Guest post by Joe Cernik, vice president business development, eMedApps.
CMS and ONC recently announced an initiative (read: funding) to connect a variety of providers to health information exchanges, expanding the list of eligible providers to include long-term care, behavioral health and substance abuse treatment providers. Meant to increase the sustainability of HIEs and support improved access to the right patient data at the right time, the increased funding supports categories of providers that have been slow to adopt HIE technology.
The intent of increased funding for HIEs translates to better, more comprehensive access to patient data, improved patient care and reduced costs.
From a recent CMS blog post: ‘The great promise of technology is to bring information to our fingertips, connect us to one another, improve our productivity, and create a platform for the next generation of innovations. Technology, when widely distributed and available, enables providers to improve patient care by distributing information and best practices leading to better experiences of care for individuals in the health care system.” *
What does expanded funding for HIE connectivity mean for patients and providers?
One organization making the most of the initiative is the Massachusetts League of Community Health Centers, the statewide primary care association representing and serving the needs of the state’s 49 community health centers (CHCs). This organization partnered with eMedApps (infographic author below), to define a programmatic approach to onboarding CHCs to the IHE and extending the value of the funding increase.
Ellen Hafer, MTS, MBA executive vice president and chief operating officer for the Massachusetts League of Community Health Centers, shared her insight and experience connecting disparate providers to the Mass HiWay: “Health information exchange is critical as I envision it for quality of care in the short run now as well as the long run. Much of those benefits revolve around connecting disparate aspects of the care continuum at the community-health level. Community Health Centers (CHCs) are often independent organizations who serve as primary care providers, social support agencies and economic engines transforming their communities, one patient at a time. Many offer integrated care, but it’s across the spectrum of clinical specialties like behavioral health or oral health and not necessarily the full complexity of medical specialties. The information connection to behavioral health and substance abuse treatment in high risk populations extends the care continuum where it’s needed.”
Reports state that only 39 percent of physicians share data using a health information exchange (HIE). There is even a lower number of only 14 percent who electronically share data with ambulatory care providers or hospitals outside their organization. While these numbers may seem astounding to some with Stage 2 fast approaching — the reason is clear. Because even though providers want to share health information electronically they are hindered by EHRs that can’t communicate with one another, lack information-exchange infrastructure, and the high expense of setting up electronic interfaces and health information exchanges.
Below are the top reasons why EHR sharing remains low for adoption:
Lack of Interoperability. The majority of providers and physicians have acknowledged lack of EHR interoperability and exchange infrastructure as major barriers to health information exchange. They have also identified the cost of creating and maintaining interfaces and exchanges as a major barrier.
Lack of Advanced Technology. Over the last few years, various HIE systems have been developed, but many have failed for technological and organizational reasons. High-level issues must be addressed to implement an HIE successfully, including disparate EHR and HIS systems. Most previous HIE research focused on high-level issues and evaluating impact on healthcare delivery, ROI, Syndromic Surveillance, etc.
Lack of Security and Streamlining. Quantitative measures are crucial to the long-term sustainability of HIEs. Interoperability of patient data doesn’t effectively address concerns on privacy, productivity, workflow and costs. Streamlining HIE access through integration with electronic health records to minimize workflow interruption, and keeping costs reasonably low for providers, may increase participation.
Lack of Affordability and Productivity. The cost and loss of productivity are major barriers to HIE adoption. While there are many compliant products on the market, not all of them provide cost savings and lead to efficiency or increased productivity.
The purpose of EHR and HIE is to make patient specific information available at the point of care to improve the delivery and quality of care. Interoperability of patient data no doubt has many advantages, including improved care coordination, elimination of paperwork, reduction in duplicate tests and reduction of medical errors. It is imperative to develop a long-term plan for standards and interoperability that will support competing public and private-sector Interoperability efforts. We should also encourage clear regulation on compliance with federal privacy and security laws. There should also be national benchmarking to share best practices and lessons learned. There should be significant cooperation among primary-care providers, medical specialists, long term care providers and hospitals to outline common information sharing needs promoting a value-based care.
Guest post by Egor Kobelev, software delivery manager — healthcare, DataArt.
There are a lot of organizational and technical challenges health information exchanges (HIEs) struggle with while trying to deploy and maintain their platforms. One of the most complex organizational and administrative challenges is to achieve sustainability. While that is often an ultimate goal for HIEs, there is a huge amount of smaller technical challenges to meet, and the way those challenges are responded to often makes a difference for future HIE sustainability.
One of those typical tasks in the industry is a patient look up and mapping. There is a well-known issue when it comes to any sort of health data integration – the lack of a global unique patient identifier. Thousands of existing healthcare providers and payers use their own internal identifiers and there is no easy way to establish a relation between these. Social Security Numbers or similar national identifiers, while useful in some of scenarios, are not suitable for the purposes of healthcare record identification, primarily because of the risks of HIPAA rules violation.
The good part of the story is the amount of talks regarding a National Patient Identifier (NPI). For instance, HIMSS is proactively driving the initiative of introducing NPI, so that eventually patient mapping, which is currently a challenge, will be routine. However, the reality is that we are pretty far away from having NPI legislated and deployed in healthcare organizations nation-wide. At the same time, as many as 8 percent to 14 percent of patient records have errors caused by mismatching patient identifiers, which in turn causes hundreds of millions of dollars in spending to repair and reconcile the records. So, while we are waiting for NPI to come, what would be a solution which is HIPAA compliant, provides high accuracy, throughput, and minimizes manual interventions at the same time?