Fifteen years ago, hospitals and physicians in Virginia were just getting onto the electronic medical record (EMR) scene, but according to Michael Matthews, current CEO of MedVirginia, a regional health information exchange (HIE) in central and eastern Virginia, a lot of those people were concerned that they might make a huge investment in some sort of EMR technology without getting interoperable results.
That was the basis of the creation of MedVirginia, which has been operational since January of 2006. “At the time, we wanted to put tools together to bring providers and health systems together, apply it into the health IT arena and see where it goes,” Matthews says. Since then, MedVirginia sure has gone. The HIE has its fair share of notable accolades, including being the first in the country to connect online with the Nationwide Health Information Network (NwHIN), the Department of Defense (DoD) and Department of Veterans Affairs (VA), and the Social Security Administration through the NwHIN.
Next month, Matthews, who is also currently the chair of the board and president of Healtheway, the McLean, Va.-based operations arm for the eHealth Exchange, will be at the Health IT Summit in Washington D.C., sponsored by the Institute for Health Technology Transformation (iHT2; a sister organization with Healthcare Informatics under the corporate umbrella of the Vendome Group). At the Summit, Matthews will be part of a panel, "Driving Forces for Health Information Exchange Adoption," which among other things, will discuss the importance of leveraging HIE and interoperability for care coordination. Matthews recently spoke with HCI Associate Editor Rajiv Leventhal about MedVirginia’s growth, how it provides value, and strategies and challenges for HIEs across the country. Below are excerpts of that interview.
Where does MedVirginia stand now in terms of growth and scope?
It’s rapidly increasing; we have 10 hospitals on board today with an 11th coming shortly. We also have the VA and DoD hospitals participating. Through our efforts with ConnectVirginia, the statewide HIE, we will have most health systems participating through that platform in the CommonWealth. Connecting with the state HIE has been a consensus-driven process, as we have gotten tremendous leadership from Secretary of Health and Human Resources for the Commonwealth of Virginia, Dr. Bill Hazel, who has been our one and only chair. There has also been deep engagement by the private sector. We have leading physicians, CIOs of major health systems, the president of the Medical Society of Virginia, and federally-qualified health centers (FQHCs) all represented. It’s been a great outpouring of support and engagement, which we appreciate, and we are providing value-added services as well.
What kinds of value-added services do you offer?
In HIE, we are moving beyond the standard query and retrieve for clinical information, and are moving increasingly to a transactional model, especially looking at clinical encounter alerts. What that means is that there is a way of providing a primary care physician (PCP) with an opportunity to see which of his or her patients has been admitted to the ED or inpatient setting. Right now, most of them aren’t aware when one of their patients has been admitted, yet with clinical integration and accountable care, they’re supposed to be responsible for the follow-up care and treatment of patients.
We developed a system where we could notify physicians when they have had a patient admitted, and that triggers their engagement process for follow-up care, which is so important to avoid readmissions. Take an auto accident for example, the physician might not be aware of it for whatever reason, but some of that care needs to be followed up by not just the orthopedic doctor, but also the PCP. So based on certain criteria, we send that alert out, and they can look at the provider portal and get more clinical background on that patient. If the patient didn’t do what they were supposed to do and reach out to the PCP, then he or she can reach out to the patient.
But we don’t believe there is a silver bullet that provides all the value. When you step back to what’s happening in healthcare, on the health IT side, the adoption of EMRs has gone up dramatically. That’s great, but to the extent that those systems hold the data captive in information silos is not good. We have tried to show value in breaking down silos and making systems truly interoperable. We have a number of use cases that show that value, including the work we did with the Social Security Administration to help automate and expedite the disability determination process. They reduced the length of time it takes to file a disability claim by 35 percent. For someone who’s disabled and unable to work, with the stress on the family and healthcare providers, being able to reduce that time for a month or several months has a great impact.
Another example is information being accessed by the ER, as often when patients come in, you can’t gain a complete understanding of a patient’s clinical picture. Also with the chronically ill, 20 percent of seniors have 5 or more chronic conditions, and on average they are seeing 12 or more doctors in a given year. Having a common clinical information set of data, so those providers can coordinate care, will help. Those seniors will average 50 prescribed scripts per year, so physicians can see the history. Imagine if you’re the 12th doctor writing the 50th script for a patient who you don’t know his or her history. In addition, we do a lot with routing clinical results from hospitals and labs to physician practices. Data needs to be fed into EMRs; faxes and phone calls are not ideal ways to get the information.
What are the biggest pain points when it comes to data exchange?
This is universal to the field, but physicians and their staffs are incredibly busy. They are running as fast as they can to get through their clinical day with their patients, do the reporting, processing, and billing. To ask them to stop, get out of their workflow, look up data and act on data is cumbersome. So as an industry, we’re figuring out how to fit that information seamlessly into the workflow so it’s not something different. We want it to add to their efficiency, not detract from it. That’s our biggest concern right now.
The funding is also a challenge, as always. Most revenues in healthcare go to providers, they don’t typically go into infrastructure that allows those systems to interoperate and communicate. In this country, who pays for the roads, electrical grids, sewage and water systems that allow our economy to flourish? Think about if each business had to create some kind of interoperable electrical grid to connect and share power with others. It seems silly, but it’s what we expect in healthcare, to fund that infrastructure when a lot of it is for social good.
It’s very hard work—the technology is hard enough, but there’s the cultural piece, which involves engaging stakeholders, and the financial piece, as you need to be creative. Any one of those, if not done right, can result in the failure of the HIE. Challenges can be too difficult to overcome in some cases.
Has the role that the feds have taken been good enough so far?
I think they have done a lot to contribute; they were the incubator for the eHealth Exchange, and got the Nationwide Health Information Network off to a great start. There is still a meaningful role they can play in standards development and establishing rules of the road. One of keys will be proper engagement of public and private stakeholders. This is not an industry that needs to be over-regulated, and I think the private sector can come up with valuable solutions like we saw in the banking industry 10-15 years ago off of the ATM backbone.
What is most critical to get to that the state of interoperability we have seen in other industries?
The biggest thing is to demand the vendors support their desires to become interoperable. There is conversation on the Hill about information blocking, and you saw ONC’s report. That’s one of the things that health systems can do. I would say that there is a lot of mischaracterization going on and a long ways for everyone to go for interoperability. The industry needs to be more collaborative. There are a number of initiatives that are paving the way for that. Healtheway and Carequality are examples of those. You can’t be in isolation in healthcare, as we are all trying to figure out what business model is best with collaboration and competition.
Do you think Epic is collaborating as much as it needs to?
Epic is a participant in Carequality, and they’re a good, strong partner there. I don’t see them being as isolated as some of the media portrays them to be. There are more Epic hospital customers hospitals on the eHealth Exchange than any other single vendor. I think they have done a lot, but like anyone else, they can do more. I wouldn’t single them out like others have though.
How do you see the next few years playing out regarding HIEs?
If you’re trying to measure effectiveness of HIEs, we need to move from users to usage to usefulness of information. In the first days of HIE, everyone touted their users, then it was about how much usage, now is that information useful? For HIE to achieve its ultimate success, it has to be viewed as a standard of care by the physician medical community. If it is, then let’s get about the job doing it as effectively and efficiently as possible, and get these tools to providers at the point of care so they can care for their patients. If it’s not a standard of care, it’s all a waste of time, money and effort. I do believe physicians can make better clinical decisions with that information available, and that puts the burden on folks like myself to make sure they don’t go chasing around for it all day.
To learn more about HIE adoption, and many other trending health IT topics, register here for the Washington D.C. Health IT Summit.