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National HIE Leader Deb Bass Shares her Perspectives on HIEs’ Opportunity in this Moment

September 6, 2017
by Mark Hagland
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NeHII’s Deb Bass shares her perspectives on the opportunities—and challenges—facing HIEs in the present moment

Very exciting things are happening these days at the Nebraska Health Information Initiative (NeHII), the statewide health information exchange (HIE) for Nebraska. Under the leadership of CEO Deb Bass, NeHII has moved ahead to embed some of NEHII’s capabilities into core, and even mandatory, state healthcare processes in the Cornhusker State.

Since January 1 of this year, all prescriptions for controlled substances in Nebraska have had to be logged into the state government-sponsored Nebraska Prescription Drug Monitoring Program (PDMP) database, which NeHII operates. And, beginning on January 1, 2018, all filled prescriptions will be required to be logged into that statewide PDMP database. Meanwhile, NeHII continues to move forward on numerous other fronts as well, particularly in terms of collaborations with payers and providers in the state.

Healthcare Informatics Editor-in-Chief Mark Hagland was able to sit down with Bass during the SHIEC Annual Conference, sponsored by SHIEC, the Strategic Health Information Exchange Collaborative, while it was being held August 27-30, at the Crowne Plaza Union Station Downtown Indianapolis. Below are excerpts from that interview.

I’m interested to hear about some of the latest developments at NeHII.

Well, we’re very excited. When I last spoke with you, we had just passed LB 471 in Nebraska. The Department of Health and Human Services is partnering with us on this. Beginning this past January 1, all controlled substances prescriptions had to be logged into our PDMP database. Now, beginning, January 1, 2018, all filled medications prescriptions in Nebraska will have to be logged into it. We are going to be able to capture all filled prescriptions in our PDMP—our prescription drug monitoring program.

Deb Bass

The vendor we were using to get our medication history, had gaps in their data. So we got this bill passed, and that mandated the reporting of all filled prescriptions to our prescription drug monitoring program across Nebraska, and that has moved us forward very strongly in this area.

Every filled prescription must now go into a database?

Yes, that’s right—into a database set up through DoctorFirst, our vendor, through a partnership set up between the state of Nebraska and NeHII. The state owns it. LB 223 passed in May 2017, and that gives nurses access to the information. It makes possible a query directly from the clinician’s EHR [electronic health record] to the PDMP—they don’t have to go into another system. It’s minimizing the clicks so that the clinician can get to the data. Plus, it’s free to all prescribers and dispensers. So we are giving a free medication reconciliation tool to all prescribers and dispensers in our state. You know how much time it takes to do med rec. We have grants from the CDC [Centers for Disease Control and prevention], and a Harold Rogers grant from the Department of Justice.

The law specifically covers filled prescriptions. Can you explain the significance of that element of it?

Yes, many prescribers write prescriptions that aren’t filled. That’s why this is so important. This will help prescribers know which of their prescriptions are ultimately filled, and which not. Our end goal is to address adverse medical events, including the opioid crisis. Look at the dollars associated with adverse medication events, in terms of extended hospital stays, readmissions, etc.

This speaks to why health information exchange is so important in terms of improving processes in healthcare, correct?

Yes, that’s right; we are that trusted community partner. We are the neutral convener. For the most part, the HIEs in SHIEC are non-profit collaboratives, and the mission for nearly all of us has to do with patient safety, increasing quality, and reducing costs. We’ve seen real-life stories of what’s happening to people, and it just makes us all the more dedicated towards those goals, with regard to improving the quality outcomes, the cost control, and the patient, family, and community experience of healthcare delivery.

Those are all Triple Aim and Quadruple Aim goals, of course.

Yes, they absolutely are.

Meanwhile, this has been the third annual meeting for SHIEC. You must be excited by how things have progressed.

Yes, I’m very excited! Those of us who are the board members of the organization started as a little user group, and formed a trust relationship with each other. We share what we’re doing well; we call each other, we share emails. I’m viewed as something like the group’s PDMP expert, and people consult with me on that subject. And we recognize that when one of us fails, it impacts all of us. And that gives you  this beautiful, no-holds-barred, trust relationship. We’re here to help each other.

One topic that might be sensitive right now is the number of HIE organizations that have failed in recent months. What I hear some healthcare IT leaders in patient care organizations expressing, is some hesitation about leading their energies to a phenomenon that seems a bit fragile or unstable right now. Could you share your thoughts on that?

We all feel the pain when one [HIE organization] goes down. But it is also a market-driven kind of initiative; so you’re seeing some mergers and consolidations. Also, we’re looking at different pricing models that are based on return on investment. And with value-based models of healthcare coming now, things are shifting. For instance, we share an admissions report with 35 hospitals in NeHII. Several hospitals have used that data to greatly reduce or almost eliminate the readmissions penalty. That is very valuable return on investment, and we are very attuned to that kind of interest. Another example involving a home health agency—they have a fleet of nurses, and the business case for them was, using our admission  and discharge alerts, they knew when patients had been admitted to the hospital who had been scheduled for a nurse visit. So they knew to cancel the appointment. It’s that kind of stuff. People somehow expect it to be magical and mystical, but it’s really pretty basic ROI.

About a year ago, I wrote a report that focused on four statewide HIEs--Maine, Michigan, Ohio and Colorado. What seems apparent now is that the leaders of successful HIEs are figuring out what their markets want, correct?

Yes. And I think each market is unique, and each of us has a different story to tell. And now as we move into value-based payment models, we’re seeing real opportunities emerging, along a number of dimensions.

What do you see as the most important trends, in the near future, in the landscape around HIE?

The leaders of any HIE looking into the future need to be clear that it’s not about moving information from point A to point B, it’s the value-added service. For us, it’s the admission and readmission alerting, the med rec [medication reconciliation]; we’re also going to be looking at providing quality data, not only clinical but claims data, helping providers to be successful. And if you don’t have an HIE in your community, you can’t do that.

Are health plans becoming more interested and engaged now with HIEs? That’s what we’re hearing.

Yes, absolutely, our Blue Cross plan has been supportive from the beginning. They get our discharge reporting, we’re working on providing the HEDIS scores, and we’ve been also doing prior authorization, disease and case management, hospital-acquired conditions.

Do you see some potential with MACRA/MIPS, in terms of the need for better exchange of data and information?

We’re perfectly positioned, in that context! First of all, we’re moving patients out of the hospital and into the community. And the leading EHR was up there—and all the white spaces, all the data critical to the future—and the EHR stops at the hospital door. You have to have that community data provider that knows where the patients are going. Are we always working on addressing the gaps? You know we are. Social services, we’re just starting to get into that.

One area that we’ve been covering more and more is the Medicaid managed care area, which involves patients/plan members with high levels of both medical needs and social-determinant factors. Their care managers could really use much more usable data and information. It seems as though areas like this are particularly fertile ones for HIE.

Yes, absolutely. We can identify the heavy utilizers. Those are the ones you want to focus on initially. But we have to also focus on that next tier, the rising-risk individuals. With those who are the highest utilizers, it’s about managing as best we can. That next tier is about prevention, and that’s where the opportunities are. Many of them are going to the ED because they don’t have a primary care physician. But until you know who they are and can talk to them, and use case management, you can’t make needed changes. But sometimes, these individuals already sometimes have five or six case managers, which is a turnoff. So many of us are working on the community care plan, tailored to these case managers.

I wrote an article years ago about dual-eligibles, and the interventions that can help them, sometimes totally non-medical ones, such as installing handrails in their houses to prevent falls. That’s just one example of how community health information could be useful, correct?

Yes, absolutely. We work with the PACE program, for dual eligibles. One recent example involved an elderly woman, who had COPD [chronic obstructive pulmonary disease] and diabetes, and her house was falling apart. And the window air conditioner had gone out of function in the middle of a heat wave with high humidity, and the food she needed was spoiling. So they [the health plan case managers] went out and got a window conditioner for $250; and much better to do that, the case manager said, than to let bad things happened.

So working with community-based data, social-determinants-of-health data, can be especially valuable, correct?

Yes, absolutely. When those patients have a community case manager, and they get our admission alerts, so that the primary care physician of a patient is alerted; he or she gets alerted right away, before the ED doctor makes any orders. So that PCP gets involved before the ED physician starts ordering tests or treatments that might be unnecessary or what the patient wants. And that data, provided in that moment of the care process, can be so valuable. It’s great to be a part of all that.

In your view, is HIE as a concept/phenomenon reaching higher level of awareness among federal and state healthcare policy leaders?

Well, advocacy is a number-one priority, for sure. That’s one of the reasons SHIEC was formed. So all of those are reasons why our voice probably has not been heard as it should be in [Washington] D.C. Plus, explaining all the things we’re doing, we’re challenged to explain this via soundbites. How do we make all of this understandable?

Yes, it’s important to be able to convey that HIE is a facilitator, simple terms.

Yes, we’re the network that supports the follow of information, but understanding the power of that information, is important—and hard to explain.

Are you optimistic about the trajectory for SHIEC over the next few years? How do you feel about the conference, in that regard?

I certainly do. Our attendance is getting bigger and bigger each time. Many speakers are from within our own ranks. Third one. And it was fascinating, wasn’t it, Dr. Rucker yesterday morning, talking about future paths and about connections? [Donald Rucker, M.D., the recently appointed National Coordinator for Health IT, was the opening keynote speaker at the conference.] We’re what the railroads were in the 1800s. And ironically, we’re in a railroad terminal here. [The conference hotel is the remodeled former Union Station of Indianapolis.] And we HIEs are neutral conveners. We can improve data quality and data standards.


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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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