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How Payer-Provider Collaboration Has Fueled Data Exchange in Pennsylvania

How Payer-Provider Collaboration Has Fueled Data Exchange in Pennsylvania | Healthcare and Technology news |

Philadelphia, not unlike many other major cities, is a metropolis with several overlapping health systems. Richard Snyder, M.D., senior vice president and chief medical officer at Independence Blue Cross (IBC), refers to it as a “virtual Venn diagram of health systems on top of each other.”

What’s more, unlike some cities where there is a predominant health system that encompasses a big portion of the population and can build its own health information exchange (HIE), Philadelphia does not resemble that, Snyder says. “It has a lot of health systems, so you have that issue which makes it complicated since they all compete for doctors. They are working on an electronic medical record (EMR) that the hospital uses and in some cases acts like a little like an HIE, but only for that system—not for others in the region,” he says.

Additionally, as physicians continue to take on more and more risk in the new healthcare, they are starting to now realize that half of all admissions occur in a different hospital than the original incident’s hospital, Snyder says. “So if I drive to Penn Medicine for surgery, then late at night I am 20 miles from home but still in Philadelphia, they will take me to the nearest hospital, rather than to Penn,” he says. “Also, if you have a couple of chronic conditions, chances are you’re getting care in more than one system. The systems don’t talk to each other so the records don’t get transported back and forth routinely. There is a recognition that we have to work together, but there is no way for each of us to build a robust HIE that fit sour needs and our patients’ needs since they’re going to different systems.”

As such, several years ago, Snyder’s peers at IBC, along with other payers in the area, knew something needed to be done. “We’re not cutting down on readmissions or complications, and we need to share information with each other. We knew we had to build an HIE. All of a sudden, it’s very important for us to have real information available at the point of care. There is no way to get that in the EMR unless you have an HIE,” he says.

As a payer, of course, IBC has exact information on which physicians patients are seeing, as they get a claim for every occurrence. “We know where patients are getting care,” says Snyder. “What are the chances that when a patient walks into the ER, that he or she will tell the person helping them at registration all of the physicians and all of the facilities he or she has been to? They will say one name; it’s all you have time for. Now when it’s time for a discharge summary to those doctors who will care for that patient, they have no idea where to send it to or where to get the records from. We as a payer know that information,” he says.

All of this was the impetus behind the creation of HealthShare Exchange (HSX) of Southeastern Pennsylvania, incorporated in May 2012, with its board and bylaws put into place in January 2013. Snyder, who is also chair of the HSX board, says that it’s the nation’s only exchange in a major metro area built on collaboration between insurers and hospitals.

State and federal grants were instrumental in the launch of HSX, which is now primarily funded by participation dues from hospitals representing more than 90 percent of admissions in the Philadelphia region and several major insurers. Currently, 15 hospitals are signed on, though Snyder says that 37 health systems in southeast Pennsylvania have signed a letter of commitment documenting their desire to participate in HSX. Further, he notes, two mental health facilities are signed on as well as a few federally-qualified health centers (FQHCs).

A Unique Business Model

Snyder says HSX is providing a master patient index that links patients to all their physicians and places they get services, so that whenever a patient leaves the ER or a specialist, at the press of a button, a discharge summary comes to HealthShare. “We will look it up and attach copies to all the doctors so everyone is in the know and has all the information. That just doesn’t happen in most places,” he says.

The idea was to get the knowledge of where to ask for records and send records to, Snyder continues. “We also collect lab results, we know claims history, so we know what physicians they see, what diagnoses there are, and what procedures have been done. We summarize that into a clinical care report, which is all we know about you, and can include up to four years of history on a patient. We make them into individual PDFs that are readily available,” he says. What’s more, if a patient goes to the hospital or ER, the registration person will put the patient’s information into a form, and an admission, discharge, or transfer (ADT) message is sent to HSX, which looks it up, and then sends a report back to the ER or the hospital’s admitting doctor. “It’s a powerful tool for the physician to take care of the patient,” Snyder says.

In April, the first month in which ADT messages were live, Snyder notes, some 480,000 such messages were passed through the system. However, he adds, not all physicians are pleased with the influx of information. “The early adopters, those who have been using it the longest, are very much interested in the value of the exchange,” Snyder says. But there is another generation of physicians that say, ‘Wait a minute, you’re telling me that when I turn on the phone in the morning, there could be 50 messages for me? Who will be responsible for them?’ But this means there is more information flowing through the system, and it’s our job to turn the data into actionable information for doctors. We will continue to do that,” he says.

Snyder says that while sustainability is the biggest barrier to health information exchange, HSX has a model that is indeed sustainable. Although most HIEs start out with query-based exchange, where there is a database full of data and you can look into it or ask for information from it when you need it, Snyder says that was not preferable in the case of HSX as it would be hard to build and maintain an accurate database in a big metro area—as well as very expensive. “We also didn’t think it would grow as quickly. If I am feeling nervous about treating a patient I know nothing about who’s in the ER unconscious, and I can receive clinical information about that patient to help me help inform me about how to care for [him or her], that would be just awesome. Physicians value that,” Snyder says.

Currently, HSX serves the five counties of Southeastern Pennsylvania, and that’s the primary goal, says Snyder. But 25 percent of admissions to the city’s academic centers are coming from South Jersey or Delaware, outside the region, he says. As such, HSX has been getting inquiries from providers in those areas to be connected, as they want access to that information that’s generated in the Philadelphia market and could go back to them, Snyder notes. “We have discussions going on and I think you will see that we’ll connect to other HIEs so information can flow better to and from,” he says.

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Vermont Gets More Robust With Data Exchange

Vermont Gets More Robust With Data Exchange | Healthcare and Technology news |

Southwestern Vermont Medical Center (SVMC) and Vermont Information Technology Leaders (VITL) have just completed a project that developed five connections to transmit health data from the hospital to the Vermont Health Information Exchange (VHIE).

According to officials of the organizations, the five interfaces were built to:

  • Send immunization data from SVMC to the VHIE. The immunization data is then forwarded on to the Vermont Department of Health Immunization Registry.
  • Modernize the existing laboratory results interface from SVMC to the VHIE.
  • Send patient demographics, radiology reports, expanded laboratory results (pathology, microbiology and blood bank), and transcribed reports (information about procedures, admissions, discharges and consults) from SVMC to the VHIE.

The SVMC interfaces complete VITL's goal of connecting all 14 Vermont hospitals to the VHIE, the statewide health data network operated by VITL. Although SVMC has been contributing laboratory results to the VHIE for over eight years, the four new connections will increase the amount of clinical and demographic data available to providers involved in a patient’s care, better informing health care decisions, its officials say.

The final phases of the SVMC interface project included the addition of a move-in process, where engineers, analysts and project managers met face-to-face at the VITL office in Burlington. The interface teams met for two in-person sessions that lasted two weeks at a time, and allowed them to completely focus on integration and quality assurance testing of health data flowing from SVMC into the health information exchange, according to officials.

The new clinical interfaces allow SVMC data to be shared with any provider in Vermont. “Southwestern Vermont Medical Center has been a part of the VHIE for over eight years, and we have actively used the data network to distribute electronic lab results to primary care practices in the southwestern Vermont health care service area,” Rich Ogilvie, chief information officer at SVMC, said in a statement. “The additional connections deliver data and reporting abilities that will enhance the provider-patient care relationship in the Bennington service area and across the state.”

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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 |

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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