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.
Thus far, more than 300,000 event notifications have been exchanged via the PCDH network, and in addition to the 17 HIEs planning to participate, SHIEC’s broader membership also includes 60 HIE organizations that manage and provide for the secure digital exchange of health data for hospitals, healthcare providers and other participants serving more than half of the U.S. patient population. This represents a great opportunity for the PCDH initiative to expand out even more.
What’s also promising is that HIE leaders see the PCDH concept helping in emergency situations, such as the Hurricane/Tropical Storm Harvey disaster that struck Houston and southeast Texas late last summer. In fact, it was Phil Beckett, chief information officer at HASA (Healthcare Access San Antonio, a San Antonio-based HIE), who spoke to Editor-in-Chief Mark Hagland about this very topic at SHIEC’s annual conference, an event which took place during the same time as the Harvey storm was unfolding.
Beckett told Hagland at the conference, “This is also a situation in which the concept of the patient-centered data home, which the SHIEC organization is promoting and encouraging, and which has been a topic of discussion at this conference, comes into play…We were on a call that was sponsored by SHIEC, and were talking about the patient-centered data home, which provides a more accurate, precise way to share data. When we make use of this concept, it means that we’re storing a zip code list of zip codes that each HIE covers, and then if a patient shows up in one of our facilities with that zip code, we will send a notification with the home state of that patient, so that we’re connected across state lines with good demographics, since we don’t have single identifiers. That will help” in situations like this one with Hurricane/Tropical Storm Harvey, Beckett said.
Indeed, it certainly seems as if a foundation for interoperability between HIEs has arrived. With SHIEC’s announcement last week, Leigh Sterling, executive director, East Tennessee Health Information Network (eTHIN), had a quote that I thought was extremely telling about the capabilities of the patient-centered data home. Sterling said, “etHIN’s region contains the most visited national park in the country. Because visitors to our area often seek medical attention while they are here, we have medical data on patients living in all 50 states. PCDH is the best way to provide needed information to our local treating providers and to keep the patient’s hometown physicians informed of out-of-town treatment events.”
At the end of the day, isn’t that exactly what we wanted HIEs to accomplish from day one? The ability to have medical data on patients in all 50 states fulfills the spirit of what healthcare leaders set out to facilitate years ago with the advent of health information exchanges.
Now that’s not to say that HIEs themselves still don’t have their fair share of roadblocks with questions around their ability to remain viable only growing over time. But it’s quite promising to see that those HIEs that are successful can now interoperate with one another. To this end, last week federal health officials also released its draft Trusted Exchange Framework, as required by the 21st Century Cures Act of 2016, calling the development “a significant step towards achieving interoperability.” The Framework outlines a common set of principles for trusted exchange and minimum terms and conditions for trusted exchange, with the idea being to bridge the gap between providers’ and patients’ information systems and enable interoperability across disparate health information networks.
For anyone who has been paying attention, it’s been a long and rocky road for HIEs and interoperability. That journey is nowhere near finished, but thanks to initiatives such as the patient-centered data home, the arrow is pointing up.
Have any thoughts or questions? Feel free to tweet at @RajivLeventhal or comment in the section below.