From 2015 to 2017, the Office of the National Coordinator for Health IT and AcademyHealth engaged 15 communities in a peer learning collaborative to identify data solutions and disseminate best practices and lessons learned.
A learning guide developed as part of the series focuses on San Diego’s experience in building a community health information exchange (HIE) and the realities of embarking on a broad community collaboration to achieve better data sharing. San Diego Health Connect (SDHC) Executive Director Dan Chavez, consultant Mark Branning, and Christy Rosenberg, director of Be There San Diego, outline eight recommendations based on their lessons learned.
Below are brief descriptions of their recommendations. Greater detail on each is provided in the learning guide.
Recommendation 1: Select a technical architecture that supports the HIE’s long-term goals. Committing to a technical architecture is a key decision point for an information exchange and has implications for the short-term and long-term utility of the platform. In 2010 when SDHC was awarded the Beacon grant, an HIE was a new, relatively untested model. This is why the San Diego Beacon Community decided to start with a federated (decentralized) model, as it was the lowest risk start-up model at the time. However, after years of implementation experience it became clear a centralized data repository would have been more advantageous in supporting long-terms goals.
Recommendation 2: Establish workgroups to enhance trust, communication, collaboration, and problem-solving. The workgroup format, in which representatives from multiple member organizations including those with specific topic expertise regularly convene around an important aspect of the HIE, is an effective way to support community collaboration and consensus building. It ensures members look beyond the needs of their own organizations to make recommendations for the benefit of the entire community.
Recommendation 3: Use a community-wide “opt-out” consent model to increase patient participation. To assure the highest possible patient participation rate, and therefore the greatest amount of information available to health care providers, HIEs should use an opt-out, community (multi-provider) consent model. This means patient data is automatically added to the HIE unless patients actively decline participation; accordingly, all of the patient’s providers in the HIE can automatically access information with an opt-out model.
Recommendation 4: Improve patient matching by being vigilant about data quality, establishing a strong master patient index and record locator service, and working with a patient-matching management company. A master patient index (MPI) and record locator service (RLS) assure that when a provider seeks information on a patient, correct and complete information comes up on the screen. There is no “silver bullet” for patient matching, but there are a few effective methods to help increase your organization’s patient matching accuracy.
Recommendation 5: Leverage patient-matching capability with community partners. Matching a patient to his/her correct medical record is fundamental to improving quality, interoperability, and population health outcomes, as well as preventing fraud and abuse. It is an integral function of an HIE and is very expensive to get right, which is why HIEs with strong patient-matching functionality should leverage this asset with community partners rather than having community partners create their own systems. Thus, the HIE can serve as the central hub to ensure accurately matched records for patients from other sources such as community service organizations.
Recommendation 6: Know your region’s community information technology assets and build trust with potential partners. Building trust, maintaining open lines of communication, and staying committed to continued improvement of one’s own information exchange is critical—especially when there are multiple information systems in place. The goal is to have a 360-degree client data view integrating medical, social, and local government data when feasible and appropriate.
Recommendation 7: Help healthcare providers achieve Meaningful Use and establish electronic transmission of reportable events to the County Public Health Department. As part of achieving Meaningful Use requirements (Stage 2) and now Advancing Care Information objectives, eligible hospitals and providers are required to establish ongoing data communication for care transitions, immunization records, reportable critical lab results, and syndromic surveillance. The HIE helped providers by providing the infrastructure needed to link them with the County Public Health Department through a single hub or portal to transmit these data electronically instead of by fax or mail or having to set up multiple independent electronic connections.
Recommendation 8: When working with community partners on population health, start small with a defined condition or population. Using the HIE to improve population health is something that happens incrementally – not all at once. Because funding is usually limited and the technology environment is ever changing, start with efforts that are small and focused collaborative population health initiatives for which results are measurable and attainable. Focusing on a defined condition or population makes it possible to design an HIE plan that is achievable, while also allowing time to identify and solve challenges before full-scale implementation
