Before they were associated with an ambitious healthcare reform agenda that sparked an enduring political controversy, health information exchanges (HIEs) were something much simpler and yet very powerful, an idea whose time had come.
Technology has utterly transformed the way businesses communicate and manage documentation, enabling instantaneous sharing of company and customer data across time zones, operating units and organizations. Technology has changed the practice of medicine profoundly on the direct patient-care side, with millions benefiting from less-invasive procedures made possible by developments such as computer-guided imaging and treatment methods.
But on the administrative side, healthcare entities have often lagged behind their counterparts in other industries when it comes to taking advantage of powerful new communication and collaboration tools. Privacy concerns are a major factor: Special regulations outlining the handling and sharing of information are in place to protect sensitive medical data, and with good reason. Still, regulation and the need to safeguard data haven’t stopped other industries from capitalizing on technological advances in communication and data sharing: The banking industry, for example, has successfully adopted many data-exchange and transaction technologies.
But despite the sometimes halting pace of change, widespread adoption of technology tools to manage medical data is occurring, and the outlines of a truly connected healthcare space are emerging, empowered in part by federal grants and initiatives to jumpstart both public and private HIE development. HIEs are gaining traction in all 50 states, paving the way for healthcare professionals to improve patient care by sharing vital health information quickly, securely and easily across multiple regions and healthcare systems. The reason the HIE initiative enjoys broad-based support is clear: Easy access to healthcare information improves outcomes and reduces costs.
This is why HIEs have remained relatively uncontroversial despite the political firestorm surrounding other healthcare reform initiatives, including the Affordable Care Act (ACA), which was subject to U.S. Supreme Court review this year and partially upheld. When medical teams coordinate patient care, outcomes improve and costs are reduced. Doctors who have access to their patients’ entire medical histories in electronic form are less prone to make errors or order duplicate tests and procedures. And access to their patients’ full medical histories allows physicians, allied healthcare professionals and other stakeholders to take all information into account when developing care plans.
In addition to improved outcomes, patients can also benefit from the move to electronic medical records (EMRs), since it will remove the burden of transporting paper records between healthcare provider offices as they receive care from primary and specialist physicians, clinics and hospitals. Businesses that sponsor their employees’ healthcare coverage and the local, state and federal agencies that administer a variety of publicly funded healthcare benefits stand to benefit from a connected healthcare ecosystem as well, since coordinated care has the potential to significantly lower costs.
Spurred by the promise of these benefits, states are now setting up HIE networks to enable authorized clinicians to send and share information and link seamlessly to the Nationwide Health Information Network (NwHIN) for interstate data exchange.
HIE implementation and adoption is still in the early stages, but even in the preliminary phase, it’s possible to draw lessons from HIE development and launch experiences and to identify key HIE success factors, including security, robust management capabilities and standards-based interoperability. A well-designed HIE enables secure clinical data exchange between public and private sector organizations and serves as a gateway to the NwHIN.
Implementing an HIE
The Commonwealth of Virginia has launched its HIE: ConnectVirginia. The effort is funded under a contract administered by the Virginia Department of Health. MEDfx, a leader in the connected healthcare space, is a subcontractor to Community Health Alliance Inc., a Virginia-based nonprofit company that is the prime contract holder with the Virginia Department of Health. Along with other subcontractors and state healthcare stakeholders, the organizations are in the process of designing, testing and fully implementing an HIE that facilitates healthcare information exchange between authorized healthcare providers throughout the state.
As a medical technology specialist, MEDfx provides direct messaging capabilities that allow healthcare providers to share clinical data securely, exchanging lab results, treatment summaries, discharge forms, care plans and other documents. Since standards-based interoperability and security are linchpins of a successful HIE and its ability to participate effectively with the NwHIN, the ConnectVirginia HIE has been designed to meet standards that will ensure effective functioning on a standalone basis and as part of a larger connected healthcare ecosystem.
The principles on which these design standards are based were defined by the Direct Project, a consortium of healthcare technology experts and other stakeholders in the initiative that works together to identify attributes that promote secure healthcare information exchange capabilities across the U.S. The Direct Project was established by the Office of the National Coordinator of Health Information Technology (ONC) in 2010. As a Direct Project participant, MEDfx has played a key role in designing systems that encrypt healthcare information so that authorized providers can access and share vital patient data to more efficiently and effectively plan and deliver care.
Pushing and pulling information
ConnectVirginia envisions a two-way data transmission system that enables participating healthcare providers to exchange medical records quickly and efficiently. It includes a direct messaging system to allow healthcare professionals to “push” information on patients to other authorized providers, and an exchange system that allows them to “pull” data for a more complete view of their patients’ medical histories.
The ConnectVirginia DIRECT messaging service functions similarly to email, but with the additional layers of security needed to safeguard confidential information and fully meet the privacy guidelines identified by regulatory agencies and the Direct Project. Only registered medical care providers have access to the direct messaging system, which they can use in place of the faxes that are widely used to exchange clinical information now. The direct messaging system allows authorized clinicians to exchange information, such as patient referrals and care transition plans.
The next stage of ConnectVirginia’s HIE implementation, which is ongoing, will enable authorized providers to pull patient data through an exchange function that provides a highly secure query and records-retrieval system. The ConnectVirginia EXCHANGE service is designed around the NwHIN standards that were articulated by the ONC, and healthcare providers and organizations who meet the legal and technology requirements will be able to join the program and gain access to their patients’ medical histories from other participating providers to enable coordinated care.
Creating a truly connected healthcare ecosystem
The ConnectVirginia rollout is in process, as are HIE efforts in all 50 states. Ultimately, the goal is to build a strong network in each state and connect regional HIEs with the NwHIN. By building secure, interoperable systems from the ground up, state HIEs are paving the way for medical professionals and patients alike to reap the benefits of a connected healthcare ecosystem, which includes better outcomes and lower costs.
Although still in the launch phase, the ConnectVirginia project has demonstrated that public and private organizations can work together to effect transformational change in the way healthcare is delivered, not only in Virginia but on a national scale. The program’s direct messaging function allows physicians to securely provide data to other authorized providers, replacing outmoded systems, such as fax machines, with electronic data-sharing capabilities to promote greater levels of collaboration.
Planned data-exchange capabilities will allow physicians to gain access to their patients’ entire medical histories, enabling medical professionals to move beyond their data-provider roles to become data consumers, take a more holistic view of their patients’ medical needs and formulate care plans accordingly, with input from the entire care team.
Successful HIEs – those that are designed with robust security capabilities, meet stringent data management and interoperability standards and connect seamlessly with the NwHIN – are forming the backbone of a larger connected healthcare ecosystem. The new communication capabilities that are emerging from this effort have the potential to fundamentally transform healthcare delivery, achieving the goals of improving outcomes and reducing costs.
About the author
Colin Barry is CEO of MEDfx. For more on MEDfx, click here.
