Group Health, the Seattle-based integrated delivery system that is both a payer and a provider, is the very definition of a model student when it comes to health information exchange (HIE). I make this comparison because the system has done well in marshalling its resources internally and externally to create a pragmatic approach for exchange. However, like many HIEs around the country, Group Health is still studying new approaches to find what works.
During a National eHealth Collaborative (NeHC) learning series spotlight, I learned about Group Health’s multi-faceted HIE approach. But first, a little background on the IDN. Group Health is a payer with 660,000 members, and a provider that contracts with 9,000 physicians, 44 hospitals (Group Health does not own its hospitals outright), and 1,280 providers in 25 primary care sites. Group Health implemented its electronic health record (EHR) from the Verona, Wis.-based Epic in 2002.
In an unusual approach, Group Health stood up its patient portal first before ever implementing physician documentation and computerized physician order entry (CPOE). Now more than 69 percent patients use its patient portal to view lab results, refill medications, and send secure messages to their providers. Initially, physicians received incentives for secure messaging with patients, but now it is an expectation.
To facilitate information exchange, Group Health built a lot of care processes around point to point transcription and lab interfaces it had set up with its larger hospitals partners like Virginia Mason, Inland Northwest Health Services, and Overlake Hospital Medical Center. The first big step took in its HIE journey was to eliminate these interfaces.
“One of the things that has been specific to Group Health is that our interfaces have been unidirectional. We receive data, but we have not been so great about sending data back,” said Gwendolyn B. O'Keefe, M.D., CMIO at Group Health. “That has been a factor in our previously closed system. We’ve wanted to develop a complete patient record within our own system.”
Group Health was in dire need of a proactive strategy, as “building point to point interfaces was not a viable long-term economic strategy,” said O'Keefe. So Group Health began to encourage open and low-cost solutions to provide one point of access for providers. A big part of this approach was to utilize the resources the system had at its disposal and to do more with the software it had already.
Group Health took a three-pronged approach to HIE:
Local: Part of its doing more with less approach, Group Health is currently optimizing its Epic Care Everywhere and Care Elsewhere modules. The Epic 2009 version is a view of chart review, and clinicians can see documentation at other institutions via a pull method. Group Health invested a lot of time to integrate images and labs into Epic, so there are no other portals for physicians to navigate. Group Health is also taking advantage of the fact that most of its healthcare partners in the Northwest Corridor will be on Epic by 2013. Using its Care Elsewhere module, Group Health can share CCDs with non-Epic customers.
Statewide: Group Health is participating in OneHealthPort, the agency designated to implement the statewide HIE, which operates on a hub and spoke model to pull data to individual institutions. Group Health is currently testing the sending of ADT messages with a community hospital partner. The revenue model for OneHealthPort is based on subscription fees, with the key goal of being sustainable within three years. Group Health will pay $50,000 to participate next year, while a typical small practice pays in the neighborhood of $300-600 a year. “Our goal is to eliminate all our point to point interfaces, as organizations around here get up on OneHealthPort HIE because lab is one of the first things we’ll all be doing,” said O'Keefe.
Nationwide: Group Health is also part of the Care Connectivity Consortium (CCC), working with industry heavyweights like Geisinger, Kaiser Permanente, Intermountain, and The Mayo Clinic to promulgate nationwide standards. CCC’s goal is to exchange electronic patient information on a minimum required clinical data set, open standards, and operational workflows to enhance care coordination.
Beyond traditional change management challenges, one of the main lessons learned by Group Health was that its privacy policy was initially too restrictive; the system required consent at every release for the initial six months. “Quickly we realized this was too onerous and makes it very difficult to effectively use the HIE at the point of care,” said O'Keefe. “We’ve grown in our approach to this, and overall, we’re taking more of a risk-based approach. We’ve greatly expanded what our consent covers.” Some physician practices have even incorporated consent into their Notice of Privacy practices.
Many emerging HIEs can learn from Group Health’s approach to tapping into all available resources at hand. Please share how your local HIE might be incorporating some of these strategies by leaving a comment below.