Better Care Delivery, Improved Outcomes, Easier Reporting
The benefits of joining BHIX and enabling automated HIE are compelling and multi-layered. First and foremost is the improvement in patient care and outcomes that is a result of lowering communication hurdles that are inevitable when dealing with multiple facilities. And, the economics surrounding this benefit are positive. Payers are increasingly interested in financially supporting programs that improve outcomes and facilitate care management models of care and may be incentivized to put resources behind such programs in the early term. Once an EHR is in place, tracking results becomes much easier.
Administering appropriate interventions and tests will help us to demonstrate and quantify decreased infant mortality, improved birth outcomes, and increase in the number of mothers getting into care at an earlier date during the pregnancy. More immediately, the BHIX network running on HealthShare can provide such information as the number of patient consents for data access, the number of data sent across the network and the level of HIE network usage—all of which are of interest to the payer community.
Finally, it’s difficult to overstate the positive impact of HIE on organizational reporting. For example, a Uniform Data System report including the birth weight of every baby born to a mother who received care from BMS during 2010 had to be submitted to the U. S. Department of Health and Human Services during 1Q11. With the HIE implementation scheduled to roll out in that timeframe, BHIX will make it possible to easily retrieve that historical data—a very immediate and demonstrable benefit of HIE.
At present, an estimated one million patients are included in the BHIX enterprise master patient index. BMS currently serves a patient population of over 18,000 regular users, all of whom will potentially benefit from the HIE implementation.
Recommendations
Solutions to the technology challenges tied to HIE have been addressed through collaborative efforts among BMS, BHIX and its partner, InterSystems. There have been some issues with natively connecting the EHR to BHIX through some very new types of Web services and protocols. However, based on recent testing, these are being successfully resolved. The HealthShare platform, which is also being used for multiple breakthrough regional HIE projects in the U.S. and for a countrywide EHR initiative in Sweden, is operating smoothly. Its adherence to industry-accepted standards of the Integrating the Healthcare Enterprise consortium is expected to enable BHIX to provide fast, seamless connectivity to many other locations once the initial project with Brookdale goes live.
On the non-technology side, BMS has some suggestions that may be of practical use for health care providers taking early steps on the road to HIE:
• Assess and Confirm Participant Commitment—How much do the health care organizations want HIE and will they commit the resources needed to make it happen? A strong commitment to a common goal makes the process much more bearable.
• Enable and Support Strong Project Management—A champion who keeps all of the participants on task, ensures all participants attend meetings and does whatever is needed to get data flowing from multiple entities into a usable format is essential to HIE success. BMS brought in an outside consultant to handle project management—an approach that avoids the issues that can arise if an internal staff member isn’t given the necessary authority to manage all participants. BMS was able to contract with the consultants via a financial grant and thereby integrate HIE into its strategic patient care management initiatives.
• Obtain and Maintain Required Funding—Obviously, there is a significant, but variable cost in time and dollars to enable HIE. If, for example, the first BMS use case had involved getting information from a radiology center via a point-to-point interface, rather than exchanging prenatal data through the HIE, the process might have initially been less costly; though more costly to scale in the long run. Having the right financial support is essential.
• Set clear goals and objectives—It is important that there is an agreement of what data needs to be exchanged and how that data will flow form one organization to the other. At BMS we described our ideal model of what data points need to be exchanged as well as how and when the data should flow from one organization to the other. Although we have not achieved the ideal model due to some technological challenges we intend to continue pushing to achieve this model and challenging organizations such as BHIX to help us in getting there.
And, perhaps most important, be sure to get buy-in for HIE from the clinical end-users. Clinicians must recognize the value delivered by implementing HIE and use it on a regular basis.
Next Steps
Once BMS goes live with HIE and BHIX, our initial focus will be on assessing the system’s impact and benefits delivery. Then, we’ll identify and prioritize the next scenarios where HIE will be of most benefit. For example, we may wish to receive notifications from BHIX when one of our patients has an emergency department (ED) visit…the more ED data that is available in real-time, the better the coordination of care for each patient. At the most basic level, anyone touching a patient’s life becomes accountable for a patient’s care and from the BMS perspective, the better the HIE, the better our ability to be a true accountable care organization.
Adam Aponte, M.D., is Medical Director at Brownsville Multi-Service Family Health Center in Brooklyn, N.Y.
