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How HIOs Can Support Ambulatory Providers With MIPS Reporting

December 29, 2016
by David Raths
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HIOs can help providers calculate their quality measures and electronically submit them to CMS
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Regional health information organizations (HIOs) have been working over the past few years to move from the startup phase to sustainability by increasing the number of revenue-generating services they provide. One way they can start adding value in 2017 is by offering providers reporting help with CMS’ Merit-Based Incentive Payment System (MIPS).

During a recent webinar presentation, Genevieve Morris, senior director of the health IT policy team at Baltimore-based consulting and technology firm Audacious Inquiry, outlined several ways HIOs can be of service to ambulatory providers getting ready for MIPS.

Quality Measures

Some HIOs already offer providers quality measurement tools, Morris noted, but if they don’t already, this is an area they could move into. There are bonus points available for providers who use end-to-end electronic reporting of CQMs (clinical quality measures). “This is a place where an HIO could step in and help providers calculate their quality measures and electronically submit them to CMS and allow providers to pick up an extra 10 percent in bonus points, which for the quality measure category can be really important,” she said.  For quality measures, providers are measured against each other, so however they perform on a particular quality measure gets benchmarked against every other provider in the country that submitted on that same measure. Therefore, picking up bonus points can make a difference between a negative penalty, a neutral payment or an increase in their payment adjustment.

Morris noted that, working in conjunction with Maryland’s state HIE CRISP, Audacious Inquiry released a clinical quality measure calculation tool called CAliPHR as open-source technology to support providers’ successful participation in federal and state incentive and value-based payment programs

There are a few other ways to do quality measure reporting electronically, she said, but you can’t use back-end ETL (extract, transform and load) or manual data entry methods to count for the bonus payment. “You want to make sure any providers using your tools to submit to the program are following all the regulations correctly,” she said. “We think this is an area where HIOs can provide support, particularly to smaller eligible clinicians, who may not have EHR systems certified for submitting quality measures and who want to maximize their scores.”

Advancing Care Information

The second area that HIOs can support is the Advancing Care Information (ACI) category, Morris explained. Several HIOs were already doing this with the current Meaningful Use regulations, and some of that work can be expanded in the ACI category.

For example, HIOs are well positioned to support the transition of care measure, she said. CMS removed the requirement that you have to use Direct as your transport method. The only requirement is that you use a certified EHR to generate a CCDA document. Whatever transport method they use, as long as it is in CCDA format, will count toward that measure. One stipulation that CMS did carry over: if you just make a CCDA available for query, the provider doesn’t get credit for that unless they can verify that the provider being referred to used the summary of care. Using an HIO as the transport mechanism or some notification service could be really helpful to providers, Morris added, particularly if they don’t know all the contact information of the provider they are referring to.

“HIOs are incredibly well positioned for transitions of care that come to a provider when they receive a patient or a referral,” Morris said. Providers have to receive and incorporate a summary of care into the patient chart. CMS has said they can use an HIO to query for the summary of care. They do have to be able to pull the CCDA itself. Pulling a PDF or text file does not help toward this measure. Providers need a machine-readable CCDA. They need to have the ability to pull it from the HIO into their EHR. “That is a really strong area where HIOs can support ambulatory practices,” she said. “If they are getting CCDAs from hospitals when patients are discharged, making that available to their ambulatory providers to incorporate into their charts will become very useful.”

There are two patient access measures in ACI. One involves providing patients access to their records within 48 hours after the data becomes available; the second measure requires that patients be able to view, download or transmit their information or access it via an API. There are some HIOs who have patient portals that can support this measure, Morris noted. “You would have to have technology that is certified to the proper criteria. If that is something you consider supporting, make sure you have proper technology in place,” she said.

Public health reporting offers a bonus score of 10 percent and if providers report to another clinical data registry they can get an additional 10 percent as well. “A lot of providers are actually planning to get 100 percent on ACI through the use of registries,” Morris said, “and if HIOs can support that, that helps them get their bonus points.”

Improvement Activities

The third section of MIPS that HIOs can support is in Improvement Activities. Most of the activities that an HIO can support are medium-weighted, she noted. One is about providing care management after emergency department visits. “If you have a system that notifies ambulatory providers when a patient is discharged from a hospital, that helps them follow up with patients routinely and meet this measure,” she said.

The second is around closing the referral loop. HIOs can help give specialist reports back to the primary care provider who referred them over, which can help them count toward that measure. “The practice still has to document it in their certified EHR, but the HIO can help them close that referral loop,” she said.

If an HIO has technology that allows providers to create longitudinal care plans, it can support them in meeting that improvement activity.

If an HIO has connections with community-based resources, such as nutritionists, or some sort of chronic disease management program, and it is helping share data, that will give providers credit for that improvement activity.

Other activities to support include use of a prescription drug monitoring program (PDMP) or working to provide analytics on total cost of care.

Morris stressed that just as with Meaningful Use, CMS will audit providers. The agency has not yet announced how many providers they plan to audit each year, “but if you support these activities for ambulatory providers, it is really important that you have documentation you can provide them so they can submit that information to auditors,” she concluded. “You could put them at risk if you can’t document it.”




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Regional New York HIE, Hixny, Adds Nine Counties to Its Territory

September 17, 2018
by Heather Landi, Associate Editor
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Hixny, a regional health information exchange (HIE) based in Albany, has added nine counties to its territory, committing a significant amount of funding over the next 18 months to connect local providers.

Hixny is one of the state’s eight qualified entities (QE) connected by the Statewide Health Information Network for New York (SHIN-NY) – a “network of networks” that allows the electronic exchange of clinical information and connects healthcare statewide – overseen by the New York State Department of Health.

“The success of the SHIN-NY hinges on meeting the needs of providers based on complete, accurate and up-to-date data,” Mark McKinney, CEO, Hixny, said in a statement. “At Hixny we’ve demonstrated the effectiveness of our model – and want to do the same for the providers and patients in our neighboring regions.”

The region in the Hudson Valley and Southern Tier has historically lagged in connecting providers to one another and collecting patient consent.

Hixny’s territory encompasses 28 counties north and west of the Capital District and south of Hudson Valley. In its existing region, 100 percent of hospitals and three out of every four providers are connected via Hixny. Ninety-two percent of adult patients have given consent to their physicians, a number that increases each month. Additionally, it offers the only patient portal in the state called Hixny for You, allowing patients to view their own medical history, with data that spans the entire state.

“Their reputation precedes them,” Yuk-Wah Chan, M.D., a family practitioner in Pleasant Valley, NY, part of Hixny’s new territory, who recently signed-up, said in a statement. “More than ever, physicians need to deliver higher quality and more personalized care to their patients while lowering costs – to do that, you need access to the best, most reliable data. And that’s Hixny.”

Eight total locations have already signed participation agreements with Hixny: Dialysis Clinic, Inc.’s three locations in Elmsford, Hawthorne and Yorktown; Hurley Avenue Family Medicine’s three locations in Kingston, Stone Ridge and Saugerties; Premier Dialysis Center in Goshen and Dr. Chan’s practice.

All participating organizations will have access to patient information across the state through the SHIN-NY.

“We are pleased to welcome these new providers to Hixny; their decision proves that providers who have a choice will choose better data,” McKinney stated. “Hixny is changing the game and this news is only the first of many announcements that demonstrate why Hixny is the best option.”


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The Power of Data Exchange as Disaster Strikes: How HIE Leaders Have Prepared for Hurricane Florence

September 14, 2018
by Rajiv Leventhal, Managing Editor
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The executive directors of GRAChIE and NC HIEA say building HIE-to-HIE connections throughout the region, in preparation for a natural disaster, speaks to the power of health information exchanges

As the nation—particularly the Southeast U.S.—braces for the force of Hurricane Florence, which as of the time of this publishing has made landfall in North Carolina, just a day after Georgia’s governor declared a state of emergency for every county in the state, healthcare and health IT leaders continue to work in overdrive to help those in need.

Indeed, major disasters such as Hurricane Florence have an effect on healthcare information needs—even before they make landfall. This particular hurricane has already resulted in the evacuation of millions who have left the places where they normally receive care and where their healthcare records are housed. In these situations, electronic health records (EHRs) and health information exchanges (HIEs) can certainly play a large role in disaster relief efforts.

For instance, the Georgia Regional Academic Community Health Information Exchange (GRAChIE), which serves healthcare organizations and providers across Georgia, is currently working to connect to eHealth Exchange participants in South Carolina, North Carolina, Virginia and Florida in preparation for displaced evacuees. The idea is for GRAChIE to expand its connectivity to HIEs throughout the Southeast via the eHealth Exchange—a health data sharing network that is part of the Sequoia Project, inclusive of provider networks, hospitals, pharmacies, regional HIEs and many federal agencies, representing more than 75 percent of all U.S. hospital and 120 million patients—as quickly as possible before Hurricane Florence hits the coast, according to the organization’s officials.

Tara Cramer, GRAChIE’s executive director, says that her organization learned from what happened last year during Hurricane Irma, in that Florida was evacuating patients who ended up being displaced to Georgia. So even though GRAChIE used the eHealth Exchange to build out connections through Florida, the problem was that they had to do it so quickly, and at the time Florida was already under evacuation. As such, there weren’t HIEs on the other side of those connections to help with testing and validation, explains Cramer. “This time, we started very early to build out functional connections on both sides. This is the power of HIE, and it’s very technically possible, although it does require some magic to pull it off so quickly,” she says.

Tara Cramer

Meanwhile, in North Carolina, where the storm is hitting hardest right now, leaders at the NC Health Information Exchange Authority (NC HIEA), which is based in Raleigh, and has only been fully functional since March 2016, have also been working throughout the week to establish and build connections with other HIEs.

Christie Burris, NC HIEA’s executive director, says she owes “a debt of gratitude” to Cramer and other GRAChIE other top executives, since on Tuesday morning Cramer alerted Burris that these connections were possible via the eHealth Exchange. “Shortly after that [conversation], we got together with the East Tennessee Health Information Network (eTHIN), I got my team together and said let’s talk with our vendors, so we can figure out the feasibility in doing these out-of-state connections,” recalls Burris. “And at that time, we weren’t sure when the storm was hitting, so we spent Tuesday through Thursday working with these different HIEs, and we pulled [those connections] off successfully,” she says.

Indeed, in addition to the connection with GRAChIE, NC HIEA signed agreements with four other HIEs this week so that bi-directional exchange could occur: Coastal Connect HIE (Wilmington, N.C.); eTHIN; MedVirginia (Richmond, Va.); and SCHIEX (South Carolina Health Information Exchange). NC HIEA also already had an established connection with GaHIN (the Georgia Health Information Network, based in Atlanta) and the VA HIE (Veterans Administration). “We signed agreements with five of those HIEs last night at 9 p.m.,” Burris says.

Christie Burris

As it stands right now in North Carolina, explains Burris, more than 20 counties in the state have been evacuated, leading to numerous displaced citizens. What’s more, many pharmacies, hospitals, clinics and doctor’s offices have been closed, and prescribing patterns disrupted, leading to many patients having to reconnect with their care regimens, often in new settings.

Shelters in New Bern, a riverfront city near the North Carolina coast, are at capacity as the town flooded last night, Burris notes. And shelters in Raleigh are also at capacity, so some of those folks got moved to Winston-Salem. Thankfully, Burris says that her HIE has a central repository in which it holds onto the patient data, meaning that even if a hospital has been shut down—such as in the town of Wilmington where every hospital but one has been closed—NC HIEA has those patient records up until the time the hospital stops sending them. “So we do have that historical [view of] the patient, and at this point we have over 5 million unique patient records in our North Carolina repository,” says Burris.

Cramer notes that caring for displaced citizens has been a core reason why GRAChIE has been such an advocate for standing up these HIE connections on the fly, and quickly, during the time of a disaster. On a day-to-day basis, she says, “We know that Georgia and North Carolina residents may present at an urgent care facility or the ER, but we also know that during these times, it’s heightened. So if we can equip clinicians with a patient’s allergy list and medication history, that’s still a great starting place to take care of someone who has been evacuated and is already going through a stressful time without friends and family. It is our job to broadcast that net and gather as much information as we can for when they present for care,” Cramer says.

To this end, she adds that at one of GRAChIE’s participating Georgia hospitals, 14 new patients with North Carolina addresses were registered yesterday. “And we are continuing to monitor that throughout the day to see where patients are coming from. It’s our job to watch that and make sure we are delivering quality information.” She also notes that even though Georgia has escaped the major brunt of the damage from this hurricane, the state will still get plenty of evacuees, and preparations have to be in order. “We started reaching out [to HIEs] before we knew a storm may be coming so that we could build relationships. We have built connections with GRAChIE that we don’t keep active all the time, but when we need to activate them, we can. That’s been a key for us since Hurricane Irma,” she says.

Both Burris and Cramer also expressed great gratitude to the Strategic Health Information Exchange Collaborative (SHIEC), a national collaborative of HIEs, for making these connections possible. “I would have not known Tara if not for SHIEC,” admits Burris. And even though GRAChIE and NC HIEA are not yet part of SHIEC’s patient-centered data home (PCDH) project—a model based on triggering episode alerts, which notify providers that a care event has occurred outside of the patients’ “home” HIE, and confirms the availability and the specific location of the clinical data—both HIEs have plans to link up to it quite soon.

In the end, while Burris and Cramer believe in the power of HIEs when a storm hits, they also attest that providers of all types should not wait for a natural disaster to participate. “We want there to be value in the day-to-day exchange of information,” says Cramer. “In these times, you might have a more heightened awareness, but there is every-day value in health information exchanges.”

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Connecticut Receives $12.2M Grant to Build Statewide HIE

September 11, 2018
by David Raths, Contributing Editor
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Earlier effort failed because HIE was not self-sustaining

The State of Connecticut will receive a $12.2 million grant to support ongoing work that will establish Connecticut’s first statewide health information exchange.

An earlier statewide HIE effort, the Connecticut Health Information Technology Exchange, was shut down in 2014 after spending $4.3 million in federal grant money over four years. A state auditor’s report noted that the exchange was never able to provide services to stakeholders and thus, never developed a self-sustaining revenue stream. (The State of Montana also recently decided to take a second try at creating a statewide HIE.)

The grant, awarded by the Center for Medicare and Medicaid Services (CMS) to the Connecticut Office of Health Strategy (OHS), supports efforts to develop a secure, modern HIE that facilitates the sharing of health data to further patient care, improve proper efficiency, and rein in the high cost of healthcare. The HIE is expected to be operational by early 2019.

The grant follows a $5 million federal investment the state received in 2017 that facilitated HIE planning. To qualify for the additional resources, states outlined how their health technology plan would improve disease management, serve the Medicaid population (over 800,000 Connecticut residents), combat the opioid epidemic, and improve overall healthcare through the use of clinical data.

The new round of funding launches a pilot program for the health information exchange, which was one of the nine recommendations made by the Health Information Technology Advisory Council, a statutory body tasked with a comprehensive examination of Connecticut’s current health technology needs.

“The health information exchange will improve care. Providers will be able to exchange clinical and diagnostic data in real time – efficiencies that will save time and resources for healthcare systems and patients,” said OHS Health Information Technology Officer Allan Hackney, in a prepared statement. “We engaged nearly 300 providers and consumers and 75 organizations across the health sector in Connecticut to help us understand the issues and opportunities for improving care delivery and outcomes. Technology can and should be a great partner in health reform.”

Another goal is for the HIE to enable a platform for measuring clinical quality and more quickly analyzing population health – one of the keys to improving healthcare accessibility and correcting racial, ethnic, and gender health inequities. Currently, analysts most commonly use insurance claims data, which is only a proxy for real-time clinical information. This use of the HIE dovetails with the work of OHS’s State Innovation Model Office and the Health Systems Planning Unit in their efforts to better address gaps in healthcare, improve community health, and evaluate the performance of Connecticut’s healthcare providers.


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