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HIEs Find Niche as Accountable Care Platforms

October 17, 2013
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A natural fit for care coordination, patient portals, ACO quality reporting

After struggling for many years to find sustainable roles in the health care system, health information exchanges, both public and private, seem to be a natural fit for the world of accountable care. During an Oct. 16 webinar put on by the National eHealth Collaborative, several HIE leaders and consultants described how their organizations are becoming foundational platforms for ACOs.

Salim Kizaraly, chief corporate officer and principal consultant for Stella Technology Inc. in San Jose, Calif., said that for care coordination, HIEs bring disparate information about one patient together. He noted that the Santa Cruz HIE in California has been used as a platform for medication reconciliation. “It is a patient safety issue,” he said. “Physicians there rely on the medication list of the HIE as the most up-to-date information.”

Another functionality Kizaraly described involves referral management and tracking of patients and creating a feedback loop as they move through the healthcare system. For instance, providers in Western New York are using the HealtheLink HIE’s messaging capability to alert payers and other providers on hospital admits and discharges.

Still another valuable tool is clinical messaging. A record of communications through the HIE can becomes part of the patient’s record. An HIE is Eastern Tennessee provides care managers access to an HIE inbox, where they can publish and subscribe to everything about the patients assigned to their ACO.  Finally, HIEs are starting to do data capture for registries and/or analytics. Kizaraly said he has worked with a rural ACO in Nebraska, which is reporting on 33 quality measures by using the HIE as a data capture tool. 

Also speaking during the webinar was Jim Younkin, IT director for Geisinger Health System in central Pennsylvania, which was one of the Beacon Communities funded by ONC grants. That effort involved improving readmission rates and improve clinician and patient satisfaction for patients with congestive heart failure and chronic obstructive pulmonary disease. “We are taking what we learned in the Beacon, which ended recently, and apply it to our ACO initiatives,” Younkin said. Using its private HIE infrastructure, called KeyHIE, Geisinger is working on care coordination and patient activation. That includes working with home health and long-term-health providers, he noted. The HIE is important, he said, because patients see a variety of providers, not just those in a single organization. The HIE is able to pull all the information together under one master patient index. It is also valuable because its patient portal lets the patients see information gathered from all their providers. Otherwise, they would have to log into multiple systems to see snippets of information about their care. “The portal at the exchange level can see the bigger view of care at multiple places,” Younkin said.

Geisinger also has found that of the 33 ACO quality measures it must report on, the HIE is able to provide in-depth reporting on two-thirds of them.

From the provider perspective, he added, Geisinger has worked with 13 different EHR vendors to allow clinicians to consume data from the HIE directly within the EHR without having to log in to the HIE separately. And just like the example Kizaraly described in Tennessee, care team members can subscribe to information about particular patients and receive notifications when they are admitted or discharged from the hospital.

Finally, Geisinger has worked on a tool to translate data from long-term-care systems into a standards-based summary-of-care record to be delivered to the HIE, and it is sharing that tool with any health organizations interested in using it.