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Health Information Exchange Supporting ACOs

A fl exible strategy for expanding health information exchange. By Gregory J. Raglow, M.D.


here is no question that this is a time of uncertainty for healthcare organizations, with many diffi cult questions being raised in regard to health informa- tion exchange (HIE), accountable care organiza-

tions (ACOs) and more. Two things, however, are clear. The fi rst is that specifi c outcomes, quality processes and cost-performance standards for value-based programs will continually evolve. The second is that provider organizations will have to adapt to stay in business.

Gregory J. Raglow, M.D., is the medical informatics director at Banner Health in Phoenix, Ariz. For more on NextGen Healthcare solutions:

In this shifting environ- ment, the non-profi t Banner Health system already has be- gun aligning its strategic initia- tives with HIE and ACO goals. We have come to recognize the importance of developing a process for innovation, devis-

ing a two-pronged approach that addresses how to: connect multiple healthcare organizations for optimal data exchange; and support employed and non-employed physicians toward common accountable care goals. While Banner’s ACO strategy is still in its formative phase, emphasis is being placed on creating processes and IT infrastructure fl exible enough to support both internal and external requirements as they develop. A phased approach is being employed.

The health system itself comprises 23 hospitals and numer- ous physician services locations across seven states. The fi rst step in our strategy, therefore, was to bring all of our hospital organizations onto a unifi ed EHR platform. We are midway through the process now of implementing the second step: expanding to bring more than 800 employed physicians in 150 locations live on the platform as well. At the same time, we have implemented an HIE platform, which goes live concur- rently with the EHR.

Both the inpatient EHR and the ambulatory EHR are con-

fi gured as an “enterprise chart,” such that providers taking care of a patient in either setting have access to the entire record (with some exceptions for things such as behavioral health). The HIE allows information to pass between the inpatient and outpatient settings.

Early in the HIE rollout process we were forced to tackle the challenge of information overload, recognizing that bom-

22 September 2011

barding physicians with every new piece of data would quickly become counterproductive. Data should enhance the provision of care, not become unwanted noise. Consequently, Banner developed procedures to make chart access and chart notifi ca- tions two distinct functions.

The enterprise chart used by all of the ambulatory practices allows physician access to any patient record. Providers can actively search for and retrieve any information they need. However, separate processes now determine who receives notifi cations about specifi c pieces of information coming from the acute-care setting. Active notifi cations to physicians’ queues are customized. For example, it was determined that primary care physi- cians want to be notifi ed of emergency department (ED) and hospital admissions, and to get summary data from ED and hospital discharges. They do not want the daily CXR or labs of inpatients, but they do want labs and imaging results of studies ordered from their ambulatory practices. Surgeons, on the other hand, indicated the desire to receive op notes. They also need to be able to retrospectively import data from inpatient systems for patients fi rst seen in the ED, but not yet registered in the ambulatory system. By confi guring automatic data exchange based on need – yet still providing data access to all – Banner hopes to reduce the “signal-to-noise ratio.” This will become increasingly important as more entities engage in HIE at broader levels. Driving Banner’s current ACO strategy is the concept of HIE at three distinct levels: private, community and state. (The fourth level – national – presumably will be obtained by exchange among the states.) The phased approach being used attempts to promote HIE adoption locally and ACO acceptance more globally, gradually acclimating users across the continuum of care.

As discussed, we began with the standardization of IT and clinical procedures across owned hospitals, then took the same process into the clinic environment. Plans call for the HIE initiative to be expanded next to non-employed af- fi liated physicians who admit to Banner (likely through the portal function of our HIE technology). Afterward, we will interface with other non-owned practices that have adopted the same EHR platform from NextGen Healthcare used at Banner-employed ambulatory practices, then to non-owned practices that use other EHR technology. Finally, the goal is


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