By Dr. Chris Hobson, chief medical officer, Orion Health.
Health information exchanges (HIEs) represent a key piece of health information technology and are ideal tools to assist providers and managers in flattening the COVID-19 case count and fatality curves. HIEs were designed from the start to enable “right care to the right patient at the right place.”
Getting real-time, complete clinical information to where it’s needed, when it’s needed assists clinicians in the delivery of individual patient care. By virtue of the high-quality data held on every patient across a population, HIEs are also rapidly becoming essential tools in population health management. Real-time, high-quality data is essential for clinical and public health decision making.
The emergence of COVID-19 illustrates how high-quality individualized data can be leveraged to help a population level effort.
COVID-19 offers the challenge and opportunity to apply HIE capabilities in a flexible way to the management of a novel infectious disease where public health measures of social distancing, contact tracing, testing and isolation are so far the only real options for management.
A range of HIE functionalities and capabilities add value here. One is the ability to generate configurable notifications to providers based on new information arriving in the HIE. The first notification type tells providers when their patients have tested positive. This can be achieved easily based on the arrival of a positive test for COVID-19 into the HIE. Providers can subscribe to alerts for specific patients, or all of their patients.
For nearly a decade, Health Information Exchanges (HIEs) have been looking for their long-term sustainable business model. This is part of the journey toward the future state of the HIE, which will be a ubiquitous healthcare utility that makes data available to all stakeholders across the healthcare landscape. Today, their work and future plans are driven by a desire to support value-based care initiatives, enhance interoperability, and leverage and manage a wider scope of data.
Representing a broad swath of HIEs, a 2019 Survey on HIE Technology Priorities uncovered various key trends and changing priorities in the sector. To become a sustainable healthcare information provider, HIEs must understand and leverage data to gain insights that improve patient outcomes while containing costs. Additionally, other trends include joining national exchanges, introducing value-added capabilities, enhancing integration of clinical and claims data, and growing payer participation in HIEs.
Participation in various national initiatives is an important driver for HIEs as it requires successful HIEs be more active across traditional geographic and state boundaries. Mechanisms for participation include the Trusted Exchange Framework and Common Agreement (TEFCA), the national eHealth exchange, Direct Trust and Carequality. Participation in Patient Centered Data Home, an event notification service that includes HIEs across the U.S. led by the Strategic Health Information Exchange Consortium (SHIEC), had the highest level of interest across all surveyed HIEs.
Like a utility, the next generation HIE must fit into the growing “Network of Networks” ecosystem, providing shared services to multiple HIEs (e.g. EMPI/record locator, patient directory, provider directory, data aggregation). This also means bringing together disparate entities into a local HIE network connecting a variety of different end-points – including practices, hospitals, systems, labs, long-term care facilities and more – while simultaneously making the local information shareable with other regional and national HIE networks. HIEs will need to support population-based use-cases and assist safety-net providers and small, independent providers to access larger interoperability initiatives across the U.S., such as TEFCA and the e-Health Exchange.
Health information exchanges (HIE) help care teams provide more informed patient care by supplying a complete longitudinal healthcare history of the patient to healthcare professionals, as well as enabling high quality reporting and analytics on the data. The goal of an HIE is to accurately store all relevant patient information from as many sources as possible, including medical history, medication history, past treatments and detailed personal information. A comprehensive reporting system allows for health delivery that is more responsive and tailored to each patient, and subsequently, the broader population.
Today the transition to value-based funding models seeks to lower costs and improve patient care and outcomes in order to lead to the better management of entire populations. Population health management (PHM) involves changing the behavior of engaged consumers to lead healthier lives and encouraging physicians to focus on providing the best possible quality of patient care at the lowest possible price. This requires providers to collaboratively address whole populations and orchestrate healthcare provision at large scale. Below are several challenges organizations must overcome before closing in on the goal of PHM.
Payer-provider collaboration and targeted incentives
Payers and providers must work together and, in particular, must find ways to effectively share their different types of data. Collaboration is needed to achieve shared goals such as understanding and improving the health of a population and enhancing the patient experience, all while constraining costs.
A key issue between payers and providers is agreement on the quality measures that will be incentivized. PHM places an unfair, high burden on providers if required quality measures vary widely across payers or if the measure does not clearly reflect a meaningful quality of care indicator. In the latter situation, a provider’s time and effort are used for inefficient purposes adding to a physician’s frustration with the healthcare system. Conversely, payers have additional data that can often help providers significantly with their population health management needs.
Fragmentation of care poses a challenge for health systems globally, and there is research to suggest that this problem is more persistent in the U.S. than its international peer countries. Studies have highlighted the major consequences of a poorly coordinated health system, including delays in care, incorrect care, and unnecessary complications, tests and procedures. Frequently, poor communication, difficulty sharing care plans and challenges coordinating actions by multiple caregivers across organizations results in confusion, delays in care and even incorrect care actions, putting the patient’s health on the line. A health system that is not well coordinated cannot deliver high quality care at lower costs.
Physician involvement in preventive care and the social determinants of health
For physicians, finding ways to move care from the acute setting toward health promotion, disease prevention and addressing the social determinants of health is quite difficult and not something they are necessarily empowered to do today. Currently, the majority of physicians do not have the tools to solve major intractable social issues such as poverty, so involving physicians and patients in the strategic design of a social determinants of health program is an essential step toward resolution of these types of concerns.
Guest post by Drew Ivan, director of business technology, Orion Health.
With such an enormous cross-section of the healthcare industry in attendance, the HIMSS Conference and Exhibition represents a comprehensive snapshot of the state of the healthcare industry and a perfect trendspotting opportunity. Here’s a preview of what I expect will be this year’s conference highlights.
Care coordination and population health and process improvement, workflow and change management are tied for the most popular category, with 29 educational sessions focused on each.
Representing 22 percent of the total number of sessions, this is clearly a focus area for the year’s conference, and it’s easy to see why. Changes in healthcare payment models are now well underway, and they are impacting payer and provider operations where healthcare is delivered, managed and documented.
Providers and payers alike are seeking information about how best to operationalize business processes and provide high quality care under new payment models, but it may be even more interesting to visit the Exhibition Hall to see what innovations vendors are bringing to the market to meet these needs.
Another topic related to changes in healthcare delivery is clinical informatics and clinician engagement, which is all about how new technologies, such as big data and precision medicine, can impact care decisions. The ability to make data-driven clinical decisions is one of the many dividends of widely adopted electronic health records. This is likely to be an important area for many years to come.
With 100 million medical records hacked last year, privacy and security is a hot topic at this year’s conference. The number of educational sessions in this category nearly doubled from 13 last year to 25 this year.
While preventing unauthorized access to records is the top priority, security will be a simpler problem to solve than privacy. As more sources of clinical data go from paper to electronic systems and more types of users have legitimate access to patient data, the problem of providing appropriate, fine-grained access in accordance with patient preferences, clinical settings and laws that differ across jurisdictions becomes very difficult to untangle.
Privacy and security concerns will need to be addressed with a combination of open standards and vendor products that implement them. Technologies from other industries, like banking, are likely to start making their way into healthcare.
This year, health information exchange (HIE) and interoperability educational sessions are combined into a single category, reflecting the fact that interoperability within a single institution is, at this point, more or less a solved problem. The next frontier is to enable interoperability across institutions to support improved transitions of care.
HIEs have a role to play when it comes to moving data between organizations; however, many HIEs are struggling or disappearing because of sustainability challenges. This year’s conference will provide an opportunity to learn best practices from the most successful HIEs. It will also be interesting to see what strategies HIE vendors will pursue as their customer base consolidates. In the Orion Health booth alone, we will have executives from HIEs talking about these same issues.