Self-Congratulation on HIE Advancement Would Be Premature at This Point | Mark Hagland | Healthcare Blogs Skip to content Skip to navigation

Self-Congratulation on HIE Advancement Would Be Premature at This Point

June 25, 2018
| Reprints
Health IT leaders face ongoing core challenges in HIE problems that patients and their families continue to experience nationwide

Even as many healthcare IT leaders are justifiably congratulating themselves on the recent advances they’ve made in the arena of health information exchange (HIE), both in its formal sense and more broadly, reports from the trenches speak to the vast gaps in efficient, effective clinical communication that remain.

Take for example the current medical odyssey that a married couple who are good friends of mine are experiencing. I’ll call my friends “A” and “B.” A is the husband, and B is the wife. They live in one of the nation’s largest cities, one known for the excellence of its patient care—which plays into this story. In any case, A is 47 years old and B is 45. They are generally both robustly healthy. But a few months ago, A began experiencing serious symptoms, including fainting, very poor sleep, and chest pain. And, a couple of months ago, after he had fainted and gone unconscious at home, he was rushed to the emergency department at the suburban hospital near to where A and B live. So far, after many diagnostic tests and other diagnostic work, he has received a preliminary diagnosis of sinoatrial node dysfunction, though many questions remain to be answered. Most patients with cases like A’s will need to have a pacemaker implanted, but his physicians are taking him through a battery of tests to help them obtain diagnostic certainty, given the seriousness of pacemaker implantation, especially at his age.

Now, here’s where the health IT and interoperability and health information exchange issues come in. A and B have been having a terrible experience with those issues at the suburban community hospital to which A was rushed a couple of months ago via ambulance. Let’s call it Happy Suburban Hospital. B isn’t certain exactly what kinds of health IT capabilities Happy Suburban Hospital has, but they clearly are substandard. They handed her several CDs, containing A’s CT and MR scans and echocardiograms, and she had to snail-mail them to the tertiary/quaternary care hospital down the road, which I’ll call Big University Hospital. Shockingly, with regard to associated paperwork and documentation, B ended up having to go to her own work office to fax piles of printouts she had received from Happy Suburban, to Big University.

What’s more, B told me in a recent phone call, she had had to make four separate trips to the medical records office at Happy Suburban, where she received poor service and experienced lackadaisical attitudes on the part of the medical records office staff.

So A and B are having two experiences here. The first is with the core clinical situation, which involves great uncertainty for A and for them as a couple and, with their children, as a family. There have even been numerous complications there, in terms of handoffs, in terms of communications between and among primary care physicians, hospitals, specialists, and subspecialists, that are too complex to explain clearly. But in any case, that is one situation.

The other, though, has to do with this incredibly frustrating experience of dealing with a lack of interoperability and data flow between and among the various clinical parties. Patients and their family members are still having to fax basic documentation, and to snail-mail CDs with diagnostic images on them, now, in the middle of the year 2018?

What’s particularly frustrating here is that the technology absolutely is available, through HIE arrangements, the DIRECT program, and other means, to move this key data and information appropriately from one patient care organization to another, and from one clinician to another. So part of the core problem is process and human and organizational, not technological. As Robert Wachter, M.D., states in his 2015 book, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age, “[T]he speed with which health IT achieves its full promise depends far less on the technology than on whether the key stakeholders—government officials, technology vendors and innovators, healthcare administrators, physicians and other clinicians, training leaders, and patients—work together and make wise choices.”

Indeed, in his chapter, “A Vision for Health Information Technology,” Dr. Wachter, in the middle of a several-pages-long description of his vision of the electronic health record (EHR) future, writes, “All patient data will reside in the medical cloud, which will provide the essential infrastructure to ensure complete interoperability. Successful EHRs will be open, not by legislative fiat but because closed systems will be unable to compete in market that demands that useful apps developed by third parties be accepted. Ditto usability: the government will not dictate usability, the market will, and it will do so effectively.”

What’s more, when Dr. Wachter delivered a keynote address at our Health IT Summit in Beverly Hills on Nov. 3, 2015, he spoke of some of the process and organizational changes that will need to take place before technology that either is already available or is beginning now to emerge, can successfully be used for optimal benefit. With regard to all the disruptive changes now buffeting providers, Wachter said, “In my book research, I did not find that there were bad people at Epic or Cerner or in the government or in hospitals, or anywhere. Everybody’s trying to do their best. But part of the problem is that we treated computerization in healthcare as technical change, meaning that you turn it on and follow a series of steps; and we thought healthcare IT would be like that, like turning on an app. But in fact, technology has posed adaptive problems: it’s been about people having to change because of technology implementation.”

So on the one hand, Wachter said, “It’s natural to think that you just put it in and it will work. But we all kind of whiffed on it. And now we’ve learned. And Erik Brynjolfsson in 1993 coined the concept of the ‘productivity paradox’ of information technology, across all industries. The idea was that there will be an inevitable delay in the productivity gains expected from computerization. And then somewhere between years five and 15, you see major gains in productivity. Brynjolfsson says there are two keys. First is that you see improvements in the technology. The second key is that people begin reimagining the work itself.” And that, Wachter said, is exactly what is beginning to happen in healthcare, as automation begins to afford possibilities for true process transformation in healthcare delivery.

Things will continue to be rocky and complicated for a while, Wachter concluded in his November 2015 address to our Health IT Summit, but he said that healthcare leaders need to be prepared for the profound changes in re-visioning what healthcare delivery will be like, that will come soon enough. And with regard to technology, he said, “It’s a standard response to change: people don’t know what they want or need from a new system until they’re using it. Henry Ford said, if I’d asked people what they wanted” before he had invented the automobile assembly line process, “they would have said, faster horses.”

Sadly, my friends A and B have come away from their ongoing medical odyssey with the sense that, in terms of health data exchanges, we in the healthcare delivery system are still using horses. Now, to be fair, advances are being made in many places, advances that in the future could help A and B and A’s caregivers in future episodes of care. For example, as Senior Contributing Editor David Raths learned when interviewing Laura Young, interim executive director at healtheConnect Alaska earlier this month, that state’s statewide HIE, that organization is working developing on a radiology image exchange with a company called Ambra. Imagine the potential of that system for diagnostic image exchange, in a state as large as the entire Upper Midwest (Minnesota, North and South Dakota, Iowa, Missouri, Iowa, Wisconsin, Illinois, Michigan, Indiana, and Ohio) states combined. It is well-known that distances are immense within Alaska; the electronic sharing of diagnostic imaging studies could be an important breakthrough there.

Meanwhile, my friends A and B would be thrilled in Happy Suburban Hospital could get its act together to get images and data on A’s tests and conditions just three or four miles to Big University Hospital. So before anyone gets overly self-congratulatory about the successes to date of HIE in the U.S., let’s keep in mind that there are countless stories like that of my friends A and B out there.

 

 

 

 

Renowned leaders in U.S. and North American healthcare gather throughout the year to present important information and share insights at the Healthcare Informatics Health IT Summits.

Find Your City


/blogs/mark-hagland/hie/self-congratulation-hie-advancement-would-be-premature-point
/article/hie/one-new-york-regional-hie-opposes-expansion-another-highlighting-issues-competition-0

One New York Regional HIE Opposes Expansion of Another, Highlighting Issues with Competition Among HIEs

September 24, 2018
by Heather Landi, Associate Editor
| Reprints
In a 2015 report, 84 percent of HIE leaders cited competition among HIEs as a barrier to development
Click To View Gallery

A New York regional health information exchange (HIE), HealthlinkNY, based in Binghamton, has publicly come out against another regional HIE’s plans to expand its services into HealthlinkNY’s market, saying it creates “confusion and uncertainty” in the marketplace.

Last week, Hixny, an HIE based in Albany that historically covered north and west of the Capital District, announced that it had added nine counties to its territory, specifically Chenango, Broome, Sullivan, Ulster, Dutchess, Orange, Putnam, Westchester and Rockland counties in southern New York. These nine counties are already covered by HealthlinkNY’s network, which covers a 13-county service area spanning the Hudson Valley, Catskills, and the Southern Tier of New York (the Southern Tier encompasses counties of New York west of the Catskill Mountains along the northern border of Pennsylvania).

With the expansion, Hixny now serves 28 counties and the HIE already has updated its website to state that it serves communities from Westchester to the Canadian border and Binghamton to Vermont. Hixny CEO Mark McKinney claims that this area, the Hudson Valley and Southern Tier region, has "historically lagged in connecting providers to one another and collecting patient consent.”

Staci Romeo, executive director of HealthlinkNY, notes that all 35 hospitals in the Hudson Valley and Catskill regions are HealthlinkNY participants. In those nine counties, Hixny has 21 sites and no hospitals, according to Romeo.

Both HIEs are two among the state’s eight qualified entities (QE) connected by the Statewide Health Information Network for New York (SHIN-NY) – a “network of networks” that allows the electronic exchange of clinical information and connects healthcare statewide – overseen by the New York State Department of Health and managed by the New York eHealth Collaborative (NYeC). According to the NYeC website, participating healthcare organizations can connect with the QE that best aligns with their business, operational, and service delivery needs. 

HealthlinkNY issued a strongly worded press release late last week in response to Hixny’s expansion plans. “The truth is that an unnecessary expansion into this service area compromises the effectiveness of the Health Information Exchange [HIE],” Romeo said in the press release. Romeo also stated, "While others seek to confuse the marketplace for their own professional gain, our focus is pure: to help providers improve the continuum of care."

During interviews Romeo and Hixny's McKinney both addressed the expansion plans. Romeo says Hixny’s expansion into its territory creates competition between the HIEs and says the competition is a “distraction, it’s confusing for participants and it’s completely unnecessary.”

McKinney says, “The primary reason for us to consider expansion is because patients and providers really are not bound by county borders. We have long been a trail blazer as an HIE both in the state and around the country. From our perspective, reaching into those regions helps to meet the needs of those patients.” McKinney says Hixny officials recognized that there was an overlap of patients seeing providers both in Hixny’s service area and in neighboring counties.

“We looked at data for patients already inside our master patient index, and we saw significant percentages of patients already had records inside our systems, so for those providers and those patients, getting a more accurate and complete record and making that system available to providers seemed like a valuable exercise to bring all that information to one place,” he says. “This gives providers a choice in terms of what they value with regard to the services that are provided.”

According to Hixny’s website, 1 in 5 residents of the Hudson Valley and Southern Tier already have Hixny records, and that figure increases to more than 1 in 2 in counties neighboring Hixny's established service area, the website states.

HealthlinkNY's service area

Hixny's service area

McKinney also notes that it is not uncommon for multiple HIEs to serve multiple markets and he believes its beneficial to have two HIEs serving the same counties. “I think what’s most important is to meet the needs of patients and providers. Ultimately, it’s about patients and providers and making sure they have access to the information that they need,” he says.

And in response to Romeo’s statement that Hixny’s expansion creates “confusion and uncertainty in the marketplace.” McKinney says, “I can’t comment on her response; what I can say it that we’re very committed to our expansion and delivering the data and the information that will improve care and lower costs for patients and providers in the region.”

Hixny (formerly known as the Health Information Xchange of New York) launched in 1999 as a collaboration between Iroquois Health Care Alliance, which represents upstate hospitals, and the New York Health Plan Association. The HIE currently serves 1.7 million patients.

Regional HIEs enable provider organizations to access and exchange health information with participants in their region, and, in New York State, all eight QEs connect to SHIN-NY, which acts as a hub to provide access to patients’ health information statewide. When contacted for comment, Valerie Grey, executive director of the New York eHealth Collaborative (NYeC), stated, “Ultimately, our role is to help expand participation in the information network and support all of our partners in that process. We’re going to continue that work with each of our eight regional networks because increased participation will improve health outcomes across New York.”

Historically, HIEs separately increase their networks within their agreed-upon geographic areas, while there also is a great deal of collaboration between regional HIEs. However, one challenge for many HIE leaders is determining how to exchange information with competing organizations.

Healthcare researcher Julia Adler-Milstein, Ph.D., who has done extensive research on HIEs, says there are regions with multiple HIEs operating and competition among HIEs is a common issue, although it’s often discussed in “backroom” conversations. Adler-Milstein is an associate professor of medicine and director of the Clinical Informatics and Improvement Research Center, School of Medicine, at the University of California San Francisco.

Three years ago, Adler-Milstein was part of a team of researchers from the Mathematica Policy Research, the Harvard School of Public Health and the University of Michigan, School of Information that published research examining health IT adoption, including the advancement of community HIEs. As part of that study, the researchers surveyed HIE leaders about barriers to development, and 84 percent of respondents cited competition among HIEs as a barrier to their development.

In Opposing Hinxy's Expanion, HealthlinkNY Claims "Sour Grapes"

HealthlinkNY officials also take issue with the wording of Hixny’s press release stating that information sharing "historically lags" in the Hudson Valley and Southern Tier region, which is HealthlinkNY's territory.

McKinney says, "There has been public information that has demonstrated that the growth of SHIN-NY across the state has been uneven and so we’re basing [that] on some of that information that has demonstrated that certain areas have grown faster than others." He adds, “We think our press release stands for itself, in terms of demonstrating that there is a need for Hixny to deliver the data and the information that will improve care and lower costs for patients and providers in the region.”

In HealthlinkNY’s press release, Romeo said Hixny’s claims against HealthlinkNY’s impact and progress are "completely unfounded.”

HealthlinkNY, which launched in 2005, has all 35 hospitals in the Hudson Valley and Catskill region participating and sending data to their HIE, as well as 1,207 sites, according to Romeo. HealthlinkNY also recently hit the two million patient consent mark and has 374 participating provider organizations, up from 271 at the end of 2017, according to Romeo. HealthlinkNY also administers two Population Health Improvement Programs (PHIPs) in the Hudson Valley and Southern Tier. HealthlinkNY’s service area population is just shy of 2.9 million residents and includes nearly 1,800 participating locations.

Further, Romeo stated in the press release that Hixny’s claims “sound like a case of sour grapes after being passed over during our search for a strategic partner.” HealthlinkNY has entered into strategic partnership discussions with HealtheConnections, another HIE located in Syracuse that serves central New York, and Romeo stated, “HealthlinkNY had recently advised Hixny that they did not make the cut.”

When reached for comment on Romeo’s claim, McKinney responded, “Hixny’s strategy for expansion is solely based on getting providers data that is complete, accurate and up-to-date and supporting the success of the SHIN-NY by improving the overall health of our communities.” 

Romeo notes that HealthlinkNY has significant plans underway in the Hudson Valley and Catskill regions to increase its presence and breadth of services offered. As part of this strategy, HealthlinkNY is looking to work with a strategic partner with “innovative services and an unwavering commitment to providing value,” she says. After interviewing potential partners, HealthlinkNY decided to collaborate with HealtheConnections.

Romeo said in the press release that HealthlinkNY entered discussions with HealtheConnections because “they are in alignment with us with respect to mission, best practices, services, capabilities, and culture.” She further stated, “They also will help power a more sophisticated technology platform as well as a complementary program for population health, critical with today’s burgeoning opioid crisis and the need for increased access to mental health services. We want to take this to the next level.”

Romeo further expanded on the partnership: “The combination of services currently provided by both QE's will be expanded by this partnership. Just a few examples are: additional functionality regarding actionable analytics, HEDIS reporting, as well as alerts provided how and when participants need them. We are looking forward to synergies and shared best practices between both organizations.”

 


More From Healthcare Informatics

/news-item/hie/regional-new-york-hie-hixny-adds-nine-counties-its-territory

Regional New York HIE, Hixny, Adds Nine Counties to Its Territory

September 17, 2018
by Heather Landi, Associate Editor
| Reprints

Hixny, a regional health information exchange (HIE) based in Albany, has added nine counties to its territory, committing a significant amount of funding over the next 18 months to connect local providers.

Hixny is one of the state’s eight qualified entities (QE) connected by the Statewide Health Information Network for New York (SHIN-NY) – a “network of networks” that allows the electronic exchange of clinical information and connects healthcare statewide – overseen by the New York State Department of Health.

“The success of the SHIN-NY hinges on meeting the needs of providers based on complete, accurate and up-to-date data,” Mark McKinney, CEO, Hixny, said in a statement. “At Hixny we’ve demonstrated the effectiveness of our model – and want to do the same for the providers and patients in our neighboring regions.”

The region in the Hudson Valley and Southern Tier has historically lagged in connecting providers to one another and collecting patient consent, according to Hixny officials.

Hixny’s territory encompasses 28 counties north and west of the Capital District and south of Hudson Valley. In its existing region, 100 percent of hospitals and three out of every four providers are connected via Hixny. Ninety-two percent of adult patients have given consent to their physicians, a number that increases each month. Additionally, it offers the only patient portal in the state called Hixny for You, allowing patients to view their own medical history, with data that spans the entire state.

“Their reputation precedes them,” Yuk-Wah Chan, M.D., a family practitioner in Pleasant Valley, NY, part of Hixny’s new territory, who recently signed-up, said in a statement. “More than ever, physicians need to deliver higher quality and more personalized care to their patients while lowering costs – to do that, you need access to the best, most reliable data. And that’s Hixny.”

Eight total locations have already signed participation agreements with Hixny: Dialysis Clinic, Inc.’s three locations in Elmsford, Hawthorne and Yorktown; Hurley Avenue Family Medicine’s three locations in Kingston, Stone Ridge and Saugerties; Premier Dialysis Center in Goshen and Dr. Chan’s practice.

All participating organizations will have access to patient information across the state through the SHIN-NY.

“We are pleased to welcome these new providers to Hixny; their decision proves that providers who have a choice will choose better data,” McKinney stated. “Hixny is changing the game and this news is only the first of many announcements that demonstrate why Hixny is the best option.”

 

Related Insights For: HIE

/article/hie/power-data-exchange-disaster-strikes-how-hie-leaders-have-prepared-hurricane-florence

The Power of Data Exchange as Disaster Strikes: How HIE Leaders Have Prepared for Hurricane Florence

September 14, 2018
by Rajiv Leventhal, Managing Editor
| Reprints
The executive directors of GRAChIE and NC HIEA say building HIE-to-HIE connections throughout the region, in preparation for a natural disaster, speaks to the power of health information exchanges

As the nation—particularly the Southeast U.S.—braces for the force of Hurricane Florence, which as of the time of this publishing has made landfall in North Carolina, just a day after Georgia’s governor declared a state of emergency for every county in the state, healthcare and health IT leaders continue to work in overdrive to help those in need.

Indeed, major disasters such as Hurricane Florence have an effect on healthcare information needs—even before they make landfall. This particular hurricane has already resulted in the evacuation of millions who have left the places where they normally receive care and where their healthcare records are housed. In these situations, electronic health records (EHRs) and health information exchanges (HIEs) can certainly play a large role in disaster relief efforts.

For instance, the Georgia Regional Academic Community Health Information Exchange (GRAChIE), which serves healthcare organizations and providers across Georgia, is currently working to connect to eHealth Exchange participants in South Carolina, North Carolina, Virginia and Florida in preparation for displaced evacuees. The idea is for GRAChIE to expand its connectivity to HIEs throughout the Southeast via the eHealth Exchange—a health data sharing network that is part of the Sequoia Project, inclusive of provider networks, hospitals, pharmacies, regional HIEs and many federal agencies, representing more than 75 percent of all U.S. hospital and 120 million patients—as quickly as possible before Hurricane Florence hits the coast, according to the organization’s officials.

Tara Cramer, GRAChIE’s executive director, says that her organization learned from what happened last year during Hurricane Irma, in that Florida was evacuating patients who ended up being displaced to Georgia. So even though GRAChIE used the eHealth Exchange to build out connections through Florida, the problem was that they had to do it so quickly, and at the time Florida was already under evacuation. As such, there weren’t HIEs on the other side of those connections to help with testing and validation, explains Cramer. “This time, we started very early to build out functional connections on both sides. This is the power of HIE, and it’s very technically possible, although it does require some magic to pull it off so quickly,” she says.

Tara Cramer

Meanwhile, in North Carolina, where the storm is hitting hardest right now, leaders at the NC Health Information Exchange Authority (NC HIEA), which is based in Raleigh, and has only been fully functional since March 2016, have also been working throughout the week to establish and build connections with other HIEs.

Christie Burris, NC HIEA’s executive director, says she owes “a debt of gratitude” to Cramer and other GRAChIE other top executives, since on Tuesday morning Cramer alerted Burris that these connections were possible via the eHealth Exchange. “Shortly after that [conversation], we got together with the East Tennessee Health Information Network (eTHIN), I got my team together and said let’s talk with our vendors, so we can figure out the feasibility in doing these out-of-state connections,” recalls Burris. “And at that time, we weren’t sure when the storm was hitting, so we spent Tuesday through Thursday working with these different HIEs, and we pulled [those connections] off successfully,” she says.

Indeed, in addition to the connection with GRAChIE, NC HIEA signed agreements with four other HIEs this week so that bi-directional exchange could occur: Coastal Connect HIE (Wilmington, N.C.); eTHIN; MedVirginia (Richmond, Va.); and SCHIEX (South Carolina Health Information Exchange). NC HIEA also already had an established connection with GaHIN (the Georgia Health Information Network, based in Atlanta) and the VA HIE (Veterans Administration). “We signed agreements with five of those HIEs last night at 9 p.m.,” Burris says.

Christie Burris

As it stands right now in North Carolina, explains Burris, more than 20 counties in the state have been evacuated, leading to numerous displaced citizens. What’s more, many pharmacies, hospitals, clinics and doctor’s offices have been closed, and prescribing patterns disrupted, leading to many patients having to reconnect with their care regimens, often in new settings.

Shelters in New Bern, a riverfront city near the North Carolina coast, are at capacity as the town flooded last night, Burris notes. And shelters in Raleigh are also at capacity, so some of those folks got moved to Winston-Salem. Thankfully, Burris says that her HIE has a central repository in which it holds onto the patient data, meaning that even if a hospital has been shut down—such as in the town of Wilmington where every hospital but one has been closed—NC HIEA has those patient records up until the time the hospital stops sending them. “So we do have that historical [view of] the patient, and at this point we have over 5 million unique patient records in our North Carolina repository,” says Burris.

Cramer notes that caring for displaced citizens has been a core reason why GRAChIE has been such an advocate for standing up these HIE connections on the fly, and quickly, during the time of a disaster. On a day-to-day basis, she says, “We know that Georgia and North Carolina residents may present at an urgent care facility or the ER, but we also know that during these times, it’s heightened. So if we can equip clinicians with a patient’s allergy list and medication history, that’s still a great starting place to take care of someone who has been evacuated and is already going through a stressful time without friends and family. It is our job to broadcast that net and gather as much information as we can for when they present for care,” Cramer says.

To this end, she adds that at one of GRAChIE’s participating Georgia hospitals, 14 new patients with North Carolina addresses were registered yesterday. “And we are continuing to monitor that throughout the day to see where patients are coming from. It’s our job to watch that and make sure we are delivering quality information.” She also notes that even though Georgia has escaped the major brunt of the damage from this hurricane, the state will still get plenty of evacuees, and preparations have to be in order. “We started reaching out [to HIEs] before we knew a storm may be coming so that we could build relationships. We have built connections with GRAChIE that we don’t keep active all the time, but when we need to activate them, we can. That’s been a key for us since Hurricane Irma,” she says.

Both Burris and Cramer also expressed great gratitude to the Strategic Health Information Exchange Collaborative (SHIEC), a national collaborative of HIEs, for making these connections possible. “I would have not known Tara if not for SHIEC,” admits Burris. And even though GRAChIE and NC HIEA are not yet part of SHIEC’s patient-centered data home (PCDH) project—a model based on triggering episode alerts, which notify providers that a care event has occurred outside of the patients’ “home” HIE, and confirms the availability and the specific location of the clinical data—both HIEs have plans to link up to it quite soon.

In the end, while Burris and Cramer believe in the power of HIEs when a storm hits, they also attest that providers of all types should not wait for a natural disaster to participate. “We want there to be value in the day-to-day exchange of information,” says Cramer. “In these times, you might have a more heightened awareness, but there is every-day value in health information exchanges.”


See more on HIE