COMMENTARY
Building trust is key to HIE success
By Lee Barrett, Executive Director, Electronic Healthcare Network
Accreditation Commission (EHNAC)
An August 2014 report1 by the Office of the National Coordinator for Health IT (ONC) found that in 2013, less than 40 percent of all physicians in the United States participated in some type of health information exchange (HIE). These numbers represent a significant jump in data exchange activity since 2008, thanks mostly to the Meaningful Use incentive program.
While HIEs have focused their efforts on helping providers meet the Meaningful Use objectives, there are still 74 percent, according to a Robert Wood Johnson Foundation (RWJF) survey2, who are struggling to develop a sustainable business model. The survey conducted by RWJF resulted in similar findings to the ONC report and was released in August 2013.
The struggles many HIEs are facing can be attributed to one overarching problem: They have failed to gain the trust of their would-be partners – and their patients. That trust includes an assurance that there is a business case for advanced data exchange beyond what is required for Meaningful Use and stakeholder confidence that HIEs are able to ensure data integrity, privacy and security, an issue that is often overlooked until there is an incident or a breach.
According to the ONC report, less than 14 percent of healthcare organizations exchange any type of data outside their own organizations. As a result, individuals reported gaps in their health information, including having to provide medical history to another provider because their records were not transferred and duplicating tests because the results were lost.
Because there’s no revenue generation in security and privacy, it’s often treated as an afterthought. To build solid data exchange infrastructures, organizations need to understand all that goes into assuring data security. It’s a fundamental component of the foundation that is paramount to building trust and gaining “buy-in” from both partnering providers and patients.
Creating value
Most healthcare organizations would agree transparency is important, but their business practices suggest otherwise, often unintentionally. For high-functioning HIEs, there are many “moving parts” and myriad federal guidelines and laws governing how they must operate. Add to that the criteria organizations must meet to qualify for federal incentive programs, and it all becomes too much for any one organization or technology vendor to fully stay on top of. A goal of EHNAC, the federally recognized, non-profit standards development organization, is to change the face of healthcare from one that is opaque to one that is transparent and accountable.
There’s also the issue of profitability. When HIEs, many of which are struggling to stay financially viable, are forced to prioritize, their focus has – understandably – been on profit-generating activities. Right now, that means maintaining a laser focus on Meaningful Use measures.
Third-party accreditation programs like the one developed by EHNAC support the needs of HIEs by helping them stay abreast of federal legislative mandates in healthcare, respond to developing trends, increase stakeholder trust and reduce risk of a breach or incident. Remaining profitable in this industry requires the acute awareness of best practices shaping the HIE landscape, a knowledge that can only be gained by the collaboration of many partners and industry experts – an asset many struggling HIEs don’t as yet have.
References
- “National Health Information Exchange and Interoperability Landscape,” Office of the National Coordinator for Health IT, August 2014.
- “Operational Health Information Exchanges Show Substantial Growth, But Long-Term Funding Remains a Concern,” Robert Wood Johnson Foundation, August 2013.
INTEROPERABILITY STANDARDS
HL7 launches Argonaut Project to advance FHIR interoperability standard
Health Level Seven International (HL7) has joined with major industry players to launch the Argonaut Project to accelerate the development and adoption of HL7’s Fast Healthcare Interoperability Resources (FHIR).
FHIR is a next-gen standards framework that leverages the latest Web standards and applies a tight focus on implementation. FHIR is a RESTful (representational state transfer) application programming interface (API), an approach based on modern Internet conventions and widely used in other industries. FHIR represents a significant advance in accessing and delivering data while offering enormous flexibility. For patients and providers, its versatility can be applied to mobile devices, Web-based applications, cloud communications and electronic health record (EHR) data sharing using modular components.
The purpose of the Argonaut Project is to rapidly develop a first-generation FHIR-based API and Core Data Services specification to enable expanded information sharing for EHRs and other health information technology based on Internet standards and architectural patterns and styles. Spring 2015 is the target date for the first FHIR profiles and implementation guides to be provided to the industry by the group.
Project members include: athenahealth, Beth Israel Deaconess Medical Center, Cerner, Epic, Intermountain Healthcare, Mayo Clinic, MEDITECH, McKesson, Partners HealthCare System, SMART at the Boston Children’s Hospital Informatics Program and The Advisory Board Co. The Massachusetts eHealth Collaborative will serve as project manager.
“FHIR is our best opportunity to accelerate interoperability,” says HIT Standards Committee Co-Chair and CIO of Beth Israel Deaconess Medical Center John Halamka, M.D. “We have an unprecedented opportunity to apply additional resources and focus, producing a simple, consensus-based implementation guide for query/response transactions in healthcare using the same type of technologies that Facebook, Google and Amazon have already implemented at scale.”
HL7 is a non-profit, ANSI-accredited standards development organization with affiliates established in more than 30 countries.
Source: HL7
HIE SOLUTIONS
Access patient records longitudinally
Capella Healthcare of Fanklin, TN, is on its way to creating easy-to-access longitudinal patient records. The organization, which includes 13 acute care and specialty hospital facilities across six states, is leveraging Clinical Connectivity solutions from RelayHealth to consolidate clinical information from a wide array of disparate EHR systems, enabling data exchange across the healthcare enterprise. With RelayHealth, Capella Healthcare is now working to acquire and aggregate information from a variety of information systems into one view, making it possible for clinicians to access comprehensive patient information in a single place. RelayHealth
Get seamless provider-to-patient portal exchange
For healthcare providers, making patient information available via a portal within four days of treatment is an important part of Meaningful Use 2 (MU2) compliance. Kodak Alaris has partnered with Access My Records (AMR) and Inofile to create a comprehensive HIE solution between physicians, care providers and patients. The solution solves workflow challenges and enables secure, standards-based patient information exchange, contributing to HIPAA compliance. It also provides a method to replace faxing with the addition of document scanners from Kodak Alaris and Kno2 software from Inofile. Doctors can easily Direct Message unstructured and structured patient information as a Continuity of Care Document (CCD) or Clinical Document Architecture (CDA) to the AMR Patient Portal, whether they are using an EHR system, a paper-based system or a hybrid system. Data from multiple facilities or practices is automatically organized into the AMR Patient Portal. This gives patients a complete view of their detailed health information from participating physicians, service care providers and other sources within an organized, search-friendly platform. Kodak Alaris
Interoperability for the lab and beyond
Consolidation of providers and diffusion of testing create networks of care providers that must be able to share information to effectively coordinate patient care. Sunquest partners with other vendors to find connectivity and interoperability solutions that meet the needs of the Affordable Care Act and participate actively in building the infrastructure to support health information exchanges (HIEs) and regional health information organizations (RHIOs) and comply with Meaningful Use criteria. Sunquest aims to deliver a seamless, reliable method for data exchange among all entities within healthcare organizations. Sunquest
Homeland Security implements eClinicalWorks
The U.S. Department of Homeland Security has gone live using eClinicalWorks’ Cloud-based EHR system for up to 1,000 of its medical professionals to help manage care at all 23 U.S. Immigration and Customs Enforcement (ICE) detention facilities. Using eClinicalWorks allows the department to create a complete, longitudinal record and share data between facilities. Integration with its current systems, including laboratory, radiology and pharmacy, will extend the benefits of this solution. The eClinicalWorks system is a key part of Harris Corporation’s solution to deliver integrated medical records, patient tracking and shared information throughout the ICE Health Service Corps. eClinicalWorks
PATIENT INFORMATION ACCESS
Portals need provider promotion for success
Americans may be more open to getting their health information online than you think – with a little extra help from their doctors.
The results from the 5th annual Xerox survey on usage of electronic health records found that many Americans are open to getting medical records online if they are given instruction on how to obtain access by their medical providers.
This information may prove especially valuable to providers, who can earn Meaningful Use (MU) Stage 2 federal incentives if they demonstrate that 5 percent of patients are using secure portals to view, download and transmit their health information.
The Harris Poll survey, conducted in September 2014 among 2,017 U.S. adults, found that a majority of Americans (64 percent) do not currently use online patient portals, but more than half of those who don’t use them (57 percent) say they would be much more interested and proactive in their personal healthcare if they had online access to their medical records.
Interestingly, while security remains a concern, the survey found that many people are simply unaware of patient portals. Among those who do not use patient portals, 35 percent did not know a portal was available, and 31 percent said their physician had never spoken to them about portals. Among Americans who do use online patient portals, 59 percent say they have been much more interested and proactive in their personal healthcare since they received access.
Survey results suggest that healthcare providers could make strides toward meeting MU Stage 2 requirements and improving care by focusing specifically on the portal needs of millennials (ages 18 to 34 in this survey) and baby boomers (ages 55+ in this survey). Millennials report the highest preference in accessing patient portals on the go, while baby boomers, with their rising need for care, are ripe for provider engagement. Boomers accounted for the highest percentage (83 percent) of Americans who say they already do or would communicate with healthcare providers via a patient portal.
