Welcome to HIE 2.0

The health information exchange (HIE) market is experiencing dramatic growth and shifting priorities, changing what this technology can, and should, deliver to healthcare teams. 

Initial goals for HIEs were to capture and share information. The next progression, “HIE 2.0,” offers not only data sharing, but also data transformation, creating meaningful intelligence. 

Today, a majority of U.S. healthcare teams exchange health information electronically, at a minimum, within their own practices. But as these care teams evolve to meet the demands of an individual’s care, reimbursement policies and a competitive healthcare landscape, a growing number are focusing on how the collected data can improve the way they work and optimize an individual’s health status.

The purpose for transforming disparate EHR system data into actionable information is simple: to engage care teams and individuals and provide the insights necessary to ensure every individual can achieve their best health. As the healthcare industry continues to transition to a value-based care delivery model that focuses more on coordinated care and improved clinical outcomes, care teams will require more from their HIEs to support the population health management evolution. To meet these growing demands, an optimal HIE platform should offer hospitals and their care teams the following: 

• Value and engagement;
• Bi-directional semantic interoperability;
• Real-time information sharing;
• Compliance with the latest clinical guidelines and national quality measures;
• Data integrity and security;
• Support and enhancement of existing clinical workflows; and
• Seamless integration.

Through implementing these initiatives, health systems, hospitals and physicians can achieve new HIE priorities and prepare for the continuously evolving requirements of the future healthcare landscape. 

Value and engagement

Since the beginning of healthcare reform, the healthcare industry has made considerable progress in the implementation of electronic health records (EHRs). EHRs exist in over 75 percent of physician offices and in about 60 percent of acute care hospitals.¹ In addition, despite many hurdles, the Centers for Medicare and Medicaid Services’ (CMS) Meaningful Use program is well underway. Healthcare IT (HCIT) goals are shifting to encourage patient engagement and deliver value to care teams. 

Healthcare teams must now be able to move beyond the first step of digitizing an individual’s medical records to transforming this information into meaningful and actionable knowledge that will enable more informed decisions at the moment of influence. Additionally, community-wide information exchange and real-time, secure information sharing will not only provide value by better informing physicians, but it will also strengthen the physician-patient relationship. 

Patient engagement is a challenging initiative – some say a nebulous concept – that many care teams struggle with. However, actionable data can help make this critical aspect of improving population health easier. A 2014 article from Chilmark Research illustrates the potential of utilizing real-time data to assist with patient engagement: “In an ideal world, real-time data – including user-generated data, mobile and social data – will simply arrive and be acted upon. The clinical care team, extended care team and the patient will receive the necessary alerts and outreach, via the appropriate channel chosen. Outcomes will be tracked, and predictive models will be automatically refined based off feedback loops built into the system.”² 

Communicating personalized care alerts to individuals in real time can help empower them with the information and resources they need to lead a healthier life. For instance, care teams can use customizable messaging templates to communicate intervention alerts and other important clinical information to individuals and their care teams. This approach can help improve the likelihood of behavior modifications and adherence.³ In turn, physicians can act as a true partner in their patient’s health. 

Bi-directional semantic interoperability

Managing population health effectively also requires the bi-directional, semantic interoperability of disparate EHR systems. This involves aggregating disparate EHR system data and translating it into common, computable concepts for the semantic interoperability of clinical code sets to enable accurate and consistent analyses. In addition, a network approach can provide additional value to care teams by enabling the bi-directional semantic interoperability of consent management capabilities, and electronic order and result processing through the delivery of Clinical Document Architecture (CDA) and Continuity of Care Documents (CCDs).

Bi-directional semantic interoperability and care team collaboration across an entire healthcare ecosystem can also ensure real-time information exchange without interrupting existing workflows. As a result, care teams can ensure that a single, comprehensive, 360-degree view of an individual’s medical profile is provided at the point of care to enable informed decisions. 

Real-time information sharing

Not only must an individual’s medical profile be comprehensive, it must also be timely and actionable. Quick, easy and secure access to analysis results within an EHR or HIE at any point in the care continuum is essential for improving the quality and coordination of care. 

Real-time insights ensure only the most relevant and accurate information is provided at the point of care by normalizing and clinically corroborating disparate EHR system data. Implausible and time-decayed diagnoses, as well as duplicate information, potential drug interactions, irreversible procedures and diagnoses, can be updated and removed to provide care teams with a current and comprehensive view of an individual’s medical profile in real time. In addition to this “full picture” view, real-time information sharing can also reduce the impact of claims processing delays and chart chasing to enhance the revenue cycle and improve efficiency. 

Compliance with the latest clinical guidelines and national quality measures

In the new healthcare landscape, it is important that care teams ensure compliance with evolving policies and regulations. Community-wide health information exchange, in combination with real-time clinical analytics, can offer the tools and resources necessary to ensure compliance with the latest clinical guidelines and national quality measures, such as:

• Meaningful Use (MU) Clinical Quality Measures (CQM) for EHR technology;
• Healthcare Effectiveness Data and Information Set (HEDIS) guidelines to measure performance on important dimensions of care and service;
• The National Committee for Quality Assurance (NCQA) medical record requirements; and
• Preventive service screenings.

By providing care teams with valuable insights on new regulations and clinical quality measures, health systems, hospitals and physicians can ensure compliance with best practices, industry guidelines and regulatory requirements.

Data integrity and security

New regulations associated with the Affordable Care Act (ACA) concerning protected health information (PHI) and EHRs increase the need for data integrity and security. Data security is a critical concern of the healthcare industry and will continue to be top of mind as PHI, payment information, intellectual property and other sensitive material continue to transition into digitized formats for real-time information sharing. 

Care teams can ensure data integrity and security by utilizing role-based access and on-demand sharing capabilities that utilize encryption and certificate-based authentication. This includes defining custom consent policies at the individual and facility level to ensure data security through transport, storage and usage. 

Support and enhancement of existing clinical workflows

An often-cited reason for physician resistance to EHRs is the disruption of existing workflows and the failure to provide accurate data.⁴ Current clinical workflows require physicians and other care team members to access several EHR systems and even paper-based systems to retrieve the healthcare data needed on a single individual, or an entire population. In addition to the inefficiencies of EHRs, information can also be fragmented, incorrect or irrelevant.

The ideal HIE platform aggregates, normalizes and clinically corroborates disparate EHR system data and presents this information in a manner that is comprehensive, meaningful and actionable. Contrary to EHR systems that force practices to become database miners, HIE platforms offer a workflow-sensitive solution that demonstrate value with every click. 

Seamless integration

Without the seamless integration of an HIE platform across a healthcare community, care teams cannot confirm if the correct information is getting to the appropriate person when needed. At the point of care, an HIE platform should integrate into any data center or health IT system workflow. These include e-prescribing, EHR or practice management systems. Additionally, an HIE platform that utilizes existing workflows should be easy to deploy, scale, manage and support. By combining real-time clinical analytics with community-wide information exchange, care teams can ensure that the right information is delivered to the right individual, at the right time, for improved care coordination and better outcomes.

As health systems, hospitals and physicians focus on initiatives that strengthen patient and care team engagement and delivering value across the care continuum, HIE priorities must also shift from merely sharing information to richly informing and supporting the health of individuals across populations and the healthcare delivery systems of tomorrow.

References:

1. Dustin Charles, MPH; Meghan Gabriel, PhD; Michael F. Furukawa, PhD, Adoption of Electronic Health Record Systems among U.S. Non-federal Acute Care Hospitals: 2008-2013 (The Office of the National Coordinator for Health Information Technology, 2014).
2. Cora Sharma, Population Health Management in Real Time (Chilmark Research, 2014).
3. See, e.g., Rosenberg S, et al. Supporting the Patient’s Role in Guideline Compliance: A Controlled Study. Am J Manag Care, 2008;14(11):737-744.
4. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3766548/