Health Information Exchanges
What private organizations should know when building HIEs
By John Dunn, September 2012
Lessons can be learned from public health.
Across the country, private healthcare organizations (HCOs) are increasingly addressing their need to securely exchange healthcare data throughout their own facilities as well as with state and regional organizations via health information exchanges (HIEs). The federal government is driving this focus on HIEs with its State Health Information Exchange Cooperative Agreement Program, through which the Office of the National Coordinator for Health Information Technology (ONC) is providing grants directly to states for the development of HIEs. Additionally, both Stage 1 and Stage 2 of the Centers for Medicare and Medicaid Services’ (CMS) meaningful-use program mandate that organizations that wish to qualify for incentives meet core measures related to HIE.
With a number of established statewide HIEs, the successful completion of the federally sponsored Direct Project for simple exchange of healthcare data, and progress made to build a Nationwide Health Information Network (NwHIN), it’s clear that the public health sector has set successful precedents for the implementation of HIEs. This is especially evident when one considers the extensive experience that state public health departments and the Centers for Disease Control and Prevention (CDC) have in electronic disease surveillance, reporting health statistics and working with HCOs to ensure that the right data is being transmitted to government organizations in readable formats and in a timely manner. As private hospitals and health systems look to connect their own systems and extend their IT reach beyond organizational boundaries with HIEs, it’s clear that there are lessons to be learned from similar deployments by public health organizations.
Private HCOs need to ensure that their HIE infrastructures meet regulatory requirements and line up with internal IT needs. Public health entities at the state and federal levels are well versed in managing systems that meet regulatory requirements and easily interface with IT systems used by external partners. Hospitals and health systems should think of their HIEs more as networks than as exchanges and develop a technology infrastructure that can adapt to meet future meaningful-use requirements, continue to be built to meet organizational needs and lead to high adoption by physicians, nurses and administrators. Public health entities have spent years creating statewide and nationwide networks for reporting and disease surveillance. These networks have lowered the bar for participation for a wide range of participants, and currently, 48 out of 50 state public health departments, along with the CDC, utilize a common data-integration engine. These systems rely on extensive participation by external organizations and on dependable technology infrastructures to be successful, as do private HIEs.
Certain health departments, such as the Mississippi State Department of Health, are beginning to link the many disparate components of individual public health records in siloed databases by implementing an enterprise master patient index (EMPI). For Mississippi, this will be followed by an implementation of a portal that compiles the components of an individual’s public health medical record so they can be viewed and updated from one user interface.
Chronic disease management and population health
Stage 2 meaningful-use requirements for public health reporting and an increased focus on public health throughout the country have made it necessary for private HIEs to include reporting capabilities within the tools they offer to physicians, but HCOs don’t always understand how complex the public health reporting system is.
For years, federal and state public health groups have collected data from a variety of stakeholders, and they know the nuances of public health reporting. They realize how complex it is to normalize, extract and format data for reporting. They are well versed in establishing interfaces that can handle large amounts of complex data and utilize the same messaging standards used by HIEs.
Furthermore, the shift to pay-for-performance reimbursement models and a focus on keeping large patient populations healthy is based in part on providing better care for patients with one or more chronic diseases. Chronic diseases are the burdens for public health departments, which measure prevalence in the population. They have experience designing large-scale, chronic disease-management (CDM) programs, but have lacked the regional infrastructure to deploy and manage them. State public health departments know what kind of CDM support is needed within their areas of operation, based on the data they capture, and they will increasingly lean on private hospitals and health systems to relieve the strain of CDM on their budgets.
Public health programs succeed because of investments in systems to facilitate timely electronic reporting and disease surveillance. Better use of integration tools and encouragement of provider participation through meaningful use will lead to more success, and public health departments will always be part of any regional health community. Their variability will never be an issue, and their burden for disease reporting and CDM will only grow in importance. Public health must be integrated into any HIE for it to remain relevant, and it’s essential that providers, HIEs, public health entities and payers all work together to facilitate CDM and improved population health. No party can build truly successful regional programs on its own.
An enterprise HIE needs to deliver a return on investment to the HCO that runs it, and that organization needs to understand the opportunities that exist for leveraging the HIE as a tool to increase efficiency, reduce costs and open new revenue streams. Many statewide HIEs arose with funding provided by ONC, and as a result, they have had to develop forward-looking business models that set up new sources of revenue once government funds run dry.
Medicare and Medicaid are set to withhold reimbursement for things such as preventable readmissions and hospital-acquired infections, with an emphasis on better reporting of these events by HCOs. Public health groups have experience with streamlining reporting operations and digging into the data around these types of occurrences. These groups are not immune from the aforementioned shifts in reimbursement and care models, and public and private payers alike are looking for ways to better manage the health of whole patient populations. HIEs that can assist with better managing these patient populations can tap payers as new sources of revenue. Public health entities are vast consumers of health information, and they are greatly improving their ability to support standards-based messaging, making them ideal partners for private HIEs.
As more hospitals and health systems and independent, regional entities develop HIEs across the country, they can look to public health organizations for guidance on building a robust technical infrastructure, understanding the complexities of data exchange and reporting, and creating new revenue streams in a challenging economic environment. Most important, by applying lessons learned from public health to the creation of enterprise HIEs, private organizations can provide higher-quality care to patients.
About the author
John Dunn is a VP at Orion Health. For more on Orion Health, click here.