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- A Reference Architecture for Healthcare Benefit Exchange
The business value for providers and patients is what will drive health information exchange forward, even though most discussions typically center on the technology involved. And different uses for exchange will require different technologies.
That was the sentiment of many organizations that are already exchanging information and shared what made their exchanges tick and what barriers stood in their way at a Jan. 29 joint hearing of the federal advisory Health IT Policy and Standards committees.
Farzad Mostashari, MD, the national health IT coordinator, noted that Camden Coalition’s director, Sandy Selzer, described how the Camden, N.J., health information exchange (HIE) has managed a sustainable return on investment because their costs are low, and they have found a way to add value, through simple ADT (admissions/discharge/transfer) transactions messages, with their existing business relationships within that community.
The competitive hospitals there want to reduce their readmissions and find their frequent flyers, many of whom are uninsured, and get them better care, he said.
“In all the different contexts, whether you’re in a community that has a lot of pay-for-performance or ACOs evolving or readmissions reductions or Medicaid managed care evolving, there are all sorts of different use cases, but on the whole, they are trending toward care coordination, trending to the arc of payment, trending toward value not volume,” he said.
"That is going to be imperative, not just for the private sector, not just for the states and Medicaid, but for the federal government as well,” Mostashari added.
ONC has recently ramped up its convening activities around health information exchange, including hosting an online listening session on concerns related to rules of the road and policies between exchanging organizations and published research on high-impact services to support HIE sustainability.
Karen Van Wagner, executive director of North Texas Specialty Physicians (NTSP), described how the health plan, which is also a Medicare Advantage plan, was able to improve significantly its Stars quality rating from the Centers for Medicare and Medicaid Services by using information in the HIE and moving it out from the plan’s systems to the point of care.
The Texas plan has already raised its quality score and hopes to get to a five Star rating, the highest, next year. The plan has combined results from around the community from different systems because the HIE tracks and aggregates claims data in the data warehouse and pushing them out to providers, she said. “An HIE does the mundane work for providers so they can do the medical work,” she added.
Combined with the use of metrics, a pop-up or icon appears on the EHR screen when the patient needs to have something done.
“That flashing red icon means that there is a Star measure that needs to be handled, an ACO Pioneer measure, or HEDIS measure. Before that note closes and before the patient leaves the office, some action is prompted to turn that into a compliant metric,” Van Wagner said.
She said that they expect to grow their exchange by 30 percent in 2013, roll out a newer platform with more compliant standards. But she also recommended that the government has a role, a mandate for the use of exchange standards, such as LOINC for laboratory diagnosis and hospital systems to generate a “just-admitted notice,” by a certain date, because “it’s happening too slowly.”
Dr. John Blair III, CEO of MedAllies and president of Taconic IPA, described how New York’s Hudson Valley is on parallel transformation paths, moving practices to patient-centered medical homes and expanding that to neighborhoods and, secondly, the use of Direct protocols for interoperability.
Its Direct initiative has just graduated from a pilot program to a full offering last week on the Statewide Health Information Network of New York, he said.
Demand and interest is growing not only from practices but hospitals “driven by the 30-day re-admission penalties, ACOs and other care coordination projects in the region,” Blair said.
Vendors are ready for the technical integration for meaningful use stage 2. However, “we have discovered that the user interface within the EHR vendor technology currently does not anticipate full clinical interoperability around transitions of care,” he said.
Intersystem interoperability has not been available in the market, and provider adoption of EHRs was previously not at the level where they would rely on it as a communication tool. Now, the EHR is becoming the access point for many different types of networks.
To drive interoperability, “it comes down to relevance to the providers. If the provider honestly believes these enhancements will improve care and efficiency — and particularly if they are indirectly tied to increased reimbursements for improved healthcare value — interoperability will advance rapidly,” Blair said. “If the providers do not believe this, nothing else we do here will make much of a difference in the long run.”