Last August I wrote a blog item titled “Using HIE as a Tool to Bend the Cost Curve.” It was about Jeffrey Brenner, M.D., a Camden, N.J.-based physician who uses data gathered in a health information exchange to target high-cost individuals.
The Camden Coalition of Healthcare Providers uses the HIE data to identify high-cost “hot spots” — high-rise buildings where a large number of “super users” of the hospital emergency rooms live. By identifying and working with these patients on patient-centered care coordination issues, CCHP been able to cut down on emergency room use and in-patient stays. (Brenner was the subject of a great New Yorker profile by Atul Gawande in 2011.)
Could we see other HIEs becoming platforms for this type of population health approach soon?
One place to keep an eye on is the State of Maryland, which recently unveiled its Health Enterprise Zone Initiative, a four-year pilot program with a budget of $4 million per year. The goals include reducing health disparities, improving health care access and outcomes in underserved communities, and reducing costs and hospital admissions and re-admissions. The program will offer tax breaks and other incentives to physicians and community groups to bring medical care to underserved neighborhoods. The five zones will be located in West Baltimore, Annapolis, Capitol Heights (Prince George's County), Greater Lexington Park (St. Mary's County) and Dorchester-Caroline counties.
Last year, Rob Horst, director of health information services at Baltimore-based Audacious Inquiry LLC, which has provided consulting services to the statewide HIE, the Chesapeake Regional Information System for Our Patients (CRISP) suggested that these zones could leverage CRISP to help reduce health disparities. For instance, using the currently available CRISP data and reporting capabilities, readmission rates in each HEZ could be studied to examine the impact of the program, he noted. And by querying the CRISP portal, providers in each zone could improve the care they provide by having a much more complete health history of the patients they are treating.
I called David Horrocks, CRISP’s president, to ask about these Health Enterprise Zones. He agreed with Horst that there is potential for CRISP data to help, but he stressed that these Health Enterprise Zones are not off the ground yet. “My guess is that the way tools are used two to three years from now will be different from what we expect today,” he said. “Those uses will be influenced by reimbursement models now being set up.”
But Horrocks said his organization is hearing from public health officials trying to figure out how to use CRISP data to emulate the Camden Coalition’s “hot spotting” approach to produce reports about areas where there are frequent hospital admissions and re-admissions.
CRISP has all 46 acute-care hospitals in the state contributing data (although 25 percent aren’t providing discharge summaries yet). The state portal is now getting 10,000 queries a month, and a survey suggests that 80 percent of the time providers are finding relevant information. But CRISP wants that number to grow substantially. “We are working on a single sign-on with the hospitals,” Horrocks explained. One of the reasons it isn’t getting greater uptake is the effort it takes to log into the portal and enter patient demographic information. “They do it when they are looking for something in particular,” he said, “but not as a routine part of care yet.” In the long run, CRISP officials also would like a summary of care from ambulatory visits. One roadblock to that goal is technical and involves creating interfaces from multiple EHRs; another is that the ambulatory physicians don’t yet have a compelling reason to contribute, something that Direct messaging, health reform and meaningful use may eventually change.