What Physician Practices Need to Know Before Joining an HIE

 

By Cherry Drulis and Dan O’Connor

The benefits of health information exchange (HIE), including cost reduction and improvements to patient care quality, are growing (Ben-Assuli, O., Shabtai, I., & Leshno, M., 2013; Weill Cornell Medical College, 2014; Regenstrief Institute, 2015), but small to midsize physician practices may not be certain if they should join their statewide, regional, or community HIE organization. There are several factors to consider before participating in an HIE, such as how many providers already participate, the HIE’s funding model, and its compatibility with the provider’s existing health information technology (IT) systems. Other crucial considerations include the quality of data providers will receive, exchange process requirements, and features such as data analytics capabilities and data security.

Successful health information exchange, however, is not just about technology. An HIE relies on the combination of technology and a trusting community in order to have robust information exchange that directly benefits patient experience and outcomes. For example, consider how many players in the healthcare ecosystem are involved during a typical inpatient surgical procedure: nurse practitioners, pain management specialists, pharmacists, surgeons, and others. Their participation in the HIE is essential for a holistic view of the patient experience.

After a thorough evaluation of the following factors, providers should be able to easily determine if participating in an HIE is the right decision for their organization and patients.

Provider and patient benefits

Through HIEs, providers and facilities have access to patient information and the ability to share it across the care continuum with minimal waiting. Providers can access the information where and when they need it. Cost reduction and improved patient care quality have been the biggest benefits observed in states and communities with high-performing HIEs. For example, a survey of 11 HIE-participating emergency departments in South Carolina showed that data access saved more than $1 million in patient charges, or nearly $2,000 per patient (American College of Emergency Physicians, 2013). Other cost reductions have come from a decrease in preventable hospital admissions (Weill Cornell Medical College, 2014) or from a reduction in procedures or tests that are unnecessary or have been performed recently at another facility. The higher-quality data obtained from an HIE and decreased turnaround time for obtaining information also offer cost reduction benefits such as reduced length of stay.

From the perspective of high-quality patient care, quickly and easily sharing clinical data presents major benefits, especially when information can be shared with numerous outside facilities or consulting providers. The ability to share accurate and up-to-date allergy and medication lists, for instance, can reduce potential medication errors and adverse reactions.

Participating in an HIE also offers the ability to benchmark a healthcare facility by measuring how it is performing compared to local competition in regard to quality measures, volume, satisfaction score, and more. Plus, participation in an HIE can be leveraged for marketing and public relations activities, demonstrating to the community that the organization is actively invested in proactive solutions for patients.

Participation and cost of entry

Before delving into details, providers must understand an HIE’s vision and mission for its community and its patients. Healthcare providers need to ask the HIE, “Why?” Why was the HIE started, and why was its particular vision and mission chosen? Why has it chosen its specific public health goals, data-sharing model, or technology? Once the “why” has been defined, the HIE needs to define the “what.” What data is the HIE going to collect, and what will it do with the data? Finally, providers should consider the “how.” How will data be shared, and how will this sharing impact the practice?

HIEs typically launch through grant funding. Successful HIEs have strong community governance structures in place during early planning and startup phases. Providers should pursue HIEs with strong leadership structures and provider participation rates across the service area. The cost of entry must be reasonable, especially for small hospitals and physician practices that are not affiliated with an integrated health system. This low cost of entry is mutually beneficial, as the HIE’s larger participants then have access to otherwise non-affiliated small practices.

Initially, the HIE needs an ongoing funding model that will allow it to sustain itself as grant dollars diminish. Many successful funding models are based on charging for the amount of information provided and/or the amount of data pulled, so the largest providers and users of the HIE’s information pay the most.

Vendor utilization

Another consideration for HIE involvement is the provider’s current health IT systems. For example, if an electronic health record (EHR) vendor offers compatibility with the state or community HIE’s technology, the provider should be prepared to ask about privacy and security features, costs to add on HIE access, maintenance and monthly fees, and time frames for HIE availability. In its annual HIE stakeholder survey, Black Book Research polled users of 224 operations, in both public and private exchanges, to determine the top-ranking vendors (Leventhal, 2015). HIEs can leverage this survey to determine if they are compatible with the top five EHR systems being utilized by potential clients, thus better positioning themselves in the marketplace.

The Ohio Health Information Partnership (OHIP), Ohio’s major HIE network, chose a vendor for its CliniSync community-based model after completing a detailed RFP process and research (Ohio Health Information Partnership, 2011). The network determined that the vendor’s modular service-oriented technology, history of effective integration projects, and reduced-cost services would directly benefit OHIP’s healthcare community. Although the state or community HIE may offer providers a browser-based interface for accessing and sharing health information, some smaller commercial HIEs may offer a direct interface to each provider participant, which may make IT compatibility an issue. A direct interface may require an expensive or complex customized solution for the provider’s IT system, as opposed to a more flexible and less costly browser-based interface.

HIE provider participants should ensure that their EHR systems are compatible with the HIE organization’s technology infrastructure and adapt practice workflows to encourage providers to use the HIE before every patient visit to ensure the practice’s records are updated and accurate.

Data quality and capabilities

Another consideration for providers is whether the HIE clearly defines what data it is collecting. It should be collecting the same data in the same standard from all participants. Without data standardization, an HIE may end up collecting a lot of data that is inoperable for many practices. That is why it is important for the HIE to define the data standard that will be used in the exchange (i.e., SNOMED-CT, RxNorm, LOINC, HL7) and normalize any collected data that does not conform to the standard. Likewise, practices must determine if their health IT systems can translate the defined standard so data can be integrated with the practice’s patient records. If not, practices will need to work with their internal HIT vendors to develop translation tools.

Having standardized data across the HIE is essential for population health data analytics. Some HIEs will perform analytics for hospitals and practices that do not have the infrastructure or resources to do so themselves. Other HIEs perform analytics to support governmental regulatory requirements. For example, an HIE that supports the Delivery System Reform Incentive Payment program, which is running in several large states, can capture data from across the continuum to perform a holistic analytics approach on patients’ outcomes and treatments.

Importance of education

For a successful effort and strong participation levels, the HIE needs to educate providers about using the exchange, what information it includes, and how easy that information is to obtain. To garner community support and encourage frequent HIE utilization, patients need to be educated on HIE benefits and the security of their health information. Addressing security is important, as it ensures patients will be comfortable releasing their information.

Once patients understand their role and trust the benefits of HIE, they will likely be receptive to education and increase their involvement in their personal health. Patient engagement is essential not just for HIE success, but also for improved clinical outcomes.

Dan O’Connor is the vice president of client relations at Stoltenberg Consulting. He is an RN with 20 years of experience in healthcare and clinical informatics, and has served in positions ranging from clinical analyst to chief information officer. His areas of expertise include strategic and project planning, clinical transformation, workflow design, IT management, and budgeting. O’Connor may be contacted at doconnor@stoltenberg.com.

 

References:

American College of Emergency Physicians. (2013, October 14). Health information exchange saves $1 million in emergency care costs for Medicare (Press Release). Retrieved from http://newsroom.acep.org/2013-10-14-Health-Information-Exchange-Saves-1-Million-in-Emergency-Care-Costs-for-Medicare.

Ben-Assuli, O., Shabtai, I., & Leshno, M. (2013). The impact of EHR and HIE on reducing avoidable admissions: Controlling main differential diagnoses. BMC Medical Informatics and Decision Making, 13(49). Retrieved from http://www.biomedcentral.com/1472-6947/13/49.

Leventhal, R. (2015). Black Book Research: Meaningful interoperability remains years away. Healthcare Informatics. Retrieved from http://www.healthcare-informatics.com/news-item/black-book-research-meaningful-interoperability-remains-years-away.

Ohio Health Information Partnership. (2011). FAQs about CliniSync. Retrieved from http://www.clinisync.org/index.php/about-us/faqs.html.

Regenstrief Institute. (2015, June 16). Study finds novel population health management program yields major health improvement (Press Release). Retrieved from https://www.regenstrief.org/news/study-finds-novel-population-health-management-program-yield/.

Weill Cornell Medical College. (2014, March 12). Study: Health information exchange may reduce hospital admissions (Press Release). Retrieved from http://weill.cornell.edu/news/news/2014/03/health-information-exchange-may-reduce-hospital-admissions-joshua-vest.html.