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Healthix Strives to Enhance Patient Matching Within its HIE Platform

September 20, 2016
by Heather Landi
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Healthix matches patient records from 300 disparate sources for more than 16 million patients through its HIE platform
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In order to deliver the right patient data to the right providers at the point of care, health information exchange (HIE) organizations must ensure that their patient matching process is as efficient and accurate as possible. To this end, New York City-based Healthix, Inc., the largest public HIE in the country, is taking steps to improve accuracy and efficiency in identifying and linking patient records across its platform.

Healthix matches patient records from 300 disparate sources for more than 16 million patients and delivers health information to hundreds of participating organizations spanning nearly 1,400 facilities across New York City and Long Island within its HIE platform. With the patient’s consent, Healthix enables clinicians to view their patient’s composite record, receive notifications when an important event happens and support population health management.

Healthix recently announced it would deploy a cloud-based patient matching platform developed by health IT vendor Verato to boost the matching performance of its existing technology. Healthix currently has a state-of-the-art patient matching process using IBM’s master data management (MDM) application, according to Thomas Check, president and CEO of Healthix. However, patient identification resolution and records matching is an ongoing and complex challenge for HIEs and healthcare organizations given disparate sources of health information and the different ways that organizations record patient identification information.

“One challenge when linking patient identity from disparate sources is that two different sources could record the information from the patient somewhat differently, whether the name, date of birth, gender, address, phone number. If the information is recorded differently, then those need to be reconciled, is it the same person or not the same person?” Check says. “The second issue is that a person’s data changes over time. While the data was accurate for a particular individual when they visited one provider in January, it may not be the same data that they presented when they visited another provider in July. They could have gotten married and their name changed, and they could have changed their address or phone number. So both are accurate at the point of time, but when that information comes together, they don’t agree,” Check says.

Thomas Check

Given the size and diversity of Healthix participating organizations, from large complex health systems to single provider practices, accurate and efficient matching and linking of patient records across the HIE is fundamental.  

“Our mission is to help our participants provide better care by facilitating the secure exchange of information between them. To do this, we want to offer the best technical solutions available to match and link records of millions of patients, each of whom may visit dozens of healthcare institutions over the course of their lives, and many of whom have similar identifying information like name and birthdate,” says Check.

Check says Healthix’s current MDM software platform efficiently reconciles patient matching discrepancies with regard to common data discrepancies, such as a misspelled address or the use of a patient’s nickname in one record and a formal name in another record. “The software is smart enough to know different representations of the same data,” he says.

Healthix utilizes a stringent, conservative matching process, and, currently, if the software platform is not able to determine whether two records match, then a manual review of the data is required, which is a time-consuming process.

As patients visit healthcare providers over time, their data changes over time and that can create discrepancies that are challenging to resolve using an automated process. “It’s difficult for software alone to know that John Jones with this date of birth who lives at this address in Queens three months ago, is now the same person with the name John Jones with the same date of birth that lives in Brooklyn now,” Check says. “It’s especially problematic when you deal with common names and dates of birth, and especially when dealing with large numbers of people as we are. The chances that you’re going to have the same last name and first name for multiple people increases, and even the chances of having the same first name, last name and date of birth for more than one person increases.”

Check says, “That’s really one of the reasons that we found over time we’re accumulating a lot of instances that we haven’t been able to resolve data discrepancies in an automated way, and that’s where Verato came into the picture.”

After a competitive test with other technologies, Healthix decided to implement the cloud-based solution because of the quality of match results it provided, its ability to provide substantiated data for its match decisions and its real-time capabilities. Moving forward, Healthix will use the identity resolution services to automatically process millions of its most difficult match decisions.

Verato’s technology is based on a reference database, called Carbon, consisting of commercially available data sources, according to Mark LaRow, CEO of Verato. Referring to Carbon as a “self-learning database,” LaRow says, unlike traditional patient matching approaches, the technology isn’t limited by underlying patient data that is inconsistent, out-of-date, or incomplete. Essentially, he says, Verato’s patient matching technology automates the manual identity resolution process.

“At any given hospital system or HIE today, there are human beings sitting behind desks determining whether person A is the same as person B. They’ll go out and do research on the internet and then make a human judgment about whether it’s the same person. It’s the same thing here, but instead of doing research, the customer is doing an automated query to us and it’s the same basic questions,” LaRow says.

As an HIE that shares electronic health data, Healthix considers patient privacy and data security as its highest priorities, Check says. With the cloud-based identity resolution platform, Healthix can take the unresolved matches and can run a real-time query of each record. “We won’t have large amounts of data leaving our premises, giving us better control over the security of the data, which is extremely important to us,” he says.

More broadly, accurate patient identity is at the core of the kind of data sharing that is vital to population health efforts and coordinated care approaches, LaRow says.

“The electronic health record (EHR) systems are now gathering much more data than ever before and that’s a good start. We’re also seeing an avalanche of start-up technologies that hospitals are interested in, technologies that don’t come from EHRs vendors. From a standards perspective, there has been a lot of work done with Health Level Seven (HL7) to make healthcare technologies interoperable at a connection level, a communication level.”

He continues, “But the one big thing missing from all these interactions from EHR systems and this new breed of new applications is interoperability at the identity level. It’s a whole new idea. So you can have interoperability at the technical level, and everybody has seen that it has gotten the industry just so far and there has been major strides forward, but people feel limited in the inter-connectability of systems. And the big stumbling block right now is the lack of identity interoperability. All of these systems need to know that they are talking about the same person and to do that, everybody could implement their own matching system on premise, at the hospitals, and try to exchange identity linkages with each side matching for everybody else, but ultimately, that’s an end-to- end problem that falls apart at scale. Population health and the need to do analytics across many different databases requires identity interoperability, and coordinated care also requires identity interoperability, and I think that idea is going to become more common.”

 

 


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Three More HIEs Join SHIEC’s Growing Community

August 3, 2018
by Rajiv Leventhal
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The Strategic Health Information Exchange Collaborative (SHIEC), a national collaborative representing health information exchanges (HIEs), has announced the addition of three new HIE members: HealthInfoNet (Maine), OneHealthPort, (Washington) and WISHIN, (Wisconsin).

These new HIE members bring new HIE members from “coast to coast and in between,” according to Kelly Hoover Thompson, CEO of SHIEC. “As SHIEC grows its membership, it continues to increase the value that it offers to its members,” Hoover Thompson said in a statement. “In addition, the rapid growth of this national collaborative of HIEs has given a stronger voice to the HIE industry nationally,” she said.

SHIEC’s 60+ member HIE organizations aim to manage and provide for the secure digital exchange of data by medical, behavioral, and social service providers to improve the health of the communities they serve. Collectively, SHIEC members serve almost 75 percent of the U.S. population, according to officials.

Shaun T. Alfreds, CEO and executive director at HealthInfoNet, in Maine, said that he sees real value in working closely with HIE peers through SHIEC. “SHIEC presents us an opportunity to expand our relationships and partnerships as well as share ideas and innovations in a manner that supports our shared vision of a truly interoperable country, where data is used to improve individual and population health while helping our providers deliver the most effective patient-centric care services, Alfreds said.”

Earlier this summer, SHIEC announced that it was establishing a Social Determinants Committee, with the core aim to help SHIEC better focus on identifying and linking social determinants of health (SDOH) data and best practices between societal sectors across the country.

The committee will be led by Jill Eisenstein, the president and CEO of the New York State-based Rochester RHIO (regional health information organization), which is a qualified entity of the Statewide Health Information Network of New York (SHIN-NY).

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In Holston Medical Group’s March to Value, an HIE Proves Mission Critical

July 18, 2018
by Rajiv Leventhal
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One Southeast medical group is using its HIE to determine patients’ risk levels and ultimately keep them out of the hospital

Health information exchanges (HIEs) have been brought into the healthcare ecosystem to connect providers, improve workflow and coordinate care with others, in real-time. But one of the lesser-discussed benefits of HIEs is how they are serving as a critical component in the industry’s value-based care shift.

It’s this reason, the desire to become more value-based care focused, why Holston Medical Group (HMG)—a multispecialty practice made up of 165 practitioners that serve more than 200,000 patients at 41 sites in Northeast Tennessee and Southeast Virginia—opted to leverage a community record from the Virginia-headquartered OnePartner for the medical neighborhood in 2012.

According to Wesley Combs, who is the CIO at Holston Medical Group, and also the president of the OnePartner HIE, recalls that it was around the time that HMG joined the HIE, in 2012, when the organization’s senior leaders began to realize that since the government was starting to expect providers to think more like insurance companies and manage the risk of patients, it was time for HMG to strategize how they would do just that.

“We needed to be informed and we needed to know more about our patients. And that’s obviously for good care, so we could treat them [well], but we also needed to know which patients required more attention and carried more risk. So it was through that lens in which we [thought about the HIE],” says Combs. “There was a managed care thought going on inside the practice, and I think that’s getting more common nowadays, as [practices] are thinking more like insurance companies now. Data helps you make good decisions.”

Wesley Combs

As such, HMG leaders came to the realization that they needed an HIE to have full access to all data on their patients. “HIE is sometimes a verb, and sometimes a noun, but [we] look at it as both. Sure, you are exchanging data, but you are also using this [technology] to access all of the data, and it helps you make decisions on patients. We looked ahead of the value-based medicine curve and realized we had to manage risk, so it became necessary,” Combs says.

One of the reasons why HMG selected the OnePartner HIE, notes Combs, is that unlike some statewide-run health information exchanges, “it’s not something that checks off meaningful use boxes for physicians, nor is it something that gives them credit for reporting in a certain [quality] program.” Rather, he attests, an HIE should be implemented so that it provides the most value possible to both patients and the physicians. “Having an aggregated data model at the point of care for doctors to help them make decisions is what patients expect. They expect that if there’s a computer in the room, the doctor knows everything about me no matter where I went. And that’s the standard now,” he says.

How HMG is Using the HIE

As it stands today, HMG has three different EHRs (electronic health records) across its system and the reason that can exist is because the HIE does the clinical integration, says Combs. Everyone on those disparate EHRs has access to all the HMG data through the HIE, at the point of care, as the physicians “literally see something blink on the screen,” explains Combs. The HIE is also connected to the hospitals in the region, meaning other large practices are using it and it’s not unique to HMG, he adds.

As such, Combs says that HMG physicians are using OnePartner daily and that the organization totals about 50,000 encounters with it per month. And they have built processes around the community data so that when a patient gets admitted to an area hospital, instant notifications are generated to the EHR from the HIE, he explains. Notifications are also sent out when patients are discharged from a hospital, at which point a case manager will work to schedule patients for a follow-up visit within 48 hours, if need be. The goal, says Combs, is to do a “transition of care” on 100 percent of HMG’s patient population.

Incredibly, he explains, the process that the HIE has replaced was employing seven staff members that worked from midnight to 8 a.m., looking through hospital census information manually, using paper and pencil, writing notes, and then faxing everything over when the day started. “This is exactly the process that was replaced,” Combs says. “And I would wonder, why would we have these seven people doing this? We wanted them doing something else, since the computer could do it so easily. We will look back one day and wonder why we didn’t do this 20 years earlier.”

Another example of how the HIE is leveraged involves what HMG refers to as “Level 3 patients,” those who have six or more chronic conditions. “Their bodies are fighting them all the time, they are on all kinds of medications and they’re really struggling. These patients do not need to be taken care of in the hospital, which happens to be the most expensive place to take care of them,” Combs says. Rather, they can be taken care of in a cheaper, more effective way—in an outpatient setting or in their home, where they eat and sleep better, and are generally more comfortable.  

The OnePartner HIE identifies these patients for HMG, as it takes all the data on patients, even the data that the health system doesn’t have—such as if a patient saw a specialist across town—"and it tells us about these patients, such as if we haven’t seen them in 90 days, and if we need to get them in and treat them, as well as make sure they’re on their medications—which [ultimately] will keep them out of the hospital,” Combs says.

What’s more, the HIE is identifying patients who are “habitual utilizers of services,” such as one patient who Combs recalls was admitted 28 times in the last 12 months. “All of a sudden, the whole [care] team is now engaged to call patients and make sure they have their medications and home care. We are throwing all the resources we can to keep them out of the hospital setting. The HIE is doing this for us; it fills in gaps, and identifies a lot of people that need identifying,” he says.

“There is No Easy Button in Healthcare”

In the end, while Combs understands that many HIEs across the country are struggling, he believes that hard work and determination could help overcome the challenges. “There is no easy button in healthcare. You only get out of the HIE what you are willing to put into it. If you are willing to integrate and get your data in there, and get the rest of your community participating, that is step one,” he says.  

But even more than that, he continues, physicians must also be willing to change their processes to take advantage of that data. “If you understand value-based medicine and the economics of healthcare, regarding insurance, risk identification and stratification, it doesn’t take any time for an HIE to give a return on investment in value-based contracting—if you are starting to go at risk.”

To this point, Combs notes that with an estimated twice as many patients coming into the system over the next 10 years—but without twice the number of doctors or twice the amount of money that Medicare can spend—there is a great need to identify the risk of each patient and keep the high-risk ones out of the hospital.

“Our HIE tells us the risk level of the patient and that goes straight to our value-based contracts. We have made more money since we started using the HIE then it ever would cost us in our contracts,” he attests. “So if you’re not figuring out how to execute on the value side and get payouts for either doing reporting or going at risk, then you will be declining in your fee schedule. We look at healthcare in general, and we see that there isn’t a choice—we have to go to value, and HIEs are [helping] with that.”


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Orion Health Selling its Rhapsody Platform for $205 Million

July 10, 2018
by David Raths
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The U.K.-based firm Hg will also take a quarter stake in Orion’s Population Health unit for $20 million

New Zealand-based Orion Health Group announced that it will sell its Rhapsody business unit for $205 million to private equity firm Hg. The U.K.-based firm will also take a quarter stake in Orion’s Population Health unit for $20 million.

Publicly traded Orion Health (NZX:OHE/ASX:OHE) built the first Rhapsody integration engine in the late 1990s and it became a popular interoperability platforms used by health information exchanges and health systems. But it had recently faced financial troubles and has cut 177 jobs since March 2018. In a recent Healthcare Informatics interview, Laura Young, executive director of healtheConnect Alaska, mentioned that her organization was stepping away from its technology relationship with Orion. 

"This investment provides Orion Health with a tremendous opportunity to deliver on our vision for customers, our people and for the healthcare sector," said Ian McCrae, founder and CEO of Orion Health, in a prepared statement. "The board and I believe that Hg is the right partner to accelerate the expansion of Rhapsody and support our vision for our Population Health business."

This investment will be made from Hg's Mercury 2 Fund. Philippe Houssiau, formerly CEO of Agfa Healthcare, CEO of Alliance Medical and a senior partner with PwC, will lead the Rhapsody business.

 

 

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