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At UC San Diego Health, a Strategic Focus on Getting Providers the Right Information, at the Right Time

January 5, 2018
by Heather Landi
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San Diego is an advanced healthcare market where leaders of patient care organizations are moving forward rapidly on risk-based contracting, population health and care management initiatives, and advanced development of health information exchange, as noted in a recent series of articles by Healthcare Informatics Editor-in-Chief Mark Hagland.

Within this regional market, UC San Diego Health, the academic health system of the University of California San Diego in La Jolla, is advancing forward on a number of fronts to improve health information exchange, health information management and revenue integrity. In a recent interview, Cassi Birnbaum, system-wide director of health information management and revenue integrity at UC San Diego Health, outlined the health system’s roadmap for health information exchange initiatives and shared the progress made, to date, on several grant-funded health IT pilot projects.

UC San Diego Health executive leaders are focused on leveraging technology to ensure providers have the right information at the right time, Birnbaum says. The health system participates in San Diego Health Connect (SDHC), the metro area’s health information exchange (HIE). Birnbaum, who serves as secretary on SDHC’s board of directors, says, “I’ve been involved (with SDHC) in many capacities, from when it was a Beacon community to where we’re at right now, where we are an independently viable, regional HIE.”

Birnbaum also views the success of SDHC as indicative of the collaborative spirit among healthcare provider organizations in San Diego. “Even though we are fiercely competitive, as many of us are vying for the same patients, I think we do come together as it relates to IT initiatives. I think for the greater good, we do come together, probably much more than other regions, and I think that San Diego Health Connect is a great example.”

SDHC is seeing particular success with its EMS Hub project, which aims to improve coordination between emergency medical services and hospital emergency departments (EDs). As the ability for EMS providers to have access to relevant health data is critical, the State of California Emergency Medical Services Authority (EMSA) developed a model to advance bidirectional data exchange—from an HIE organization to the on-scene EMS provider and from the EMS provider back to the receiving facility and the HIE.

To this end, EMSA developed the Search, Alert, File and Reconcile (SAFR) model to serve as an HIE framework for EMS by defining the minimum functionality necessary to achieve HIE. The California EMSA was awarded a grant from the Office of the National Coordinator for Health IT (ONC) to pilot the SAFR model as a new EMS HIE workflow. In July 2016, California began two pilot SAFR implementations with SDHC named as one of two HIEs to serve as information hubs, with the Orange County Partnership Regional Health Information Organization (OCPRHIO) serving as the second hub.

UC San Diego Health is a pilot site for the SAFR project, which has been live since April 2017 in the city of San Diego, according to Birnbaum. The pilot involves American Medical Response (AMR), the agency that supports EMS services in the City of San Diego, and both main hospitals of UCSD Health—UC San Diego Medical Center in Hillcrest and the La Jolla campus.

The project focuses on four functionalities: the Search functionality enables paramedics to search individuals’ health information for past medical history, medications and allergies; the Alert functionality enables the receiving hospital to receive real-time data about an individual’s status directly onto a dashboard in the ED; the File functionality enables the structured data of the EMS electronic patient care report (ePCR) to be filed directly into the receiving hospital’s EHR system; and the Reconcile functionality enables the EHR information to be reconciled back into the EMS ePCR for use in clinical quality measures and population health.

“The ER or trauma center is able to see the EMS run sheet, all the documentation, any EKGs that are done in the field, and any other pertinent information that needs to be transmitted to us,” Birnbaum says. “So, once we identify the patient within our enterprise-wide master person index, and our electronic health record (EHR) is Epic, we are able to pull in all the information and assimilate that just within our EHR. And that information is available not only for the emergency room and trauma providers, but also if the patient is transferred to another unit in our organization.”

Drilling down into the progress of the project, for the Search functionality, paramedics are finding HIE data on 42 percent of the patients they query from the scene or in-route, according to Birnbaum. What’s more, the receiving hospital ED sees real-time data in their EHR from the paramedics in 87 percent of the runs, she says. An electronic PCR is sent from the paramedics to the ED’s EHR, and with more than half of cases (55 percent), the ePCR is sent within 24 hours of the patient arriving at the ED. And, 37 percent of the time, an updated report from the hospital is sent back to the paramedics. And, these numbers are considered highly successful by the California EMSA, she says.

Due to the success of the project, SDHC is planning to expand to more ED and agencies, and others EDs are likely to implement SAFR in the next six months, according to Birnbaum.

“At UC San Diego Health, we also reap a financial benefit because we’re able to verify trauma activation and we are able to provide the right level of care confirmation from a charge capture and coding perspective,” she says.

UC San Diego Health also is a pilot site for California’s POLST (Physician Order for Life Sustaining Treatment) eRegisry pilot project. Funded by the California Health Care Foundation, in joint effort with EMS Authority and the Coalition for Compassionate Care of CA, San Diego Health Connect was selected to be one of two pilot communities to launch a POLST electronic registry in its region. 

POLST is a standardized form that clearly states what level of medical treatment a patient wants during serious illness or toward the end of life. Unlike an advance directive, POLST is signed by the patient and a physician and becomes a medical order that moves with the patient across care settings. In most states, including California, most POLST information is maintained only as a pink piece of paper that stays with the patient or the medical record.

“POLST gives seriously ill patients more control over their end of life as far as medical treatment. For us, it’s very important to get it into a registry beyond our own integrated delivery system, so we are now scanning in all of our POLST forms. And, one of the things that we’re working on as well is an outbound interface from our document management information system so we can send the information directly without any manual steps associated with it,” Birnbaum says.

To date, SDHC has launched the registry tool and started to receive POLST forms from UC San Diego Health, as well as Sharp HealthCare and Integrated Health Alliance, and HIE users can now retrieve POLST forms.

For Birnbaum and her team at UC San Diego Health, there is an ongoing strategic focus on leveraging technology for identity management, which is critical to exchanging information and treating patients, not only across the organization's continuum of care, but even outside the walls of its facilities. "That’s why we use San Diego Health Connect. We’re constantly looking at better technology to help make sure we have the right information at the right time in order to advance all of our healthcare initiatives," she says.

Health Information Management Across a Vast Network

UC San Diego Health operates three acute care hospitals, the two mentioned above as well as Sulpizio Cardiovascular Center. In addition, the health system operates the Moores Cancer Center, the Shiley Eye Institute and also provides ambulatory services across three counties. Health system leaders also developed the UC San Diego Health Care Network, a collective of regional health care providers, community hospitals, medical groups and physicians based in San Diego, Riverside and Imperial Counties. The network is a clinical integration network that collaborates on developing shared systems, infrastructure, care pathways and quality initiatives.

UC San Diego Health also recently went live on a shared EHR platform with UC Irvine, the first time two U.S. academic medical centers have linked up on one instance of Epic. “UC Riverside provides ambulatory services in the Riverside area, and they are also on our instance of Epic. We also have four large ambulatory specialty organizations that are on our instance of Epic,” Birnbaum says.

Birnbaum notes that sharing a single EHR platform with UC Irvine allows for greater efficiencies and benefits for UC San Diego Health as well. "From a scope and scale perspective, there are certainly a number of advantages to coming together. Obviously, there are some cultural challenges and technical challenges.”

As system-wide director for revenue integrity at UC San Diego Health, Birnbaum is leading efforts to utilize leading-edge technology for coding and reimbursement as well. “We’re doing some really cool things right now with NLP (natural language processing) and working on a coding and reimbursement solutions, not only for the professional fee side, because that is a market that has been largely ignored, but also looking at coding to meet all of our different requirements, whether it is professional fees, facility, coding and charge capture, as well as risk adjustment, and meeting the needs and requirements for some of the population health initiatives,” she says.

However, there are a number of challenges in this work as well. “I think there is always a competition for resources. So, at times, my team and I would like to move a little faster, but we are limited by resources. And, even with the vendor community, because we’re leading the pack, it’s about getting the right vendor support and willingness to partner with us and build a better mouse trap or to create something new and look at innovative approaches.”


2018 Raleigh Health IT Summit

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September 27 - 28, 2018 | Raleigh


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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