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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 |

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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Connecticut Legislature Considers Giving Statewide HIE Another Try

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

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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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 |

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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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 |

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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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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Has Health Information Exchange Improved Healthcare Reform?

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

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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