Healthcare Informatics has been closely following the pace of change at regional and state health information exchanges over the past few years as they seek to become increasingly relevant to hospitals, clinics and physicians.
In September our editor-in-chief, Mark Hagland, did some excellent reporting from annual conference of the Strategic Health Information Exchange Collaborative.
From Mark’s news story:
“At a time when some in U.S. healthcare are prematurely writing a collective obituary for HIEs, the reality behind the scenes is both brighter and far more complex than the announcements of HIEs forming and breaking apart. And that complexity and nuance were on full display at the SHIEC annual conference. On the one hand, no one attempted to gloss over the fact that HIEs face challenges going forward — challenges around funding, policy issues, and above all, sustainability. On the other hand, the leaders of numerous HIEs are developing strategies that are putting them on more and more solid ground.
For instance, many HIEs are building on the trust they have established to help physicians with their MIPS reporting under the Center for Medicare & Medicaid Services' Quality Payment Program (QPP), under the Medicare Access and CHIP Reauthorization Act (MACRA).
In a recent interview, Deb Bass, executive director of the Nebraska Health Information Initiative (NeHII), told me: "When the MACRA legislation first rolled out, I thought, here is our opportunity to step up to the plate." The HIE set out to become a qualified clinical data registry (QCDR) and offer MIPS calculator tools to allow providers to report to the QPP through NeHII in 2018.
I was reminded of all this when I came across the new strategic plan for the Statewide Health Information Network for New York (SHIN-NY). Its SHIN-NY 2020 Roadmap echoed many of the things people at the SHIEC conference told us about how they were aligning with stakeholders in the shift to value-based care.
The decade-old SHIN-NY is comprised of eight regional health information networks connected together to share patient information. The ultimate vision, according to Valerie Grey, executive director of the New York eHealth Collaborative, is that the SHIN-NY will create a 360-view of a patient’s health, empowering them and their care team to create a treatment plan that addresses not only an illness or injury, but underlying conditions, medical history, and social determinants of health.
The roadmap stressed that organizations using the SHIN-NY are already seeing a significant impact: fewer hospital readmissions and emergency department visits and reductions in unnecessary lab tests and x-rays.
But the roadmap also acknowledges the financial pressure SHIN-NY is under. It notes that virtually all Affordable Care Act (ACA)-related proposals at the federal level would have negative fiscal implications for providers and create immense challenges for New York State's Budget. “New York will likely face reductions in federal Health Information Technology for Economic and Clinical Health (HITECH) funding in the near future and the enhanced HITECH match expires in 2021. While all stakeholders will strongly advocate for maximum funding, the SHIN-NY will potentially face a perfect storm of reduced support over the next several years.”
• Other Headwinds HIEs Are Facing? New and potential advancements such as Fast Healthcare Interoperability Resources (FHIR), Blockchain, machine learning, and natural language processing could have significant impacts on the traditional forms of HIE, the strategic plan notes. In addition, “some argue there are alternatives to state HIEs given several EHR vendors’ eﬀorts to connect diﬀerent systems through private exchanges and the availability of national HIEs.”
The roadmap identifies several key strategies to address the challenges it faces, including:
• Ensuring a Strong HIE Foundation Across the State: Partly due to initial design and rollout, statewide SHIN-NY participation is strong for hospitals, federally qualified health centers, and public health departments, but not as robust for physician practices (especially small ones), home care agencies, nursing homes, behavioral health providers, and others. There is also wide variation across the regions in terms of participation, data completeness, consent, and usage of core services. As more community-based organizations are involved in care teams and population health eﬀorts, it will be necessary to develop additional participation targets and determine appropriate levels of data viewing and data contribution.
• Supporting Value-Based Care: An independent statewide assessment of provider input is underway to further inform prioritization of potential enhancements. Based on earlier stakeholder discussions, some functionality enhancements that could be undertaken to improve workflows and help providers include, but are not limited to:
• Single sign-on for DOH’s Health Commerce System (e.g. prescription drug monitoring, immunization registry, etc.)
• Advanced alerts with action-oriented information or results delivery with flags for abnormal results
• Documentation of upload and view/download of summaries of care to demonstrate compliance for MACRA/MIPS
• Increased integration with EHRs
• Ability to exchange care plans among teams
• Potential expansion of available data related to national patient centered data home