As they move from their initial phase of getting established toward a sustainable future, most statewide health information exchanges are incrementally ramping up their service offerings, and thereby enhancing the value proposition of participating. The 800-member Kansas Health Information Network is a good example. I recently spoke with KHIN Executive Director Laura McCrary about several recent developments there.
In one big change, KHIN has started including behavioral healthcare data, resulting in a more complete medical record for patients. How did KHIN work around regulatory rules limiting the sharing of substance abuse information without patient consent each time the data is accessed?
“We worked through those issues and got a sign-off from the Association of Community Mental Health Centers and SAMHSA (Substance Abuse and Mental Health Services Administration) on the procedures we put in place,” McCrary said.
KHIN’s technology vendor, ICA, does a global opt-out of the patient information if the patient does not provide consent to participate in the health information exchange. The data is still in the exchange but it is locked. “We allow the security to be overridden, or the more common term is “break the glass” in two instances: If the patient gives consent at the point of care, or in the event of a medical emergency,” she said. So pertaining to substance abuse treatment, KHIN opted out every single patient that had received substance abuse treatment services. That allows the patient to provide consent at the point of care to a provider in that one instance. “It is a fairly simple solution to a very complex problem,” McCrary said, “but it works quite well. Prior to any facility beginning to integrate their data with KHIN, if it provides substance abuse treatment services, we opt out all their substance abuse patients, but it just blocks the data until the patient provides consent.”
KHIN also is making progress in its efforts to offer Kansans personal health records independent of health systems’ portals. The MyHealth eRecords PHR is now officially launched, after being in a “soft launch” since October 2013.
The early implementation was a little clunky, McCrary admitted. “Initially populating the patient’s personal health record was a manual process. The provider had to send a Direct message to the patient’s PHR account and Direct e-mail account with the C-CDA attached,” she said. “For a small hospital of physician practice, it isn’t all that challenging. But when you start looking at larger organizations, they don’t have the resources to do that.” In phase 2 the PHR will be automatically fed from the HIE. “So anytime a C-CDA is launched to the exchange, it will also be launched to the PHR across all providers,” she said. The PHR solution, working with vendor NoMoreClipboard, is currently in a pilot phase with 16 small and mid-sized healthcare organizations.
Another milestone for KHIN is joining the national health information network, the eHealth Exchange. “One of our key reasons for joining the eHealth Exchange was to share medical records with the Veterans Administration and the Department of Defense,” she said. “Kansas is the home of three large military bases and over 200,000 veterans.”
KHIN also is in the early stages of developing reporting templates for providers. It noted that before 2014 there was not enough information in KHIN to make reports feasible or valuable. However, KHIN now has real-time clinical information on over one million patients and access to information on over five million patients.
The first report offering involves sending alerts to physicians or care coordinators if a significant event occurs with their patient, such as a hospital admit or discharge. Another involves information for physicians who want to determine gaps in preventative care for their patients.
“We also are looking at working with health plan members to start alerting them that a patient has had a medication prescribed by a doctor but it hasn’t been filled,” McCrary said. “This really is a new idea for us. Health plans have the filled prescription data, which we do not have. We only have what’s been ordered, which the health plans don’t have. So when you bring those two pieces together, you can begin to identify patients who have not gotten an important prescription filled, and that could be critical to health outcomes.”
A secondary data committee is working to determine under what conditions data can be made available for research, population health and emergencies.
She said KHIN hasn’t yet worked out business models for these reports. “We know the health plans will pay for things they receive. In terms of the providers, we are a provider-led organization, created by the Kansas Hospital Association and the Kansas Medical Society. Our goal is to help providers, so if we can provide these reports at low or no cost, that will be what we do.”
Sustainability is an issue for every HIE and each one is looking for ways to provide value to their constituent base and to cover what is pretty expensive technology infrastructure, McCrary said. “I think that as an HIE you have to have a wide variety of revenue sources. Provider revenue is only one piece of that pie. If you rely entirely on that piece, in my opinion, you are likely to fail. There are just not enough resources to cover the costs.”