It was quite interesting to read a recent evaluation of the Vermont Health Information Exchange (VHIE), which found governance and data quality issues, as well as low usage rates. As Senior Contributing Editor David Raths reported, “Only 19 percent of Vermont patients’ records are currently accessible in VHIE, and statistics show providers generally use VHIE for limited purposes.” It was also noteworthy to read in that story that the organization that operates VHIE agrees with the evaluation and “believes the state should undertake a comprehensive realignment of the governance and delivery of its health information technology and exchange initiatives statewide.”
More broadly, research on the value of health information exchanges (HIEs) to date has been mixed and unclear. One study, published recently in Information Systems Research, concluded that HIEs do have the potential to cut billions in Medicare spending, but the key being that the healthcare market must have an established HIE infrastructure in place. In reality, many markets do not. Then there is the issue that it has been challenging for researchers to even come to real conclusions on the impact of HIEs. A recent paper published by healthcare researchers found that slowness in implementation and usage makes it difficult to measure their effectiveness.
But despite a lot of the negativity surrounding HIEs—and the many challenges that they face—a fairly new initiative from the Strategic Health Information Exchange Collaborative (SHIEC) has gotten me thinking that the narrative around HIEs, and specifically HIE-to-HIE exchange, might soon be shifting.
SHIEC, a Grand Junction, Colo.-based national collaborative representing health information exchanges, announced in June 2016 that three HIEs in the southwest—Arizona Health-e Connection (AzHeC), Quality Health Network (QHN) in western Colorado, and the Utah Health Information Network (UHIN)—planned to explore a method of sharing data between HIEs based on triggering episode alerts, which notify providers a care event has occurred outside of the patients’ “home” HIE, and confirms the availability and the specific location of the clinical data.
This piloted concept, called the “patient-centered data home (PCDH),” works by synchronizing patient identity records among the several HIEs whose participants are caring for the patient, as well as providing detail about where the patient record is located for easier, faster query and response. “For patients, this provides reassurance they can receive high-quality, personalized care regardless of where they are in the country,” SHIEC officials note. Other industry leaders have referred to the project as an extension of the “no wrong door” philosophy, meaning that services and information are always available regardless of where the patient seeks care.
The PCDH concept has continued to grow since its inception. Last week, SHIEC announced that the initiative will be rolled out nationally and is serving tens of millions more patients through the network. The national launch unifies three smaller regional implementations in which 17 HIEs worked together to prove the concept of inter-HIE information sharing and notification. These regional implementations (the western implementation, the heartland implementation and the central implementation, each which involved coordination among multiple HIEs spanning geographic areas and states) had been set up for months, and now the regions have all been connected to each other, as we reported last week.
Based on the success of the implementations, the participating HIEs have each agreed to a common, national agreement for participation, which set the stage for connecting the regional implementations together and rolling out the full-scale, national implementation, according to officials.
As SHIEC’s leaders have explained, through this HIE-to-HIE hub, when a patient living in one of the states has a medical encounter in one of the other participating states, an alert is sent to the patient’s home state HIE. Primary care physicians participating in that HIE then receive an ADT (admission, discharge and transfer) notification, and can query their system for the patient’s record. That initial query from HIE to HIE is based on the patient’s zip code.