Hospitals and health systems are fueling the growth of private health information exchanges (HIEs) to strengthen care coordination among their employed and affiliated physicians. One example of this surge in private activity is a grassroots, community-wide HIE cultivated by Huntington Hospital, a 626-bed regional medical center located in Pasadena, Calif. Huntington has used its mantra “Right Care, Right Place, Right Time,” to facilitate coordination across the care continuum and link its large population of 3,200 community physicians (2,300 physicians of whom are not on the medical staff).
As the physician practices in California’s San Gabriel Valley were using multiple EHR systems, Huntington needed to aggregate and harmonize data from those disparate systems, and used a module from the Pittsburgh-based dBMotion to assimilate patient data generated at other locations and facilitate physician-to-physician communication via secure web-based messaging. The module gives providers a snapshot of their patients’ care pathway via specific data points on their desktop, including encounters, admissions, and lab results for their patient population.
Rebecca Armato, executive director of physician and interoperability services at Huntington Hospital, says her organization began piloting its exchange in August 2011 with 150 users. At the end of this month, they plan to have 300 physicians live in pilot. Different types of practices were chosen with the caveat that they would have to agree to use the exchange and give feedback. Physicians are able access patient information from the hospital and other participating practices, e-prescribe, and be notified when their patients are admitted at the ED.
On the first day after go-live, the chair of the Medicine Committee received a notification that her patient was admitted to the ED, and was able to instruct the ED doctors before the patient was even seen what tests to order to streamline the patient visit. “So the hospital saved money; they didn’t have to order a bunch of tests,” Armato says. “The patient was admitted faster, got care faster, got the right care because they knew exactly what they needed to do, which means they are going to get discharged faster, and [the physician] got a good night’s sleep.”
Not only has the HIE aided in clinical care, but practice viability has also been improved, says Armato. “We knew there would be value in getting dictated reports, from which they bill for their services,” she says. “So a lot of times if they are dictating at the hospital, it’s a while before their own billing gets it; and this way their billing staff can get the information and bill more quickly after their services.”
Flexible Governance, Long-Term Goals
To aid in flexibility and sustainability, Huntington created a federated architecture for the HIE, which has streamlined governance issues. “This fact negated the need to get a bunch of stakeholders around coming to terms,” says Armato. “Because we engaged the physicians early on as we were putting up the architecture. It’s all about standards terminology; I don’t need a bunch of people in a room to say how you map a LOINC code.”
Armato expects the HIE will likely grow to include organizations outside of Huntington Hospital, as nodes to connect are easy to purchase. “We intentionally created two nodes, so if we had to legally spin off something to let other stakeholders feel ownership of it, we would do that in the best interest of the community,” says Armato.
A long-term goal for the exchange is to offer chronic disease management tools, Armato says, which will be key to engaging clinicians’ interest. Preexisting multi-disciplinary teams, like the CHF (congestive heart failure) transition team, will be engaged in focus groups to leverage what has already been done and tools will be created and embedded into the HIE. “Now we have all this discreet data,” Armato says. “What is it exactly on a page that will help [doctors] quickly find out, is this patient CHF-managed or diabetes managed? We’ve thrown a lot of information at them, so what do they really need?”
Huntington also plans to focus on care transitions by embedding navigator tools to follow chronic patients with CHF or stroke, or senior patients, to ensure they are getting the care they need and to maintain contact with those patients.
Armato sees a main challenge of the proliferation of information exchanges like hers to be interoperability, which lies squarely in vendors’ hands, as many proffer common excuses of lack of federal exchange protocols. Engagement has sometimes been difficult with vendors, she admits. While many have claimed portability of data, they don’t always deliver on discreet data points, she notes. “The challenge is to getting the vendors to realize that you’re not going to sell in this marketplace with that attitude. We’re not waiting till 2014,” she says. “They talk a good game, but their systems were made to hold data hostage; that’s how they kept clients.”