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HIE Leaders Crack the Code on Indispensability

September 7, 2017
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HIE leaders showed last week in Indianapolis that they’re figuring out how to sustain HIE organizations into the future

 

It was excellent to attend the sessions at the third SHIEC Annual Conference last week in Indianapolis, sponsored by SHIEC, the Strategic Health Information Exchange Collaborative. 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 that 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.

One great example is the Nebraska Health Information Initiative, or NeHII. I was able to sit down with NEHII CEO Deb Bass during the conference, and hear about some of the great things her organization is doing. Under her leadership, NeHII has moved ahead to embed some of its capabilities into core, and even mandatory, state healthcare processes in the Cornhusker State. For example, as I noted, “Since January 1 of this year, all prescriptions for controlled substances in Nebraska have had to be logged into the state government-sponsored Nebraska Prescription Drug Monitoring Program (PDMP) database, which NeHII operates. And, beginning on January 1, 2018, all filled prescriptions will be required to be logged into that statewide PDMP database. Meanwhile, NeHII continues to move forward on numerous other fronts as well, particularly in terms of collaborations with payers and providers in the state.”

I asked Deb about all of this progress. As she noted of the PDMP initiative, “This will help prescribers know which of their prescriptions are ultimately filled, and which not. Our end goal is to address adverse medical events, including the opioid crisis. Look at the dollars associated with adverse medication events, in terms of extended hospital stays, readmissions, etc.,” she said. What’s more, she noted, this initiative speaks to the core of what HIEs can do. As Deb put it, “[W]e are that trusted community partner. We are the neutral convener. For the most part, the HIEs in SHIEC are non-profit collaboratives, and the mission for nearly all of us has to do with patient safety, increasing quality, and reducing costs. We’ve seen real-life stories of what’s happening to people, and it just makes us all the more dedicated towards those goals, with regard to improving the quality outcomes, the cost control, and the patient, family, and community experience of healthcare delivery.”

And that isn’t all: as Susan Beaton, R.N., M.S.N, vice president, provider services, care management, & risk, at BlueCross BlueShield of Nebraska, noted in her presentation as part of a session that brought together payer executives and HIE executives, she continues to be very excited by all the innovative work that her organization has been able to do collaboratively with Deb Bass and her colleagues at NeHII, and with local provider groups. “We at BlueCross BlueShield of Nebraska serve over 700,000 members—two of every three Nebraskans carry our card,” Beaton said during that session. “Physicians and payers working together to utilize NeHII-facilitated data helps provide a path forward” to improving patient/plan member health status and better managing costs, she said. “So it’s very important to participate in health information exchange. And it’s important to make sure we can help NeHII work smarter.”

Among other things, the BCBSNE folks and the NeHII folks are working, together also with provider leaders, to align on a smaller, more standardized group of quality metrics, to help providers to improve care management, and to enhance the use of data as a tool. As she told the audience, “The fact is that 300,000 of our 700,000 members are in patient-centered medical homes or ACOs”—accountable care organizations. “We want providers to work from harmonized sets of measures; we understand that they are very frustrated over having to work with so many different sets of quality measures.”

So right there, you have two very exciting areas that pioneering HIEs like NeHII are getting into: initiatives like the prescription drug monitoring program, and ones involving collaborating with health plans and providers to harmonize and reduce the volume of, quality outcomes measures that providers, especially physicians, have to report on and be incented around.

Meanwhile, two other fascinating areas that innovative HIEs are getting involved in are the collection and sharing of data around the social determinants of health, and, most commonly, providing alerts on transitions of care, something that is becoming very common now.

And what do all these elements have in common? They all involve HIEs making themselves indispensable, in some form or another, to payers, providers, public health agencies, and the healthcare-consuming public.

In a session devoted to the concept of the patient-centered data home (PCDH), and the National Patient-Centered Data Home Initiative, Melissa Kotrys, CEO of Health Current, a Phoenix-based HIE, noted that the patient-centered data home offers “standards-based, cost-effective, scalable data exchange, and links existing HIE systems together.” It also gives providers “comprehensive real-time patient information.” As Kotrys noted, the PCDH “answers three questions: the who, when, and where” of data collection and sharing. That means answering the following, she said: “First, where are my patients getting care? Then, when did my patients get care? What’s happening in my own region, and when patients are traveling? And who is the patient who got care?”

Furthermore, Kotrys told the audience, the PCDH concept “helps to resolve issues with identity across HIEs,” without requiring the development of a single, “universal” identifier. What’s more, she noted, the PCDH “preserves local governance and protects local stakeholders—it honors local data use policies.” And it “enhances data aggregations required for reporting for value-based programs.”

The potential for all of these capabilities, and for these implementations to support value-based healthcare, is tremendous; and the HIE leaders gathered in Indianapolis know it.

What’s more, the leaders of the successful HIEs, especially of the successful statewide HIEs, have been learning very quickly how to leverage the provision of all of these types of services into real sustainability.

And that is where the future lies in all of this. It is about HIEs finding ways to support the new, value-based, accountable, transparent healthcare system that is emerging, in ways that only HIEs can.

And while HIE leaders will continue to face a thicket of challenges going forward, what is clear is this: the really smart leaders of the really strategically developed and managed HIEs nationwide, are figuring this out. Will the intense challenges that face HIEs right now continue into the foreseeable future? Absolutely. But there’s no question that some of the smartest, savviest HIE leaders are figuring out that the secret to HIE sustainability lies in HIE indispensability, and are moving very quickly to skate to where the puck is going, on that front.

It will be fascinating to watch the HIE sector evolve forward in the coming year, and beyond. One thing is clear: for every challenge facing that sector, there is equal opportunity. The SHIEC Conference’s sessions and discussions demonstrated that reality in living color. I look forward to our publication covering he ongoing unfoldment of this important industry sector. It certainly will be a fascinating next few years in this area.

 

 

 

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Hawaii’s HIE Leveraging Technology to Improve Patient Identification

November 8, 2018
by Heather Landi, Associate Editor
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Hawaii Health Information Exchange (HHIE), Hawaii’s state-designated HIE, is taking action to improve patient identification and the accuracy of provider data for enhanced care coordination across the state.

HHIE is working with Pasadena, Calif.-based NextGate to implement an enterprise cloud-based master patient index and provider registry software to create a sustainable statewide system of accurate patient and provider data by resolving duplicate and incomplete records.

HHIE was established in 2006 to improve statewide healthcare delivery through seamless, safe and effective health information exchange. The HIE covers more than 1.2 million patients and has more than 450 participants including Castle Medical Center, Hawaii Pacific Health, The Queen's Medical Center, and the state’s largest insurance provider, HMSA.

“Accurate, comprehensive data that flows freely across boundaries is a catalyst for informed, life-saving decision making, effective care management, and a seamless patient and provider experience,” Francis Chan, CEO of HHIE, said in a statement.

Chan adds that the technology updates will help to ensure providers have “timely and reliable access to data to deliver the high-quality level of care every patient deserves.” “We are building a scalable, trusted information network that will positively influence the health and well-being of our communities,” Chan said.

“The partnership will enable HHIE to develop internal support tools to create accurate, efficient patient identity and provider relationships to those patients to support focused coordinated care,” Ben Tutor, information technology manager of HHIE, said in a statement.

Cross-system interoperability is critical to the success of HHIE’s Health eNet Community Health Record (CHR), which has more than 1,200 users and 470 participating physician practices, pharmacies, payers and large healthcare providers that contribute to over 20 million health records statewide. Deployment of the EMPI’s Patient Matching as a Service (PMaaS) solution will support HHIE’s vision of a fully integrated, coordinated delivery network by establishing positive patient identification at every point across the continuum for a complete picture of one’s health, according to HHIE leaders.

By ensuring that each individual has only one record, participants of HHIE will be able to map a patient’s entire care journey for informed decision-making and population health management, HHIE leader say.

The provider registry will synchronize and reconcile provider data across clinical, financial and credentialing systems to enable an accurate directory and referral network of providers. Using a single provider ID, the registry aggregates and maintains up-to-date information about individual providers and provider groups, such as specialties, locations, insurance options, hospital privileges, spoken languages, and practice hours. Providers can also easily identify who else is on their patient’s care team as well as what other clinicians should receive test results, lab reports and other treatment summaries.


 

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HIE 2.0: CORHIO’s Leaders Map a Pathway to Advanced Data-Sharing Success in Colorado

November 7, 2018
by Mark Hagland, Editor-in-Chief
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CORHIO’s leaders have been involved in intensive work to improve data quality, while expanding data-sharing more broadly

The leader of CORHIO, one of the most progressive health information exchange (HIE) organizations in the country, continue to innovate forward across a broad range of areas. The Denver-based CORHIO already connects 65 hospitals across Colorado—virtually all of the inpatient community and academic facilities in the state—and connects around 5,000 physicians statewide as well.

As the organization’s website notes, “CORHIO empowers people, providers and communities by providing the information they need to improve health. Our advanced health information exchange (HIE) technology, data analytics tools and expert consulting help healthcare providers access information that saves lives, streamlines care coordination, reduces costs, and improves clinical outcomes for millions of people.”

Recently, CORHIO’s leaders, including Morgan Honea, the HIE’s president and CEO, and Mark Carlson, its director of product management, have been pushing ahead to connect providers across the state both more broadly and more deeply—extending out into the behavioral health sphere as well as facilitating the sharing of more granular data across Colorado, through data normalization work. Honea and Carlson spoke recently with Healthcare Informatics Editor-in-Chief Mark Hagland regarding their current initiatives. Below are excerpts from that interview.

You’ve been expanding some of your core data-sharing capabilities of late, correct?

Mark Carlson: Yes; we certainly do have some activity and infrastructure that we’ve been building out. I’ll focus in on clinical and population health first. One area we had identified a couple of years ago in terms of being able to generate information for population health, at the state level, or in partnership with ACOs, came about as the state pushed forward an initiative called “regional care collaboratives” with ACOs. As part of that initiative, we did work on packaging and bundling notifications around ED visits and hospitalizations and discharges, for providers, as well as helping smaller physician practices in that area. And we’ve been looking at expanding out that concept around clinical indicators, initially focusing on labs.

We have 65 hospitals sending data into CORHIO, and we had 30-plus representations as to how a hemoglobin a1c might be represented, in terms of vocabulary and coding. So we used NLP [natural language processing] to help us with that, to help move forward in disease management in areas like diabetes. We’ve also focused on another use case with our Department of Health in Colorado, around an influenza use case, where we’re able to flag a positive influenza use test and track for an inpatient admit that occurs within 48 hours, to map the cost of care as well as the ability to access supporting resources that hopefully would avert an inpatient admission.

That’s what we’re working on—normalization across general labs and clinical metrics; and as we expand our data types, we’re expanding towards social determinants, as well as labs that extend beyond the general labs.

Morgan Honea: I agree with everything that Mark said. I would just add that this is, really, in my opinion, kind of a second evolution around the interoperability question. We’ve got a tremendous HIE with tremendous participation here in Colorado. The important fact is that, after laying the infrastructure for a statewide HIE, it next becomes imperative move into normalization across data sources, so that you’re not changing vocabularies or nomenclature.

That sounds like “HIE 2.0,” in terms of the advanced work, doesn’t it?

Carlson: That’ll work.

What’s next or top priority now for providers?

Honea: Our top priority is to continue to expand the type of data available in the HIE. In that context, we’re facing up to the incredible challenge of continuing to integrate behavioral data into the system. We’re also working with state agencies, to make sure that folks are getting the best care coordination for the best outcomes possible. And probably the highest demand from our clients is fewer queries and more push notifications and types of functionality, greater integration into EHRs [electronic health records] and other population health-type tools, with really clean, neatly packaged data, which is where this conversation becomes more important, because as Mark said, with hemoglobin a1c, things get very messy as the volume of the data grows, if you’re constantly having to clean up the data. So providing the data in interoperable, easily usable ways, is a top priority.

Carlson: And you have to follow the money in terms of reimbursable events and other value-based areas. So as we improve our inbound CCDA-type activities, we want to improve the quality of submission at the level of formatting as well as presence of charted measures, as being able to format and report those out, from practices, including around broader performance measures.

With regard to the capture and sharing of data, are you making any use of artificial intelligence? And where is that going?

Carlson: One of our core initiatives is, how do we become more situationally aware? I’ve looked at FHIR as a path forward, in that context Whereas the CCDA is a blunt-force instrument, FHIR provides the opportunity to be a lot more precise in packaging and bundling data. For example, we’ve been working on a use case for an anesthesiology group. They want to see problems, meds, last treatments, discharge summary, they don’t want to see everything. FHIR helps us to bundle and package data, and then via an API connection, they can receive more precise information that meets their needs, rather than via all-encompassing data. More targeted, based on clinical needs.

Honea: The ability to get down the discrete data level, understand the data points and bundle and share them, is where I think things are going. A CCDA is a big, narrative summary of an encounter, and doesn’t get down to that level of granularity.

Carlson: In the media right now, there’s been a lot of discussion around where the next steps of IBM Watson should be. And we’ve had this discussion with a lot of vendors in the past, where we’ve been introduced to some very compelling functionality; but then some wonderfully designed tools absolutely choke on some of the variability of the nomenclature in the data. And that prevents us from getting to advancing the Quadruple Aim. Those learnings and market information that we’ve gathered over time, indicated our absolute need to partner with organizations that have a foundation for creating mappings that are clinically valid and reliable and backed with the expertise behind it. That can help us get to the population health insights that you’re referencing when you mention AI.

Do you think you’ll be able to incorporate some social determinants of health data into what you’re sharing?

Honea: That’s an area where I’m spending some of my time now. I have no doubt that we’ll run into the same challenges with local code sets and varying terminologies with that type of data that we’ve had with clinical data. I don’t see that that process is strictly limited to hospital and clinic data; I think it will go across all sorts of systems; and when we share from one program to another and one type of data system to another, we’ll face the same types of challenges and requirements for data standardization. So we’ll probably rinse and repeat every time we go out and get another data point.

Carlson: We are working with United Way 211, understanding how their community resources and curated content and partnerships are working, and getting insights from diabetic prevention programs and food banks—the data quality is as variable as some of the source organizations involved. I think this opens up a whole new opportunity for whole-person care, but it will pose some of the types of data normalization and use challenges as clinical data.

How do you see the next few years evolving forward at CORHIO?

Carlson: We’ve touched on a lot of priorities—ECQM work… our learnings in various areas. It’s a big lift to ingest the CCDA documents and get consistency at the data level. Our partner organizations continue to work with us and with Wolters Kluwer, to work on various types of data together. When we spoke at the HIMSS Conference earlier this year, Morgan and I talked a lot about data normalization work and about data visualization, and about being able to visualize risk across counties and the state, to identify pockets of need. And in that context, the social determinants data will help us understand where the food deserts are, and where high levels of chronic diabetics live. We have a number of mountain and rural communities that are fairly isolated, so our opportunities to impact that, are large, but so are the needs, and thus, we need to address data quality issues.

Honea: I agree with everything that Mark said. We’ve got this never-ending effort to include programmatic elements, site-specific elements, into the HIE, every kind of element—that work will never end. But I’m also continually focused on the question of how we as a state, with only 5 million people, can identify ways to leverage the infrastructure built with significant investment at the federal, state, and local levels, to advance our overall HIE efforts as a state, and minimize the risk of continually building new silos of data that will just require new efforts in the same fashion? How do we improve coordination when folks are moving across different geographies or service areas, without rebuilding existing infrastructure? How do we partner with communities to get the biggest bang for our buck? That requires a lot of planning and coordination and collaboration.

Carlson: For HIEs to provide value, Morgan and I often say, it’s data versus documents. Document exchange has a very valuable place in the broader landscape, but where the HIEs are differentiating themselves is at local-level attention and relationships and meeting community needs, and where we can operate at the data level to provide the insights to drive patient care quality forward.

 

 

 


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Seven HIEs Now Connected to Military Health System

November 1, 2018
by Heather Landi, Associate Editor
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Seven physician-led health information exchanges (HIEs) are now connected to the Military Health System (MHS), enabling MHS providers to have access to patients’ electronic health records to support clinical decision making at the point of care.

The Kansas Health Information Network (KHIN), the eHealth Exchange, and KAMMCO, a provider of insurance and health care technology services for physicians and other health care professionals, assisted in facilitating the connection.

With this new development, medical records can be shared across the world as military personnel and their families transition between multiple locations, stateside or overseas. Military hospitals and clinics now can quickly and securely access patients' personal health information 24/7 and have access from the physician-led HIEs in Kansas, Connecticut, New Jersey, South Carolina, Georgia, Missouri and Louisiana.

“This represents the growing capabilities of HIEs to share records in all locations from which a patient has received care,” Laura McCrary, executive director of KHIN, said in a statement.

“MHS cares for 9.4 million beneficiaries, delivering care globally in military hospitals and clinics and providing coordinated, integrated care through civilian networks," Kimberly Heermann-Do, Health Information Exchange Office Lead in the EHR Modernization Program Management Office, said. Heermann-Do added, “Through HIEs, records are available securely from the private sector if the HIE is onboarded to the MHS. Having access to records for patients across the KAMMCO network will assist MHS providers with clinical decisions.”

“The Medical Society of New Jersey (MSNJ) has a long history of supporting the healthcare needs of our active duty military in New Jersey. Sharing clinical information from our physician practices with MHS through OneHealth New Jersey furthers our support in this important area,” Larry Downs, MSNJ CEO, said in a statement. “With a large joint base located in New Jersey our physician members provide care to many active duty military and their families.” MSNJ is one of seven medical societies who partner with KAMMCO in the delivery of a physician-led health information exchange platform.

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