At iHT2-Denver, Discussion of HIE Turns to Cultural and Business Issues

Oct. 4, 2016
At the Health IT Summit in Denver, discussion of health information exchange inevitably turned to the cultural, strategic, and business issues around data exchange

At the Health IT Summit in Denver, discussion of health information exchange (HIE) turned strongly towards strategic, business, and cultural issues on the opening panel of the conference, entitled “Strategies for Advancing Interoperability,” as the Summit kicked off on July 21 at the Sheraton Downtown Denver. The Health IT Summit is being sponsored by the Institute for Health Technology Transformation (iHT2), a sister organization to Healthcare Informatics under the Vendome Group, LLC corporate umbrella.

Tuesday’s opening panel on interoperability, which was moderated by Steve Hess, CIO at the University of Colorado Health, also included Dana Moore, senior vice president and CIO at Centura Health; Joe Preiss, chief technology officer at Evans U.S. Army Hospital; Jeff Messer, chief development officer at CORHIO; Justin Gesso, director, business development, at BETSOL; and Jeff Garland, vice president at Relay Health.

In a wide-ranging discussion of all things interoperability and HIE, strategic, business, and cultural issues kept cropping up as major areas to tackle, as provider organizations move forward to exchange data and information to improve care quality and clinician workflow and control costs.

Panelists discuss cultural challenges in interoperability

Still, things are moving forward. Asked how he views the current landscape of data and information exchange, CORHIO’s Messer said, “I think the HIEs across the country are in a similar spot where we’re beginning to get a handle on exchanging data. Most HIEs are doing that fairly well, at least from the inpatient setting out to the ambulatory setting, and all of us are now wrestling with how we become value partners to bend the cost curve, improve care, improve outcomes. A lot of the HIEs across the country are now banding together,” he added. “We’re connecting together and have joined organizations like the Mid-States Consortium, where we’re beginning to help each other move beyond just sharing data. We need to get to the place where HIEs are beginning to connect with each other. And at CORHIO, we’ve been able to connect with KHIM, the Kansas Health Information Network, to share data across both Colorado and Kansas. So we’re starting to achieve some of the things we’ve been working on for years.”

Relay Health’s Garland said, “One of the things that’s key for us as a country when we think about the transformation of those care processes, is that that has to be thought about as a core element in what we do. There’s clearly value in having data follow the patient; we’ve got to find a way to make that a fundamental part as opposed to a bolt-on.”

“We see a lot of large systems acquiring small systems; and system consolidation seems to fly in the face of the need for HIE,” said the University of Colorado’s Hess. “Joe, how do you see those market forces playing out?”

“You’d think that DoD [the Department of Defense] would be advanced; we’ve actually had an HIE for more than ten years, and we can follow the treatment for a wounded military member from the battlefield through to ongoing care,” said Evans U.S. Army Hospital’s Preiss. “But the silos of Army, Air Force, and Navy, have been silos. And the Defense Health Agency is trying to take that next, serious step, to create something more comprehensive. We’re also about to take on a new EHR, which will be announced next week. What I’m finding, though, is that the technical issues are one thing; but the cultural things end up being the most challenging, in trying to figure out how to get the Air Force to give up their control and partner with us, and vice-versa. These DoD issues easily translate to the civilian side,” Preiss emphasized. “Whoever has more resources will probably try to take control; and whoever has fewer resources probably will feel more threatened. So part of what I have to do is to help manage the cultural change issues. It’s a big culture change for them—the Air Force folks—and if you’re in that role, working with a smaller health system, keep that in mind. If you thought it was all going to be about the technical challenges, keep the cultural and human dynamics elements, in mind.”

Centura Health’s Moore said, “There’s this theory that if consolidation proceeds to a certain level, there’s no longer a need for HIE, or the need diminishes. But in fact, now that we’ve acquired a hospital in Kansas, we’re no longer purely Colorado-centric. Also, with minute clinics and pharmacy-based care sites, the landscape is changing. And how do we get information exchanged? So yes, consolidation will help insofar as the number of connections on the acute-care side is concerned, but HIE will continue to play a vital role.”

Is accelerating consolidation making HIE easier? “It does make it a little easier, because instead of having to connect to 12 different hospitals, 15 different hospitals, sometimes, we’re working with just one hospital system,” said CORHIO’s Messer. “It allows us to spend more time with long-term care, with all the other connections. I was at a conference this summer in Washington, DC, and everyone was talking about social determinants factors. How do you connect across all the many elements that are outside the traditional healthcare system? That will continue to expand out the needs around information exchange.”

“As you look at HIE as a tool, what are some of the people and process things Centura is doing to support care processes?” Hess asked. “Centura is part of a couple of ACOs [accountable care organizations], and the Medicare Shared Savings Program,” Moore said. “So you’ve got this flood of information. How do we take all that information and present a holistic view of the patient? If it’s totally outside the clinical workflow, the odds of providers using that tool are somewhere between zero and zero; it’s just not going to happen.”

Moore went on to say, “So we’re trying to pull all the tools together and integrate them back into the workflow of the provider. You’ve got multiple vendors, and you need to integrate the tools into their workflow. There’s a lot of work there, a lot of governance, and then you’ve got a lot of trust issues. And when you get to two physician groups that are competitive, how do you ensure that the data won’t be used by one cardiology group to harvest the patients of the other cardiology group? So you end up spending a lot of time and effort on all those issues. And if you don’t spend the time doing that, you are going to pay for it on the back end, because people won’t connect. So you spend a lot of time explaining to people what the data means. And you have to figure out what is meaningful and what is not. So right now, it’s an interesting time, because we have a foundation built, but in some cases, we have five sets of blueprints for what the house we’re building might look like, so we’re having to create consensus now going forward.”

Indeed, Moore added, “There is still also a reluctance on the part of some providers [physicians] to embrace patient-centered, patient-created, data, as from wearables and other devices. And there’s going to be a flood of data coming in. And now’s the time to determine the rules for data usage going forward, because it will be too difficult later on.”

“And how do I put that data in front of the physicians?” Preiss asked. “If you’re in the early stages of your HIE or your EMR consolidation, you need to make sure to get really good input from physicians in the early stages.”

“And a primary care doctor is extremely different from an orthopedic surgeon,” Hess noted. “Just ask an orthopedic surgeon if they care about vital signs and medications, and they probably don’t. So you need to keep that in mind.”

BETSOL’s Gesso said that in that context, “Predictive analytics will become key in patient care, as people are staying more and more in their homes and being cared for more and more remotely.”

Expanding the discussion out, Centura’s Moore noted that “We’ve been talking about cultural issues, but our approaches to cultural issues also have to extend to patients.”

“We say we want to put the patient at the center, but most often we do everything around the patient,” Hess said. “So what role does the patient have in HIE going forward?”

“That role is going to become extremely central going forward; it has to be,” said Messer. “That’s the only way we’ll make sure that control of information is where it needs to be. And as the patient takes on more and more of the cost—historically, patients have had very little skin in the game financially, at least as they’ve understood it. But as that changes,” he added, “patients are going to demand more accountability, and more access to their data. Right now, it’s mostly education. A recent study done in Pennsylvania,” he noted, “found that 39 percent of patients weren’t aware of the existence of HIE at all, but 70 percent said they’d want access to their data. So we’re in a very early stage of education around this.”

The reality, Messer said, is that “HIE right now is still very provider-centric, but as patients have the ability to change and correct data, they’re going to demand things. Right now, they don’t even know it exists, so bringing them into the fold, beyond, do you want to opt in or opt out—helping them to understand that their record follows them around the continuum of care-eventually, they’ll demand information provided to them in certain ways and certain places.”

Moore emphasized that “It’s going to e a long cultural shift” towards all these processes really being made patient-centric; “it’s not going to happen overnight. We have the responsibility to educate. But if you think about the average person, they think about primary care and maybe emergency care.” And he noted that “Practically every hospital organization has something in its mission statement about improving the health of its community. And we’re finally going to be compelled to do that, to put communities at the center, and not just think about the individual patients we’re treating directly ourselves.”