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Trouble Getting HIE Data in the ED? Maybe You Need a FHIR HIEdrant

November 14, 2017
by David Raths
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FHIR HIEdrant won first-place prize in Pitch IT contest at last week’s AMIA Symposium

When new patients with chest pain show up in an emergency room, physicians are often so busy that they don’t take the time to go beyond what is in their own health system’s EHR to search the regional or state health information exchange for relevant tests. A new SMART on FHIR app being developed at the Regenstrief Institute in Indianapolis retrieves that HIE data and integrates it in the clinical workflow in the EHR.

The team that developed the cleverly named FHIR HIEdrant won the first-place prize of $12,500 at the Pitch IT contest, a shark tank-like event held at last week’s AMIA Symposium in Washington, D.C.

Matthias Kochmann, M.D., a pediatrician and clinical informatics fellow at the Regenstrief Institute, said that as the team studied this problem, they first asked ED physicians which data elements residing in the HIE would be valuable to them. They mentioned five things:

• Last EKG

• Last cardiac catheterization report

• Last stress echocardiography

• Last cardiology note

• Last discharge summary.

One of the problems with accessing the HIE is that involves a separate workflow outside of the usual process of reviewing patient data in their EHR, without assurance that any meaningful data will be found. “We did a time-motion study to see how often ED physicians access the HIE in order to retrieve documents,” Kochmann said. “The result was that most of the time, they just do not have time. It wasn’t convenient for them. They would go with the information in the chart or provided by the patient.” If there is nothing in the EHR chart, then they order the tests.

The key point, he said is that the tests are sometimes invasive, expensive and take time. “Ideally, no tests would need to be repeated. The patient saves time; the health system saves money; and the physician can spent more time with the patient.”

The developers sought to bring that HIE information directly into the ED physicians’ workflow. They built a FHIR server connected to the Indiana HIE. “Using Smart on FHIR technology, we created a tab within the clinician’s work flow. They use it to open up the FHIR HIEdrant and it then searches the HIE for the physician,” Kochmann explained.

Starting Dec. 4, the FHIR HIEdrant will begin a four-month evaluation project at Indiana University Health Methodist Hospital.

If that pilot goes well, there are three ways the developers plan to branch out. One is to make the chest-pain app better with more functionality, Kochmann said. Another pathway is to try to get the app placed in the Epic and Cerner app stores. The third is to find different use cases in other hospital departments. One could be a surgery dashboard for pre-surgical clearance. Another could be pain management, which could be used in the ER, family medicine, or neurology.

The FHIR HIEdrant team is looking forward to another competition sponsored by Medstartr at the end of November in New York.



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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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