news | Scoop.it

As Healthcare Informatics reported last month, the Office of the National Coordinator for Health Information Technology (ONC) released a report in early April that highlighted what the federal healthcare IT agency referred to as “information-blocking.” As Senior Editor Gabriel Perna noted in his April 10 report immediately following the release of the ONC document, “The report’s authors and researchers detailed several examples of electronic health record (EHR) developers and health systems blocking health information sharing between each other. The act of information blocking occurs when an entity or person knowingly and unreasonably interferes with the exchange of electronic health information. Examples of this,” he noted, “are charging prices and fees for data exchange; creating terms of a contract that restrict individuals access to their health information; developing health IT in a non-standard way that dissuades information sharing; and developing health IT in a way that locks in information.”


The ONC cited examples in its report of anecdotal evidence suggesting that “EHR application developers are breaking several of the rules in this regard,” Perna’s report noted. “Using interviews with people at regional extension centers (RECs), the authors detailed complaints from industry sources on how developers are charging fees that make it cost-prohibitive to send, receive, or export electronic health information stored in EHRs. Some EHR developers even charge a substantial transaction fee any time a user sends, receives, or queries a patient’s electronic health information, the report says. The variation in prices reported to ONC suggests that some are taking advantage of the situation.”


In announcing the availability of the report, National Coordinator for Health IT Karen DeSalvo, M.D. noted in a blog on the agency’s website that it is difficult to pinpoint concrete evidence of information-blocking. “The full extent of the information blocking problem is difficult to assess, primarily because health IT developers impose contractual restrictions that prohibit customers from reporting or even discussing costs, restrictions, and other relevant details,” she noted. “Still, from the evidence available, it is readily apparent that some providers and developers are engaging in information blocking,” she said.


Given all this, I read with interest a May 20 blog in Health Affairs online by Julia Adler-Milstein on this subject, because of the clear way in which she frames the dynamic tension taking place right now in the industry between the forces that would restrict information for profit or proprietary gain, and those that would advance it for the common good. AsAdler-Milstein, who is an assistant professor of information in the School of Information and an assistant professor of health management and policy at the School of Public Health at the University of Michigan, states very bluntly in her blog, “When it comes to sharing electronic patient health information, public good should trump private gain. While it may seem like an obvious statement, it represents a tectonic shift in the narrative surrounding health information exchange,” or HIE.


As Adler-Milstein notes, “For more than a decade, our federal strategy has largely left HIE to the market under the assumption that, if there is benefit to be created (and estimates suggest that there is), we should see the emergence of ways to capture that benefit. In practice, this means that HIE efforts have sprung up in various health care markets across the country, and where public money has been spent on HIE (largely at state and community levels), it has come in the form of one-time start-up funding, not a commitment of ongoing support or regulatory mandates for HIE participation.”


Here’s where Adler-Milstein really scores a home run on this, in my view: “What has been substantially underappreciated, however,” she writes, “is the fact that, for the key actors needed to enable HIE to occur—provider organizations and vendors—there might be more benefit, or at least more certain benefit, from not doing so. And as a result, these actors may behave in ways that interfere with the free-flow of patient information that is needed to improve health and health care.”


Instead, she says, “With the release of the information blocking report, which was produced in response to a 2015 Omnibus bill request that introduced the term ‘information blocking,’ ONC makes plain that this behavior will no longer be tolerated. This enormously exciting development means we might see real progress after decades of investment that has failed to convert into sustainable approaches to robust HIE. The key to such progress, however,” she warns, “lies in how well we can identify when information blocking is occurring. This will not be easy.”


And in those short paragraphs, we can see some of the core opportunities and challenges moving forward in this critical area. In this arena as in so many others in healthcare, we see a dynamic tension based on conflicting incentives within the U.S. healthcare system. On the one hand, there is broad consensus that data- and information-sharing will be essential to accountable care organization (ACO) development, population health management, bundled payment-facilitated care delivery, patient-centered medical home work, and indeed, every iteration of the new healthcare. Yet at the same time, there are many elements embedded even in those concepts that speak to at least short-term—and certainly arguably, medium-term as well—market advantages that can be gained through data- and information-hoarding.


It is this clash of incentives that we are collectively burdened with at this early stage of the trajectory towards the new healthcare. The rhetoric around healthcare policy right now is all about sharing for common gain, and yet the incentives in the moment are far from purely conducive to—well, purity.


That’s why it’s good to be reminded at times like this by elegantly concise writings like those of Julia Adler-Milstein. Adler-Milsteiin’s blog reminds us what the ultimate prize is, on which we should at least theoretically all be setting our eyes. This is not to engage in the laying of blame on those working for specific market advantage, but rather to affirm the need to continue to push forward collectively as an industry and indeed as a society, towards a more mature healthcare system—one in which all the incentives really all will be aligned. In other words, keep watching this space.

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Scripps, Sharp HealthCare to Fully Participate in San Diego HIE

Scripps, Sharp HealthCare to Fully Participate in San Diego HIE | Healthcare and Technology news | Scoop.it

The San Diego-based Scripps Health and Sharp Healthcare are beginning full participation in the San Diego Health Connect, a regional health information exchange (HIE) that now facilitates the data exchange of more than 2.7 million San Diego County residents.

In October of 2013, both of these provider organizations originally announced they were participating in San Diego Health Connect, but according to reports, integration and consent issues kept them from fully being on board until this summer.  


In 2013, San Diego Health Connect officially evolved from the San Diego Beacon, the largest of the 17 Beacon Community projects that received a total of $250 million in three-year grants from the Health and Human Services Office of the National Coordinator for Health Information Technology (ONC). Funding for that project ended on Sept. 30. The regional health information exchange was one of the initial projects of that Beacon community.


“The real-time exchange of medical information between San Diego providers will ensure patients receive timely and cost-efficient care,” Mike Murphy, Sharp HealthCare CEO, said in a news release statement. “Lives will undoubtedly be saved as result of sharing critical patient care information in a secure and confidential manner."

Through the program, information is shared with healthcare professionals at the point of care and only by authorized requests and with patient permission. Patients served by Scripps Health and Sharp HealthCare can opt-out at any time. “Using San Diego Health Connect offers real advantages for everyone involved,” said Scripps Health president and CEO Chris Van Gorder. “It not only facilitates better care, in many cases it also eliminates the likelihood of tests and procedures being repeated unnecessarily.”


San Diego Health Connect acts not as a keeper of information, but rather as a conduit, its officials say. Requests from providers are sent to a data hub, where pertinent information is assembled and routed for real-time electronic delivery. More than 200,000 messages are safely exchanged through the system every day among the San Diego hospitals and community clinics currently in the system, the organization says.


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The Pain (and Gain) of Building a Private HIE in NYC

The Pain (and Gain) of Building a Private HIE in NYC | Healthcare and Technology news | Scoop.it
Frat Iqbal, senior manager of information management at New York University’s Langone Medical Center, led off his presentation at HIMSS15 in Chicago with two photos that provided a stark reminder of what happens when information doesn’t flow properly through the healthcare system. They were two pictures of his brother two years apart, one in full health and the other wheelchair-bound and permanently disabled by multiple sclerosis.
 
“It took two years to diagnose MS as he went from doctor to doctor, lab to lab,” he said. “His life was ruined by inefficiencies in the healthcare system.”
Iqbal said it is a reminder of the importance of improving patient care at the community level, of connecting all the small practices in New York so that data can flow from their offices to specialists, labs and hospitals. 
 
NYU Langone has been working to build a private health information exchange to link 200 practices and 1,900 clinicians using 26 different EHRs as the state and country work toward building larger exchanges.
 
The HIE was established in mid-2011 and privately funded by NYU Langone Medical Center. The goal was to become a central repository of clinical information for community providers to review, reference and share data and to provide 360-degree care to patients, Iqbal said.
 
Anthony Antinori, senior director of clinical affairs IT at NYU Langone, said a private HIE has advantages over a public one. “We can make decisions quickly. We have a small ecosystem of private practices and one governing body. We are local and funded by a private organization, with no federal or state funding required,” he said. The HIE is able to rapidly align itself with the strategic goals of the organizations it is serving, he added.
 
Instead of dictating which EHRs it would support, NYU Langone decided to work with whatever the providers had. “We left it open. If the EHR has the capability, we will integrate with it. It’s more headaches for us, but we did that for the community,” he said. 
 
They knew it was going to be challenging, and it has been, Iqbal said. “It is one of the most complicated projects I have ever embarked on,” he said. Interfacing with all those EHRs has been a “project management nightmare,” he added. Project prioritization has been tough, in terms of deciding which data is most valuable to the HIE. A whole team has been focused on privacy and security of the 4 million patient records in the HIE.
 
There are technical challenges, but more difficult have been cultural changes and setting the right expectations, he said. Many physicians are not inclined to share data and don’t want to change. Most EHRs are designed to retain, not share, information. 
 
Some providers are resistant to change. They don’t care if more information is available and they don’t want to share information. With these providers, you really have to make them realize the benefit the HIE brings to the table, he said. (Members of the NYU Provider Network are mandated to connect to the HIE.)
 
Legal and policy issues were a challenge. Getting data sharing agreements vetted by the practices, vendors and NYU Langone’s legal teams took longer than the integration itself. Consent policies are also difficult to work through, he said.
 
Despite the huge challenges in getting it set up, the HIE offers an array of benefits. Here are a few listed in the NYU presentation:
• Providers gain immediate access to valuable clinical data that provides a more holistic view of patient health when using the HIE;
• Providers will be able to reduce unneeded patient visits and lower the cost of care;
• Providers can begin to embrace the powerful benefits of trend and pattern analysis toward new decision-making frontiers;
• HIE facilitates evidence-based medicine and creates a potential positive feedback loop between health-related research and actual practice.
• Patients can expect improved payment coordination and smoother care transitions
• Duplicative procedures or tests will be reduced and visit satisfaction will be improved when patients opt to participate in the HIE;
• The collection and linking of data across the HIE facilitates extensive and robust community health records that can foster the ability to quickly detect, respond and efficiently prevent threats to public health;
• The HIE will also enhance public health practices at all levels of government through infectious disease case investigation and health surveillance.
 
The next step, he said, is analytical innovation that will pull together payer data, HIE data and Epic data from the hospital system to get more proactive at recognizing issues and monitoring patients and populations.
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Greater Houston Healthconnect Expands Network

Greater Houston Healthconnect Expands Network | Healthcare and Technology news | Scoop.it

GreaterHouston Healthconnect, a regional health information exchange (HIE) in Houston, has just added CHI St. Luke’s Health, a major health player in Texas, to its network.


Houston’s CHI St. Luke’s earlier announced its intention to build a broad network of primary care and specialty physicians to complement its six hospitals, three emergency centers, and other service locations. With population health as a key goal, the CHI St Luke’s network will utilize access to patient health information from any of the participating Healthconnect facilities in order to achieve clinical integration, manage transitions of care, and improve long term health outcomes, its officials say.


“CHI St. Luke’s and our network of partner physicians are endeavoring to reach patients where they are in the community by offering them flexibility of care options and smart information systems to help them stay healthy,” Michael Covert, the organization’s president and CEO, said in a statement. “As part of Greater Houston Healthconnect we’re letting our patients know that we care about them no matter where they had or will receive care in the future. Their medical information should follow them wherever they go―seamlessly. We need a neutral, community-based organization to accomplish that.”


Healthconnect partners with the Texas Health Services Authority (THSA), the statewide body responsible for connecting regional HIEs throughout Texas. Greater Houston Healthconnect currently has agreements with 284 healthcare organizations, representing over 50 percent of area hospital beds and 40 percent of physicians. Millions of patient records are available for query through the exchange and almost all major Texas medical center institutions participate, officials say.


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Has Health Information Exchange Improved Healthcare Reform?

Has Health Information Exchange Improved Healthcare Reform? | Healthcare and Technology news | Scoop.it

In 2013, the Workgroup for Electronic Data Interchange (WEDI) released a roadmap for the development of effective health information exchange (HIE) that would lead to lower costs, improved delivery, and better patient outcomes.

This week the Louis W. Sullivan Institute for Healthcare Innovation released a report updating the industry on the results from the 2013 WEDI framework and offers guidance on potential improvements within HIE development and health IT adoption.

The 2013 report focused on four key areas of improvement. These include:

  1. Patient Engagement
  2. Payment Models
  3. Data Harmonization and Exchange
  4. Innovative Encounter Models

The Sullivan Institute report states that patient engagement strategies are on par with the recommendations offered by WEDI and are progressing efficiently. The progress around payment models is not as quick, as more questions and issues stem from the use of newer payment models. The report encourages the development of an “evaluation framework of core attributes and technological functionalities” meeting WEDI requirements.

Additionally, more innovation is needed to systemize and harmonize data. Greater efforts will need to be put forth into interoperability and information exchange. Efforts in innovative encounter models are on par with WEDI recommendations, the report finds. Strategies from the industry and federal pilot programs are all leading the way in incorporating innovative encounter models to provide patient-centric care.

The report provides certain recommendations for the healthcare sector such as incorporating patient identifiers to standardize patient identification across multiple health records distributed among various medical facilities. The issues surrounding redundant data due to improper identification has led to inaccuracies and errors within the healthcare system.

Poor quality of data is associated with worse patient outcomes, which is why implementing patient identifiers could vastly improve the quality of care among hospitals and physician practices. Better patient matching and identification could also strengthen privacy and security measures across the healthcare spectrum.

One effort from the Office of the National Coordinator for Health Information Technology (ONC) occurred in early 2014 when an issued report spoke on patient identification and matching, indicating key strategies to implement in order to accurately match patients to their records.

The Sullivan Institute report also encourages stakeholders to increase health IT education and literacy programs on a broader spectrum in order to improve patient engagement with patient portals, EHRs, and other health IT tools. Additionally, developers should continue to create systems for capturing patient information and leveraging mobile devices to improve health data access and exchange.

While there have been significant strides made toward the adoption of EHR technology and the movement toward lower cost and better quality of care, there is still plenty of work to be done in efforts to meet Stage 2 and Stage 3 Meaningful Use requirements and increase HIE adoption.

Challenges surrounding patient identification, data harmonization, and the improvement of payment models will need to be addressed. Regulations and new technologies will be shaping the healthcare sector for years to come while patients will begin to take a greater role in their own healthcare management.


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The Secret of HIE Sustainability

The Secret of HIE Sustainability | Healthcare and Technology news | Scoop.it

It was great to speak with Dev Culver back in November, as I prepared the Top Ten Tech Trends article on health information exchange (HIE) sustainability. In reporting on and writing that Trend, I wanted to give readers a sense of the landscape around the sustainability of statewide HIES in particular, at a time when numerous statewide HIEs are failing outright, or at least faltering.

HealthInfoNet, Maine’s statewide HIE, is flourishing at the same time that other statewide HIEs are stumbling. Indeed, along with the statewide HIEs in Ohio, Michigan, and Colorado, HealthInfoNet is serving these days as a shining beacon of success at a time of great peril for the health information exchange sector. So what gives?

Basically, what Dev Culver of HealthInfoNet—as well as what Dan Paoletti of the Ohio Health Information Partnership/CliniSync, Doug Dietzman of Great Lakes HealthConnect, and Brian Braun of Colorado’s CORHIO, know—is this: the only way to survive these days is to be useful—that’s right, useful. For all the high-minded conversations five and even two years ago, about how health information exchange would transform the U.S. healthcare industry, when the proverbial rubber really came to meet the proverbial road, particularly once most of the federal and state funding began to dry up two years ago, HIE survival was suddenly no longer a sure thing.

But Dev, Dan, Doug, and Brian, and their colleagues, all knew that from day one. And all are creating real, concrete value, value that people are actually willing to pay for (not that more abstract value is not without its own significance—only that the more abstract forms of value are no longer strong enough to keep the doors open anymore). And most of that value derives from very practical things.

As Dev told me back in November, HealthInfoNet is now providing leading-edge support to providers, as they move towards full population health management and value-based purchasing models of care delivery and payment. “We have a set of tools in the field that is dynamic—the data being used is a day old, driven by clinical and event data," he noted, “and is predicting things like who will show up in the emergency department. Who’s going to get readmitted in the next 30 days? That runs while the patient is in the bed.”

When I asked Dev whether some of what has been created by some HIEs was not truly needed, he told me that “I think part of what leads to success starts with the building out of consensus among diverse stakeholders, so that there is at least the potential for value. And so you know,” he added, “when I think about our history, the work started in 2004, and we didn’t have an operational health information exchange until late 2008, early 2009.” He and his colleagues spent quite a long time building consensus among the HIE’s stakeholders on the organization’s purpose, and also spent time raising seed money for the long journey ahead.

But the revolutionary thing they’re doing now that really makes a difference is this: HealthInfoNet is sharing live data—usually one day old—with providers in Maine, data that is predicting which patients will show up in the ED, and helping them to be able to predict which patients will be readmitted within 30 days. That kind of data, delivered in a far more timely way than ever before, is like gold for patient care organizations, as they become involved in accountable care organizations or respond to value-based purchasing demands.

So this will be the currency of health information exchange going forward: HIEs will need to be able to offer practical data and information, in a far more timely way, that can help providers survive and thrive in the new, more connected healthcare.

On one level, this shouldn’t be so terribly surprising. After all, on a very broad level, we all know the direction in which U.S. healthcare is headed, as driven by purchasers and payers. On the other hand, actually coming up with concrete services that other stakeholders in healthcare find valuable on a practical level—turns out to be terribly challenging to actually design, develop, and deliver. Thus, CliniSync’s facilitating the sharing of CCDs (continuity of care documents) among providers, and CORHIO’s alerting health plans in Colorado when their plan members are cared for in EDs or admitted to hospitals—all these services are not only quite valuable in the abstract, but very much so, too, in the practical world of transactions and money and self-generated survival.

So the “secret” of HIE sustainability, particularly of statewide HIE sustainability—is not really such a big secret after all. But making it real—now that seems strangely to be a closely held stratagem. So really—it seems well past time for a whole bunch of people out there to make pilgrimages to Maine, Michigan, Ohio, and Colorado—and to strike while the proverbial iron remains hot.


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Future of interoperability is here | Healthcare IT News

Future of interoperability is here | Healthcare IT News | Healthcare and Technology news | Scoop.it
Hard to believe, but it has been a decade since the George W. Bush administration created the Office of the National Coordinator for Health Information Technology and issued a challenge to the healthcare industry that it should be seamlessly interoperable by the year 2014.

The initiative outlined some bold ideas and served as motivation for an industry that lagged behind in information technology development. And while the initial vision of a completely interoperable healthcare system may have had an off-the-mark time frame, experts agree that it got the machinations spinning in the right direction.

“To me, interoperability should be about that seamless flow of information,” says Joy Huntington, RN, clinical specialist at Roper St. Francis Healthcare in Charleston, S.C. “In reality, we’re not experiencing it at this particular point – we’re still in siloes electronically and gaps still exist. We’re not where the pundits thought we should be, but we can see now that they weren’t realistic in their expectations. That doesn’t mean we haven’t made substantial progress – we have in many ways.”

Currently Roper St. Francis has “a higher degree of interoperability than most,” Huntington says, as the inpatient and outpatient sectors “have some degree of interoperability.” The ER has its own system apart from the enterprise because it operates in its own self-contained environment, she says.

“We needed documentation that was easier to use, more specific and customizable,” Huntington says. “What we managed to do is let clinicians in the enterprise see and share the patient’s information, which they can view and validate.”

Looking back 10 years, Kirk Larson, regional CIO of Healthcare for Sunnyvale, Calif.-based NetApp, says the 2004 initiative helped to push healthcare out of its IT lethargy.

“Before that, organizations were content not to be interoperable,” he says. “That was OK because it was the norm and there was no pressure to change. Now as meaningful use is well into Stage 2, progress is not only encouraged, but mandated.”

If there is one place where interoperability has taken hold, it’s with health information exchanges, Larson says.

“They may not be eloquent, but they achieve the spirit of interoperability,” he says. “They can access data at the point of care and that makes a difference.”

More than EHRs

The impetus for the ONC’s creation and subsequent 10-year interoperability assignment focused on electronic health records and the seamless exchange of patient information among healthcare entities. And though that remains the chief concern, interoperability has various dimensions of functionality, says Zane Schott, vice president of business development for Salt Lake City-based BlueStep.

“You don’t need an EHR to be integrated,” he says. “There are so many organizations in post-acute and long-term care that are still running paper. Even so, they have the ability to be interoperable because with the MDS (Minimum Data Set) they have to produce files that can be sent to CMS electronically. We can lift that piece of information and submit it to an HIE or hospital based off the MDS so that even without an EHR they can be interoperable.”

A key reason why providers in the post-acute sector are still dealing with paper is that they were not included as eligible for ARRA funds and therefore are not involved in the meaningful use push.

“What this means is that, ironically, seniors are being left behind in the interoperability initiative,” he says, “and that is tragically unfair.”

‘Cross pollination’

Connectivity with payers is another important aspect of interoperability, which is the bailiwick of Cambridge, Mass.-based Pegasystems. While the company serves most of the major health plans, it also focuses on government agencies, health systems and life sciences.

“It’s a great pollination of ideas from retail verticals to financial services,” says Elizabeth Hart, industry principal for healthcare. “We target the different pain points and verticalize them for the customers we sell to, but also extend from those so that you can start a CRM system and call center and build an enrollment system out of that.”

Hart concedes that despite gains, healthcare is still reliant on 30-year-old legacy systems that don’t have the functionality needed to make interoperability a reality.

“Traction is being made, but it is still not moving at the pace we need,” she says. “A lot of it has to do with the fact that there is more data coming out with in-home monitoring and mobile devices that weren't envisioned from the old systems and existing EHRs. We end up wrapping around those systems to give them the capabilities and capacity they need.”

A new ‘connection’

The hallmark event for interoperability is the IHE North American Connectathon, which will be held Jan. 26-30 at the Cleveland Convention Center and HIMSS Innovation Center in Cleveland. The sponsors are enthused with the new venue after 15 years in Chicago.

“Cleveland’s state-of-the-art Convention Center and Global Center for Health Innovation – called ‘The Globe’ by the locals – has provided Cleveland with the opportunity to become an epicenter for healthcare and innovation,” said Celina Roth, HIMSS manager of informatics and staff liaison to the IHE. “Together these two venues are creating a new renaissance in downtown and revitalizing the city.”

The IHE Connectathon is a cross-vendor, live, supervised, and structured testing event with more than 100 participating vendors and 600-plus engineers and IT architects. All these organizations and IT experts converge on-site for one week of interoperability testing and problem resolution. Participants test their products against multiple vendors using real-world clinical scenarios contained in IHE's Integration Profiles.

With implementation of IHE Profiles growing, IHE USA has introduced new programs, such as a new one-day technical program called Connectathon 101. It will be offered on Tuesday, Jan. 27, to help engineers gain a full understanding of the Connectathon testing process, experiment with the testing tools, and work one-on-one with industry experts. Engineers who complete the session leave prepared to participate in next year’s IHE North American Connectathon 2016.

“While EHR usage has increased significantly, the interoperability necessary to achieve continuity of care, population health, patient management and clinical quality improvement is not yet realized,” Roth says. “Interoperable health IT has made strides in many areas like ePrescribing, but widespread progress remains slow.”
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Nursing homes get help with HIE

Nursing homes get help with HIE | Healthcare and Technology news | Scoop.it

While nursing homes have traditionally been one of the weakest links when it comes to health information exchange and care coordination, a new project aims to help improve those facilities' electronic communication with hospitals.


A recent study published in Applied Clinical Informatics, "Preparing Nursing Homes for the Future of Health Information Exchange," spotlights the efforts of University of Missouri researchers as they worked to get 16 nursing homes up and running with HIE capabilities.


The MU researchers took stock of these facilities' readiness for electronic data exchange – evaluating their Wi-Ficapabilities, for example, and assessing the state of their computer hardware. With help from Centers for Medicare &Medicaid Services money – a $14.8 million CMS grant aiming to reduce avoidable re-hospitalizations among nursing home residents – they then helped the nursing homes acquire the infrastructure they lacked.


Researchers then conducted 32 hours of clinical observation, 68 site visits and 230 interviews to study how staff integrated the technology and HIE processes into their workflow.


MU researchers also spotlighted the areas most integral to patient care, and explored how technology can facilitate those tasks. With diagrams, they developed visual representations of the communication flow and how technology could streamline and integrate existing processes.


"Our goal was to develop a more integrated system by providing an information exchange that could be used by all stakeholders involved in patient care," said Greg Alexander, associate professor in the MU Sinclair School of Nursing and lead researcher of this study, in a statement. "We want to build a network through identifying key players and their needs."


Researchers found that all the nursing homes used IT to support patient care, whether through tracking dietary needs and medications or to complete other administrative activities. Most of the technology was used to communicate patients' information within the nursing home rather than to communicate with external units, such as hospitals or off-site pharmacies.


Many nursing homes used technology to complete tasks, such as keeping track of patients' medications or scheduling appointments, but these systems often were separate. The researchers concluded that many nursing homes needed additional technological and human resources to build and implement an effective HIE network.


"The exchange of accurate, complete and timely information between hospitals and nursing homes can be complicated when older adults transfer from one place to another," said Alexander. "Ultimately, we want to facilitate a way for staff members to communicate safely and securely about patients' health. We want to prepare nursing homes to communicate externally as well as internally so that care transitions smoothly and patients have better health outcomes."


In the next phase of the project, researchers will evaluate whether HIE implementation improves communication about resident care, and will assess how clinicians and other staff feel about integrating the HIE into their workflow, according to MU. The goal, ultimately, is to provide a mechanism for nursing homes and hospitals to share patient information and medical documents securely through the health information exchange.

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Providers Looking for More out of HIEs

Providers Looking for More out of HIEs | Healthcare and Technology news | Scoop.it

Healthcare providers’ health information exchange (HIE) needs have moved beyond connecting disparate systems and meeting meaningful requirements. They are now looking for HIEs to ease access to “actionable” data, according to a report from NORC at the University of Chicago.


The researchers conducted an in-depth examination consisting of site visits and 37 semi-structured discussions in six states (Iowa, Mississippi, New Hampshire, Utah, Vermont, and Wyoming) in the early months of 2014 to understand provider perspectives on the state HIE program and their experiences with electronic exchange. The report was funded by the Office of the National Coordinator for Health Information Technology (ONC).


The report found that providers highlight the potential for HIE to ease access to actionable data that integrates data from across the care continuum and provides clinicians with information at the point of care to improve care delivery and care coordination. Providers highlighted several exchange priorities: admission, discharge, transfer (ADT) alerts, services that facilitate care coordination, and interstate exchange.


Additionally, meaningful use and payment reform are creating new requirements for health IT-enabled information sharing related to care coordination and management as well as new models for patient care. Providers anticipate a growing need for vendor provided HIE services and infrastructure as expectations for electronic exchange of health information increase under this shift, the report found.


Providers also encountered various challenges, specifically competing priorities, issues managing multiple funding streams, lack of qualified staff on the provider side, and difficulty obtaining adequate support from electronic health record (EHR) and HIE vendors. They also noted a need for interoperable systems to meet exchange and health system reform goals.


What’s more, providers in most states believed that the state HIE program contributed to building awareness around HIE and the benefits of exchanging information. Providers conveyed a general sentiment that a state-based HIE effort is important, due to their stature as neutral entity, capable of bringing stakeholders together. Even though the meaningful use program did not provide incentive payments to long-term care and behavioral health providers, the state HIE program was instrumental in engaging these providers, identifying their specific needs and the gaps that grantees needed to fill, particularly around care continuity, the report revealed.


The researchers concluded, “Throughout the life of the program, HIE has become more visible and better established, meaning that provider priorities and challenges have likewise evolved.” In addition to highlighting providers’ current needs and perspectives on HIE, findings from these conversations emphasize certain areas, the researchers said:

  • Providers have additional use cases beyond meaningful use and payment reform they are or would like to pursue to meet their specific exchange needs.
  • New healthcare system priorities, such as care coordination suggest expanding interoperable health IT systems and services to providers in eligible for meaningful use to ensure that the information needed to manage care is available electronically.
  • There is a need to push for interoperability at the vendor level.
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Reflecting on the Clash of Incentives Around “Information-Blocking” in the Push Towards the New Healthcare

Reflecting on the Clash of Incentives Around “Information-Blocking” in the Push Towards the New Healthcare | Healthcare and Technology news | Scoop.it

As Healthcare Informatics reported last month, the Office of the National Coordinator for Health Information Technology (ONC) released a report in early April that highlighted what the federal healthcare IT agency referred to as “information-blocking.” As Senior Editor Gabriel Perna noted in his April 10 report immediately following the release of the ONC document, “The report’s authors and researchers detailed several examples of electronic health record (EHR) developers and health systems blocking health information sharing between each other. The act of information blocking occurs when an entity or person knowingly and unreasonably interferes with the exchange of electronic health information. Examples of this,” he noted, “are charging prices and fees for data exchange; creating terms of a contract that restrict individuals access to their health information; developing health IT in a non-standard way that dissuades information sharing; and developing health IT in a way that locks in information.”


The ONC cited examples in its report of anecdotal evidence suggesting that “EHR application developers are breaking several of the rules in this regard,” Perna’s report noted. “Using interviews with people at regional extension centers (RECs), the authors detailed complaints from industry sources on how developers are charging fees that make it cost-prohibitive to send, receive, or export electronic health information stored in EHRs. Some EHR developers even charge a substantial transaction fee any time a user sends, receives, or queries a patient’s electronic health information, the report says. The variation in prices reported to ONC suggests that some are taking advantage of the situation.”


In announcing the availability of the report, National Coordinator for Health IT Karen DeSalvo, M.D. noted in a blog on the agency’s website that it is difficult to pinpoint concrete evidence of information-blocking. “The full extent of the information blocking problem is difficult to assess, primarily because health IT developers impose contractual restrictions that prohibit customers from reporting or even discussing costs, restrictions, and other relevant details,” she noted. “Still, from the evidence available, it is readily apparent that some providers and developers are engaging in information blocking,” she said.


Given all this, I read with interest a May 20 blog in Health Affairs online by Julia Adler-Milstein on this subject, because of the clear way in which she frames the dynamic tension taking place right now in the industry between the forces that would restrict information for profit or proprietary gain, and those that would advance it for the common good. AsAdler-Milstein, who is an assistant professor of information in the School of Information and an assistant professor of health management and policy at the School of Public Health at the University of Michigan, states very bluntly in her blog, “When it comes to sharing electronic patient health information, public good should trump private gain. While it may seem like an obvious statement, it represents a tectonic shift in the narrative surrounding health information exchange,” or HIE.


As Adler-Milstein notes, “For more than a decade, our federal strategy has largely left HIE to the market under the assumption that, if there is benefit to be created (and estimates suggest that there is), we should see the emergence of ways to capture that benefit. In practice, this means that HIE efforts have sprung up in various health care markets across the country, and where public money has been spent on HIE (largely at state and community levels), it has come in the form of one-time start-up funding, not a commitment of ongoing support or regulatory mandates for HIE participation.”


Here’s where Adler-Milstein really scores a home run on this, in my view: “What has been substantially underappreciated, however,” she writes, “is the fact that, for the key actors needed to enable HIE to occur—provider organizations and vendors—there might be more benefit, or at least more certain benefit, from not doing so. And as a result, these actors may behave in ways that interfere with the free-flow of patient information that is needed to improve health and health care.”


Instead, she says, “With the release of the information blocking report, which was produced in response to a 2015 Omnibus bill request that introduced the term ‘information blocking,’ ONC makes plain that this behavior will no longer be tolerated. This enormously exciting development means we might see real progress after decades of investment that has failed to convert into sustainable approaches to robust HIE. The key to such progress, however,” she warns, “lies in how well we can identify when information blocking is occurring. This will not be easy.”


And in those short paragraphs, we can see some of the core opportunities and challenges moving forward in this critical area. In this arena as in so many others in healthcare, we see a dynamic tension based on conflicting incentives within the U.S. healthcare system. On the one hand, there is broad consensus that data- and information-sharing will be essential to accountable care organization (ACO) development, population health management, bundled payment-facilitated care delivery, patient-centered medical home work, and indeed, every iteration of the new healthcare. Yet at the same time, there are many elements embedded even in those concepts that speak to at least short-term—and certainly arguably, medium-term as well—market advantages that can be gained through data- and information-hoarding.


It is this clash of incentives that we are collectively burdened with at this early stage of the trajectory towards the new healthcare. The rhetoric around healthcare policy right now is all about sharing for common gain, and yet the incentives in the moment are far from purely conducive to—well, purity.


That’s why it’s good to be reminded at times like this by elegantly concise writings like those of Julia Adler-Milstein. Adler-Milsteiin’s blog reminds us what the ultimate prize is, on which we should at least theoretically all be setting our eyes. This is not to engage in the laying of blame on those working for specific market advantage, but rather to affirm the need to continue to push forward collectively as an industry and indeed as a society, towards a more mature healthcare system—one in which all the incentives really all will be aligned. In other words, keep watching this space.

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Is This Population Health’s Moment? Time for Data and Analytics

Is This Population Health’s Moment? Time for Data and Analytics | Healthcare and Technology news | Scoop.it

Every year, the annual HIMSS Conference, sponsored by the Chicago-based Healthcare Information and Management Systems Society, offers its attendees a kind of conference-based snapshot of where the U.S. healthcare industry is with regard to the forward evolution of healthcare information technology adoption, as well as a sense of the overall policy and operational landscape of healthcare. Attendees can get a sense of the healthcare IT Zeitgeist through attending keynote addresses, educational sessions, association meetings, and networking-focused gatherings, as well as by wandering the exhibit hall and simply by having meaningful conversations with fellow attendees.


HIMSS15, held at the vast McCormick Place Convention Center in Chicago the week of April 12, offered perhaps the clearest portrait of the current moment that has yet been offered to date. Session after session focused on the shift beginning to take place from volume-based healthcare reimbursement to value-based payment, across a very wide range of mechanisms, between providers and both the public and private purchasers and payers of healthcare, and the implications of that shift for healthcare IT leaders.


Further, as part of the keynote session on Thursday, April 16 in the Skyline Ballroom at McCormick Place, Andy Slavitt, Acting Administrator of the Centers for Medicare and Medicaid Services (CMS), made the intentions of federal authorities crystal clear, when, referencing the statement of Health and Human Services Secretary Sylvia Mathews Burwell in January that she wanted the bulk of Medicare fee-for-service payments to providers to shift as quickly as possible over to quality- and value-based payment, Slavitt said, “Our priority is simple: to drive a delivery system that provides better care, smarter spending, and keeps people healthier. The success in the first five years since the Affordable Care Act has been very encouraging… Our agenda now,” he said, “is to get busy strengthening these gains. That will mean that more providers in more communities will need to be able to transform the care they provide so that they will benefit from value-based reimbursement. And they will need technology to help them get there.”


What’s more, in his keynote address two days earlier, Humana CEO Bruce Broussard had told HIMSS attendees, “We have to change the conversation on what we are doing in healthcare from a supply-based system to a system around demand, a system where we put the customer first as opposed to the system. Over the years,” he added, “healthcare has been built by creating more and more supply. I hope I leave today by convincing you that we have to change the focus towards how we improve health for our customers, members, and patients.”


The good news on the solutions side of this landscape is that vendors are rushing forward to provide population health- and accountable care-driven analytics solutions, at a time when such solutions are most desperately needed. Certainly, the hype at HIMSS15 was all around population health, care management, and accountable care solutions. The only question now, as the U.S. healthcare industry hurtles forward into the near future, is, is this a breakthrough moment for population health efforts? And if so, are provider and health plan leaders ready to effectively leverage the tools to make pop health really happen?

The long journey ahead


Leaders from all sectors of healthcare understand that the journey to population health and value-driven care delivery and payment success is going to continue to be a long, challenging one. Donald W. Fisher, Ph.D., president and CEO of the Alexandria, Va.-based American Medical Group Association (AMGA), says he and his colleagues are putting the vast bulk of their efforts into helping prepare physician group leaders for the transition. “We’re not quite there yet, and as we change to a new reimbursement system, even the large, sophisticated medical groups are going to need a few years to make the transition,” Fisher says.  “You’ve got to put the infrastructure in place, and the large integrated health systems have been putting those elements in place—EHRs [electronic health records], alert systems, analytics systems, data warehouses—and some have teams of people mining the data to assess patient status.”

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Connecticut Legislature Considers Giving Statewide HIE Another Try

Connecticut Legislature Considers Giving Statewide HIE Another Try | Healthcare and Technology news | Scoop.it

Although it is surrounded by states that have had relative success with statewide health information exchange efforts, Connecticut has struggled to develop an HIE. Last year it pulled the plug on its earlier efforts after spending $4.3 million in federal grant money. But legislators are taking another stab at it. Last week the state Senate passed a comprehensive healthcare bill that would establish a statewide HIE, according to the Connecticut Mirror, an online publication. 


The Mirror story quotes Senate Minority Leader Len Fasano, R-North Haven, as warning that the lack of a neutral, statewide system can give large health systems a business advantage, steering patients to other providers within the same system.


In written testimony earlier this year, Yale New Haven Health System noted that an earlier form of the bill did not take into account what many hospitals are already doing to share data and provide access to healthcare agencies and community physicians.


Between 2010 and 2014, the Health Information Technology Exchange of CT, or HITE-CT, spent $4.3 million unsuccessfully trying to create an exchange before being shut down by the state.


A state auditor’s report noted that the exchange was never able to provide services to stakeholders and thus, never developed a self-sustaining revenue stream.


“HITE-CT was unable to meet its strategic and operational schedule primarily due to its inability to adapt quickly to changing market conditions. The exchange’s board of directors recognized that the terms in the original contract with its vendor required significant modification to reflect the evolving market place for an integrated statewide electronic health information infrastructure,” the audit said. “A lengthy renegotiation period with its primary vendor reduced the exchange’s options for achieving sustainability. The resulting amended contract with the vendor had a reduced scope for deliverables. It no longer included the establishment of an operational statewide health information exchange that could provide desired revenue producing services to stakeholders through fees and other assessments.”


The responsibility for health information exchange efforts rests with the state Department of Social Services, and the bill allows DSS to propose an alternative solution to a centralized statewide HIE, the Mirror article said. The bill now goes to the Connecticut House for consideration.

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Health Information Exchange Thrives and Flounders across USA

Health Information Exchange Thrives and Flounders across USA | Healthcare and Technology news | Scoop.it

Health information exchange is becoming more important than ever before in the attempts to avert medical errors and provide physicians with key data needed to make informed clinical decisions. As such, the healthcare systems Scripps Health and Sharp Healthcare announced on May 12 that they will be participating in the San Diego Health Connect (SDHC), the region’s health information exchange (HIE).

This move will allow physicians and other healthcare professionals to quickly access the information of more than 2.7 million patients who reside in the County of San Diego. At this point in time, patients have been notified of this development through the mail. It is expected that quick access to data through the health information exchange system will lead to better coordinated care among physicians.


Additionally, the HIE includes strong security measures and will allow doctors to view laboratory results and test imaging, hospital discharge summaries, medical history, and information on drug reactions or allergies.


“The real-time exchange of medical information between San Diego providers will ensure patients receive timely and cost-efficient care,” Mike Murphy, Sharp HealthCare CEO, stated in the press release. “Lives will undoubtedly be saved as result of sharing critical patient care information in a secure and confidential manner.”

Scripps Health President and CEO Chris Van Gorder also mentioned in a public statement that participating in a health information exchange eliminates test redundancy and any procedures from “being repeated unnecessarily.” Patients will need to provide permission and authorization for clinicians to access their information at the point of care.


Currently, the San Diego Health Connect exchanges more than 200,000 secure messages across local hospitals and clinics every day. While San Diego seems to have an effective health information exchange system, the state of Connecticut may be struggling with EHR interoperability and efficient health data sharing.


The Connecticut Mirror reports that patients throughout the state who end up in an emergency room may not have their records and drug prescriptions sent to a pharmacy electronically but by fax.

Connecticut has attempted to develop a health information exchange network before but it failed. The Health Information Technology Exchange of CT was first established in 2010 with the help of $4.3 million in federal grants, but had severe difficulties with its vendor and never developed the network it intended to create. In 2014, the organization was dismantled and the Department of Social Services took over its functions.


In order to improve the quality of patient care, some state legislators have begun discussing the need for a health information exchange system in Connecticut. One bill proposed by the Senate instructs officials to use $50 million in bonding funds to develop a health information exchange network throughout the state.


Many within the Department of Social Services, however, reject the bill, explaining that the department is attempting to improve information sharing and close any gaps regarding the exchange of medical records instead of creating a whole new network.


Whatever the state of Connecticut decides to do, it is clear that effective and efficient medical data exchange across the nation will bring about a stronger healthcare industry and better patient care.


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A Strive Towards “Meaningful” Data Exchange in the Midwest

A Strive Towards “Meaningful” Data Exchange in the Midwest | Healthcare and Technology news | Scoop.it

Although the successful exchange of health data has been a struggle in most U.S. regions, a commitment to the free flowing of information on a patient’s history—regardless of what local healthcare facility they have been at—has helped spur health information exchange (HIE) in the Midwest.

Indeed, the Lewis and Clark Information Exchange (LACIE) is one of the first fully operational, multiple-state HIEs in the country, providing patient information to healthcare systems and providers in Kansas and Missouri. Getting the HIE up and running to a point where it could successfully exchange data required a few key elements, starting with getting hospitals on board that were willing to share data. To this end, in the last 18 months, LACIE announced two major connections: first with the Kansas Health Information Network (KHIN), another major HIE in Kansas. This was a significant moment for data exchange in the Midwest, as in the past, the two organizations had failed to reach an agreement on sharing data.

A few months after that, LACIE announced that patients' electronic medical records (EMRs) were being securely shared with Tiger Institute Health Alliance (TIHA) in Columbia, Mo. In total, LACIE is now connected to 17 hospitals in two states in addition to three accountable care organizations (ACOs), the two aforementioned regional HIEs, multiple private HIEs, and the Kansas City Metropolitan Physician Association (KCMPA), a large independent physician group with 80 clinics and 350 providers. The 24 different EMRs those organizations use have been connected via a hub that has been put in place from Cerner, says Mike Dittemore, the executive director for LACIE. Dittemore says that LACIE connects to that hub so it doesn’t have to do all of the independent connections, leading to greater efficiencies and cost savings.

However, getting different provider organizations on board has not been easy, Dittemore admits. “There are always challenges with provider participation, and one of reasons we had the strategy to work with hospitals and get them on first is that we felt if we did a good job with them, that would spur participation from others. The best marketing out there as far as HIEs go is word of mouth by providers who actually use it,” he says. What’s more, LACIE’s board of directors consists of several physicians, including multiple CMIOs of organizations in the Kansas City area. “That’s really helped us, having these physicians have conversations with other providers or their clinics and talk to them about why it’s important to share this information and participate,” says Dittemore. “They can show other [providers] the value by being able to not tie up so much staff in administrative time in tracking information down that already exists in the HIE.”

Still, there are additional challenges for independent providers who have all kinds of mandates and rules they are struggling with, in addition to low reimbursement rates, Dittemore notes. “So we try to have a price point that works for them, and we also have found some grant funds through the Office of the National Coordinator for Health Information Technology (ONC). In Kansas, we used some of those funds to help folks to connect, but it’s always an uphill climb to get individual providers on board. We do think that if we can get in and meet with clinic managers, maybe not the providers themselves, but a trusted person they go to, and show them the value, getting these smaller providers on board might not be as hard,” he says.

One of these physicians on LACIE’s board is board chair, Gregory Ator, M.D. CMIO and practicing physician at the University of Kansas Hospital. Ator says that as of late, LACIE has become much more focused in getting smaller practices on board. “It’s been a great experience, it’s very refreshing to see all of these large organizations that are not competing around the ‘this is my data and you can’t have it’ concept, but rather the ‘let’s compete around quality of care and let information freely flow’ concept. That’s been quite refreshing, and moving forward we’re looking at the next tier of smaller physician practices,” Ator says.

LACIE further attempts to make the exchange process more doable by not charging organizations a fee to connect. “We have always believed in connecting to other HIEs, be it community, regional, or state. But we don’t pay other organizations to connect nor do we charge others to connect to us,” Dittemore says. “LACIE is a public type of entity. We think that’s why it’s here, for the spirit of moving information regardless of where they reside. We have been adamant about that, but not all facilities feel the same way. So that’s been a barrier,” Dittemore notes.

Making HIE Valuable

Currently, LACIE is consistently seeing 100,000 queries per month going through the HIE, and according to Dittemore, one of the things that really helps provide value to its providers is getting robust information trading rather than just checking a box. “If checking a box is what you want, our HIE won’t be for you. We’re about the meaningful trading of information,” he says.

To this end, all of LACIE’s connected providers are encouraged to share radiology reports, discharge reports, clinic visits, and any summaries, Dittemore adds. “What we have found is that when you have that type of information above and beyond the continuity of care document (CCD) or consolidated-clinical document architecture (C-CDA), it really provides a great platform for providers to go in and look at the information and find out what is really going on with patients in those last visits,” he says. “We want to try to get rid of the fax machine, or reduce its use by as much as possible. Having this robust information available does help providers to move onto other duties like taking care of patients. They become valuators rather than investigators,” says Dittemore.”

Expanding on the notion of meaningful data exchange, Ator notes that fax machines are how providers are doing HIE right now, and what’s more is that Direct also has issues with people’s addresses as well as its own technological problems. “I am an Epic customer at KU, so we have a number of Cerner operations in town as well as Epic operations, and when you log into Epic for instance, we can go out to the HIE and search for a patient, at which point a very robust matching algorithm kicks in and we get textual documents presented in reverse chronological order. Operative notes, progress notes and discharge summaries are all within Epic without a separate log-in,” Ator explains. “Our providers don’t have to dig through exchange formats such as CCDs and CCDAs to see it in a meaningful manner. And that’s Cerner shop looking at Epic and vice versa,” he says.

Value to providers is further seen in the form of impacting patient outcomes. According to Ator, the strongest use case now is in the ER. “The patients here in a big city circulate around the EDs, and it’s fabulous to have the notes as it was was signed from an organization right down the street that a person might have checked into,” he says. “So we have seen improved outcomes around the ED, and the literature backs that up. I think that it is clear there is benefit in ED world, but rest is bit too soon to call,” Ator says.

Dittemore also says that value has been seen on the care management side. Kansas City has multiple medical facilities and acute care facilities, but even more non-acute facilities, he says. Just because a patient happens to go to a provider or an urgent care clinic that they have affiliation with, they might not go there for all care, and that’s something that needs to be seen in the HIE, he says. Also with specialists, making sure to ensure patients have done the appropriate follow up and have been to specialists allows care managers to see if that has happened and if not, find out why, Dittemore says. “Was it a transportation problem, an illness or what? It gives them something to go off of when they reach back out to the patient. Care managers have seen great value in this to manage that care between multiple facilities that might not be financially related to one other. That’s been rewarding,” he says.


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What’s the Best Foundation for a Health Information Exchange? How About a Practical One?

What’s the Best Foundation for a Health Information Exchange? How About a Practical One? | Healthcare and Technology news | Scoop.it

It was both informative and enlightening to speak with David Watson on March 23 in Washington, D.C., just after he had participated in a panel on interoperability at the World Health Care Congress (held March 22-25 at the Marriott Wardman Park. As the CEO of the California Integrated Data Exchange, or Cal INDEX, Dave Watson has a very strong sense of both vision and mission, as he leads his health information exchange (HIE) forward.


As I wrote in my interview-report on March 27, “The development of statewide health information exchange (HIE) has proven to be a very long, twisty journey in California. The nation’s most populous state has seen both HIE expansion and HIE collapse, including not only a very early HIE in Santa Barbara, but also the first two statewide HIEs in the Golden State—CalRHIO and Cal eConnect (which merged and later collapsed)—even as a dozen and a half regional HIEs have been created and survived so far.”


I further wrote, “But perhaps the third time really will be the charm, when it comes to statewide HIE efforts in California: the Walnut Creek-based California Integrated Data Exchange, or Cal INDEX, was formally incorporated on July 31, 2014, and was publicly announced several days later on August 5. Initially created by the two biggest Blues plans operating in the state—Blue Shield of California and Anthem Blue Cross (formerly Blue Cross of California), which pledged $80 million in funding for the next five years.”


Importantly, as Watson noted in my interview with him, Blue Shield of California and Anthem Blue Cross (formerly Blue Cross of California) had already each been “building their own private exchanges to share clinical data with their ACO providers. So they agreed not to compete on a utility function,” he noted. And right now, he said, “We’re doing outreach to the providers, and are in negotiations with 10 providers in both Northern and Southern California.”


Meanwhile, Watson told me, “The biggest challenge is getting to critical mass. So having two payers contribute roughly 10 million records is a start; but we need to sign up the other big payers in the state, as well as providers.”


Here’s what was particularly heartening to me in all this, with regard to the winding journey that health information exchange has taken so far in California: Watson understands where things need to go, and is helping to lead the movement in the right direction. As he told me, “The challenge is not only getting to critical mass, but also making sure we have very high accuracy of patient matching. And then the quality of the data that comes in requires a lot of scrubbing, so you have to scrub the data, and do semantic mapping. And so whether the data came from a health system, primary care doctor, or payer, it’s mapped to a payer model so that when you consume it, you always see it the same way in the longitudinal patient record.” And so, he said, “Our value is that we acquire, curate and manage the data. And our goal is not just to create interoperable points; the question is, how do you join systems of care to appropriately share information? So our goal is to complete the system of care; and we’ll get at that in stages, and it will define itself as we do the work.”


And so what is great here is how practical the vision is that Watson and his colleagues at Cal INDEX have. After two failed experiments with statewide health information exchange in California, a third statewide HIE has been created, one that has been founded with strong seed funding from two of the state’s biggest health insurers; and the Cal INDEX folks are focusing on building practical HIE bridges, not trying to build castles in the sky or boil the ocean.


That strategic vision jibes very well with the strategies of several major statewide HIEs—in Maine, Michigan, Ohio, and Colorado—that have achieved sustainability in the past few years. As I noted in one of our Top Ten Tech Trends in the January/February issue of the magazine, the statewide HIEs that are surviving, and even thriving, long-term, have senior leaders who recognize that sustainability will require the ability to meet some kind of set of market needs, whether it be providing ED visit or hospitalization alerts, enable the participation in outcomes measurement, help support clinician-to-clinician messaging, facilitate the sharing of continuity of care documents (CCDs), or provide some other type of service that individuals or organizations are willing to pay for.


Of course, there are terrific justifications in principle for establishing statewide HIEs. But the reality of the history of health information exchange in California, a huge, complex state, is that abstract principles and broad ideals around data exchange have in the past not been able to sustain actual HIEs.


So the fact is, the reality of health information exchange at this point in the history of HIE, is that statewide HIEs will be sustained based on their practical usefulness to actual people and organizations, not on their fulfilling abstract ideals.


So when it comes to achieving true statewide health information exchange, it appears that Dave Watson and his colleagues at Cal INDEX have a very good chance of making things work out this time around. Only time will tell, of course. But they understand something their predecessors in that state, in this space, found too difficult to solve—how to make the economics and ideals of health information exchange align and work together. Godspeed to all HIE leaders, as they endeavor to make a concept critical to the future of U.S. healthcare, really work. Meanwhile, stay tuned, because the forward march of Cal INDEX is a phenomenon we should all keep our eyes on in the next few years. It certainly will say a great deal about the broader advance of healthcare nationwide.


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Maine’s HealthInfoNet: Secrets of Sustainability

Maine’s HealthInfoNet: Secrets of Sustainability | Healthcare and Technology news | Scoop.it

At a time when the broad survival of health information exchanges (HIEs) is in question nationwide, and a number of statewide HIEs are shutting down or in danger of doing so, a small number of such organizations are actually flourishing, among them HealthInfoNet, Maine’s statewide HIE.

The Portland, Me.-based HealthInfoNet has long been known to the readers of Healthcare Informatics; indeed, the magazine named the organization one of its Innovator Awards winning organizations in February 2011, and described its successes up to that date, in this profile.

But much has happened in the past four years, under the leadership of HealthInfoNet’s executive director, Devore (Dev) Culver. Culver and has colleagues have figured out how to keep their organization relevant, even as many other statewide HIEs struggle or even fold. In that context, HCI Editor-in-Chief Mark Hagland interviewed Culver in November for his perspectives, as Hagland prepared one of the Top Ten Tech Trends for the January/February issue of HCI, on HIE sustainability.  Below are excerpts from Hagland’s extended interview with Culver.

Would you agree that there is a core sustainability problem for many HIEs nationwide right now, particularly for statewide HIEs?

Yes, I would agree. My best guess, reinforced by some discussions, is that fewer than 10 HIEs will remain within about two years. What I’m talking about are the so-called statewide HIEs. Officially, there were 50, one for each state, based on the HITECH [Health Information Technology for Economic and Clinical Health] Act. And that’s part of the problem; in fact, it’s a major part of the problem. The core issue there is that they never developed a reason to exist. You can do all the nice convening you want, but if you don’t create value, you won’t last.


Was some of what was created not truly needed?

I think part of what leads to success starts with the building out of consensus among diverse stakeholders, so that there is at least the potential for value. And so you know, when I think about our history, the work started in 2004, and we didn’t have an operational health information exchange until late 2008, early 2009. A lot of that time was spent raising seed money, which took a lot more time than I’d expected; and the other part was spent building a consensus on our purpose, including developing a fairly robust economic impact study. We started with some models developed in Oregon and used those models, using Maine data running through them. Maine has had an all-payer claims database since the late 1990s. They had started managing a discharge data set as early as the mid-1990s.

So we asked questions like, what is the potential for reducing redundant testing in the state of Maine? Long story short, in 2008, the analysis coming out of that indicated a $50 million opportunity. So if you’re going to run an exchange costing $6 million, then that potential savings alone would be a huge return on investment. And you know you’re not going to get it all; but you start to build a value proposition, and you go out and get commitment from some of your larger, more data-rich organizations. And we started with a demonstration phase, one that included data from 50 percent of the providers in the state. There’s the core question of critical mass—if you don’t get to critical mass fairly quickly within two or three years, so that you have 70 to 80 percent of provider or healthcare activity in the exchange, it will be very difficult. If I as a provider go to the exchange and don’t find something the first time—maybe I’ll go back a second or third time, but that would be it. So you need critical mass that’s sufficient that people will actually use it. And right now, as of November, 96 percent of the residents of the state of Maine are in the exchange. That’s pretty damned powerful.

And then other things have to start to happen; you have to get experience and demonstrate practical value. Last month, in October, in terms of people actively clicking into the portal from within their EMR, last month was our all-time high for the number of patients whose records were accessed—23,000. That’s almost a 70-percent increase over last year. We went live in February 2009. At the beginning, a good month was a couple of hundred clicks.

And this is another problem with health exchanges. For those that are portal-based and cause you to have to go out to them, as ours is, that feature automatically creates some hesitation, when I have to take extra steps in my workflow to use them. So you’d better be pretty sure that will work. An initial assumption of ours was wrong, BTW, when we thought it would be doctors querying, but it’s actually mid-level practitioners, physician assistants and nurses.

So that is one of the big mistakes that statewide HIEs are making?

They’re making a couple of mistakes. One, because the federal government said it was a good idea, it was assumed to be a good idea. If you haven’t done the work on the ground to build a constituency for this before creating it, you’re probably in trouble. And the other thing is that even ONC [Office of the National Coordinator for Health IT] estimated just how hard it is to put one of these creatures up. It’s hard—it’s hard work, starting from the challenge of becoming a trusted entity, to actually trying to build a business case. It’s hard work.

And a lot of it was under-funded, right? About $640 million was bestowed through grants. And then they further complicated things—they pivoted and decided that the DIRECT solution was going to be a requirement of every HIE was funded. You can’t make a living through DIRECT, I’m sorry; it’s secure e-mail. We were lucky because we got our application into ONC very early and were already a live exchange. DIRECT hadn’t even been thought of yet when we were set up. We were the fifth or sixth operating plan approved by ONC, and DIRECT hadn’t even been thought of yet as a concept. When that happened, that put most of the state exchanges into a difficult place; it forced them into an operating model that couldn’t be financially sustained. And the value of being a post office? Meh. And frankly, the value is not about me delivering you a lab result, it’s about the data, about making that lab result truly interoperable so you can do something with that result; and that lab result in conjunction with other data around the patient, that is important. So simply moving data points from point A to point B, is just a necessity. But not sufficient. And from the get-go, your value proposition was endangered.

And the handful of exchanges that are truly succeeding now, they figured that out early. You can count on one and a half hands the number that truly are doing well and will survive. And if you look at the so-called private exchanges—and I take exception to that term, because we are a privately run organization—but those created by providers—they have a different starting point from the concepts of value, they become an expense line. They’re not trying to create operating margin by themselves.

And everyone says, “Oh, that’s the better model.” Well, no, because inherent in both  of those, both the  payer-driven and provider-driven models—if the provider controls it, it automatically makes other providers uncomfortable. And the same thing is true of the payer-driven model—it makes providers uncomfortable. And that’s why you set up a neutral-convener structure as we have, a neutral convener that has no stake in the use of the data. And frankly, it took us a few years to get there. But the epiphany came when we realized that the statewide exchange was a business line and BTW, a loss leader, and that HealthInfoNet was a business organization operating multiple business lines, and that was very liberating.

So the exchanges that are succeeding are either heavily funded by state money, as in Vermont, or have figured out the business value. Indiana is a great example of the latter. They started where the genesis was of delivering value by reducing costs. A group of hospitals that were competitors joined together to save money. And they were part of Regenstrief, which was a research group; you had multiple dimensions at play. But that’s a successful exchange. For us, realizing we weren’t the exchange; the exchange was a business line—and that opened up multiple thought lines. And also the concept of lazy assets—something you have to do in order to do your business, but that others will pay for—and one of the things we do is manage patient identity. And lo and behold, there’s a marketplace out there for provider organizations with multiple record numbers looking to get to a single record number. So, hello! That’s what I do. And people pay us, sending us multiple record numbers, and we send them back a master number per patient.

So the key is that we’re doing some really amazing stuff around analytics. We have a set of tools in the field that is dynamic—the data being used is a day old, driven by clinical and event data, and is predicting things like who will show up in the emergency department. Who’s going to get readmitted in the next 30 days? That runs while the patient is in the bed.

 And we’re starting to see impact. One of our clients has been using this to manage their discharge functions, particularly around self-pay and around Medicaid patients—it’s economically more advantageous to keep those patients out of the ED or a hospital bed, because they lose money on them anyway. And any patient running more than 30 percent likelihood of being readmitted, they’re put into primary care coordination right away.

What will happen in the next two years in terms of the evolution of HIEs overall?

I think a couple of things are going to happen. I think the marketplace for exchange will become driven by things like analytics, sort of turning things on their head. Everybody thought exchange was the answer—and it is the answer—but in a different sense. We’re taking data from disparate sources and standardizing it through LOINC, SNOMED, RxNorm, NDC (those two are medication standards), ICD-9, ICD-10—all of those are standards. You map as much clinical data as you can to those standards. I call it a CPC and you call it a CPC with differential.

Here’s a classic example: there are two private reference labs in Maine, one in Bangor, one in Portland. Each has an order catalog of tests built locally, so the same test will have different names. They also have local numbers, with no standardization. So when you’re mapping in the catalog for purposes of taking data into the exchange, LOINC allows you to equalize what is the same test, regardless of what it’s called locally—same body part, same type of test (fluid, etc.), and that allows you to equalize. And whether wisdom, genius, or stupid luck, but the people creating the first exchange in Maine deemed it necessary to standardize language. Most exchanges around the country haven’t yet been standardizing data, well, hello? That’s the whole point.

So what is market-driven will lead to survival, right?

Yes, exactly. Ask simple questions around complicated issues. What are your pinpoints, and what is critical now, and how can you help? If an organization is managing a patient’s life under an ACO structure and is responsible for that, there is a pain point that needs to be addressed, and that an HIE can address. The other thing that makes the exchange valuable is the data. Most claims data is 60, 90, 120 days old. So you’re predicting events based on old data. My predictors are based on new clinical data coming in every night and recalculated every night. And we’ve got a very complex, sophisticated engine, with the ED analyzer looking at 40,000 variables. And you can predict core activity based on one-day-old data. And that’s incredibly valuable.


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FTC Settles Deceptive Patient Portal Case

FTC Settles Deceptive Patient Portal Case | Healthcare and Technology news | Scoop.it

A recent Federal Trade Commission settlement with a medical billing company shines a spotlight on deceptive practices related to the collection and disclosure of patient's personal health information.


The case illustrates why healthcare providers must assess authorizations carefully before releasing patient health data to third parties, especially as the exchange of electronic health information between disparate organizations becomes more widespread. And it spotlights the need for Web portal providers and others to explain clearly to consumers what data they collect and what they will do with that information.


The FTC disclosed earlier this month that it had settled a case with PaymentsMD, an Atlanta medical billing company, and its former CEO, Michael Hughes. As part of the settlement, the company agreed to destroy the consumer data it inappropriately collected.

The FTC earlier this year filed complaints against PaymentsMD and Hughes, alleging they misled thousands of consumers who signed up for an online medical billing portal by failing to adequately inform them that the company would also seek detailed medical information from third parties, including pharmacies, medical labs and insurance companies.

According to the FTC complaint, PaymentsMD since 2008 operated a website on which consumers could pay their medical bills online. However, in 2012, PaymentsMD and a third-party vendor, Metis Health LLC, began developing a separate service, Patient Health Report, designed to provide consumers with online access to their comprehensive medical records.

The FTC alleges that to collect the patients' medical records to populate the Patient Health Record portal, PaymentsMD "altered" the registration process for its billing portal to include permission for the company and its partners to contact consumers' healthcare providers to obtain their medical information.

Consumers consented to the collection of their health information by signing off on four authorizations that were presented in small windows on the billing portal, displaying only six lines of the extensive text at a time, the FTC says. The four authorizations also could be accepted by clicking one box to agree to all at once. "Consumers registering for the Patient Portal billing service would have reasonably believed that the authorizations were to be used for just that - billing," the FTC says in the complaint.

The FTC alleges that PaymentsMD used the consumers' registrations to gather sensitive health information from pharmacies, medical testing labs and insurance companies to create a patient health report. The information requested included prescriptions, procedures, medical diagnoses, lab tests performed and the results of the tests. The complaint alleges that Metis Health, for the PaymentsMD health record effort, contacted pharmacies and other medical providers located near the consumers, without knowing whether the consumers were actually customers of the particular pharmacy or healthcare provider.

PaymentsMD made 5,500 requests for consumers' health information to 31 companies, according to the FTC. Fortunately, in all but one case, the healthcare companies contacted for data refused to comply with the information requests because the individuals in question were not patients of those companies. Also, many of the requests sent by PaymentsMD sought health information about minors, the FTC alleges.
Lessons Learned

David Holtzman, vice president of compliance at security consulting firm CynergisTek, says the PaymentsMD case sends an important message to healthcare providers, Web portal companies and patients about practices involving the collection, use and disclosure of individuals' sensitive health information.

"The biggest lesson for healthcare providers is they need to be observant of the authorizations that they receive that appear to be signed by an individual for disclosure of sensitive and protected health information," he says. Inappropriately disclosing a patients' health information with invalid or fake authorizations can not only result in possible privacy breaches, but could also potentially result in personal information landing into the hands of cybercriminals for medical ID theft and other fraudulent purposes.

For consumers, the case offers a reminder about carefully reading and evaluating terms and conditions before agreeing to use a healthcare website portal or authorizing release of personal health information, Holtzman says. And Web portal developers and other companies that collect patient information need to be clear about their privacy practices, as well as obtain consumers' express consent before collecting health information about the patient from a third-party, he adds.

The FTC says that, initially, PaymentsMD did not inform consumers that the company was attempting to collect their sensitive health information. "When PaymentsMD began informing consumers, via an e-mail sent a day after users registered for Patient Portal, numerous consumers filed complaints with PaymentsMD regarding the collection of their sensitive health information," says the FTC complaint. "The common themes of the complaints were that consumers did not want their information collected, and that they had only registered for the Patient Portal to track their bills."



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