In Holston Medical Group’s March to Value, an HIE Proves Mission Critical | Healthcare Informatics Magazine | Health IT | Information Technology Skip to content Skip to navigation

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.

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