Healthcare providers increasingly want and need access to their patients’ data for the purposes of care coordination and care management, and, to meet this need, regional healthcare information exchange (HIE) organizations are pushing into advanced analytics and developing new services to bring actionable data to providers at the point of care.
During a session titled, “Emerging Services among Health Information Exchange Networks: Towards Sustainability,” during a pre-conference sessions at HIMSS17 on Sunday, executive leaders at three HIE organizations were joined by John Rancourt, deputy director, office of care transformation (OCT), from the Office of the National Coordinator for Health IT (ONC), to address the issue of HIE sustainability and to discuss several emerging services that HIE organizations are offering to support individual care delivery as well as population health.
However, before the discussion began, John Kansky, president and CEO, Indiana Health Information Exchange, said he took issue with the idea that HIE sustainability is a challenge.
“It’s hard work. I feel like any business that can generate value and has the opportunity to create new value shouldn’t have any problems sustaining itself as a business. With the healthcare system as fragmented as it is, there is no shortage of things that HIEs can do to add value,” he said.
With that being said, the panelists shared what is driving innovation at their HIE organizations and where they are focusing their investments to deliver more value to providers and payers and support interoperability of health data among providers, payers, and other health care organizations.
Brandon Neiswender, vice president and COO, Chesapeake Regional Information System for our Patients – CRISP, a regional HIE serving Maryland the District of Columbia, said, “One of the new things driving innovation at CRISP and what are we investing in is, we believe a lot of the access to C-CDA (Consolidated-Clinical Document. Architecture) clinical data is going to get easier. We see we’re making progress with large national efforts, such as The Sequoia Project and Carequality, moving data a little bit easier upon query,” he said.
However, Neiswender noted, “Connectivity is not interoperability. We have a lot of connectivity, but interoperability is still a challenge for us. FOR CRISP, our stakeholder community is driving us to build care coordination solutions,” he said.
He said CRISP is investing in delivering actionable data at the point of care, “so want to glean relevant information out of C-CDAs and make them snippets of information available at the point of care and building out the C-CDA so other EHR vendor can ingest that directly into the EHRs.” And, CRISP is focusing on connecting the care team, behavioral health use cases and Big Data concepts applied to claims and clinical data.
“We’re also taking a preliminary look at patient-generated data from value-based payment perspective, with a focus on getting that PGD to providers so they can prevent an acute admission,” he said.
Charles Scaglione, CEO and executive director, Bronx RHIO, described his organization as a regional health information organization servicing greater NYC area, specifically the borough of the Bronx, with a population of 1.4 million people. Stakeholders represent appropriately 100 organization from small specialty community-based organizations to integrated delivery systems. Collectively, these providers deliver more than 95 percent of the borough’s annual hospital discharges, more than 600,000 annual emergency department visits and 4.5 million annual ambulatory care visits. Bronx RHIO participates in the Statewide Health Information Network for New York (SHIN-NY).
Currently, key drivers for Bronx RHIO, Scaglione said, health indicators for the Bronx population. “The Bronx historically is poor performing in health outcomes; it’s ranked lowest in New York State, despite the great work being done. It’s a unique population, it’s young, there’s a lot of poverty and challenging health, social and economic indicators, so it’s challenging.”
Health reform initiatives, such as Medicaid redesign and the Delivery System Reform Incentive Payment Program (DSRIP) had a big impact on the organization, he said. “We were the beneficiary of a CMS [Centers for Medicare & Medicaid) innovation grant four years ago and we have used that to push into analytics and working to introduce analytics into the point of care,” he said.
Further, Scaglione says the organization is being driven by providers moving into value-based care models, such as accountable care organizations (ACOs) and patient-centered medical homes.
Scaglione said Bronx RHIO is specifically focusing on data quality assessment and improvement initiatives. “About four years ago, we were starting out on analytics and we realized we didn’t know enough about our data. So, we’re really focusing on data knowledge, data intelligence and we have a board-level priority to focus on this and we’re working with our stakeholders on data quality initiatives.”
The organization also is focused on advanced analytics targeting interventions and improved outcomes, data aggregation and routing to improve care transitions and coordination, patient and population health safety as well as education and research partnerships.
Providing the ONC/ONT perspective, Rancourt said one of the underpinnings of the MACRA legislation is providing a strong incentive to drive providers from payments based on volume to payments based on value. “That requires quality improvement by providers, including a range of interoperable, health information exchange capabilities,” he said. Rancourt said his office actively engages with state leaders and industry stakeholders to focus on the health IT functionalities that providers need and how industry stakeholders can play a role in the healthcare system.
“An area to watch—qualified clinical data registries,” he said. The qualified clinical data registry (QCDR) reporting mechanism was introduced for the Physician Quality Reporting System (PQRS) beginning in 2014. According to the Centers for Medicare & Medicaid Services (CMS, a QCDR will complete the collection and submission of PQRS quality measures data on behalf of individual eligible professionals and PQRS group practices. For 2016, a QCDR is a CMS-approved entity that collects medical and/or clinical data for the purpose of patient and disease tracking to foster improvement in the quality of care provided to patients.
“Another key area to watch is the Comprehensive Primary Care Plus model, which is an advanced alternative payment model under MACRA legislation. This model includes very specific health IT requirements that can be satisfied by a number of different entities, the EHRs within the practice, or through an HIE, or another entity. That’s another area that we’re focusing on with states and HIEs as an area to driving improved interoperability in the space.”
Rancourt asked the panelists to highlight emerging and innovative services at each of their regional HIE organizations.
“Analytics been a cool service in terms of getting to another level of detail and focusing on their business needs,” Scaglione with Bronx RHIO said. However, on a more basic level, he said, the functionalities having the greatest impact on HIE usage are single sign on and data availability alerts.
“A challenge we face on a daily basis is getting end users to use the HIE services. One of the areas where we’ve seen a dramatic impact is single sign-on from within the EMR into the HIE, as opposed to forcing providers to access data in a different way,” he said.
“The other one is data availability flag, where we are embedding the flag into the local system, the ED system, so that the end user or the provider knows when there is data available in the community outside of what’s in their EMR,” he said, and added, “Part of the reason that it that there are specific use cases when need HIE services. Some organizations in the Bronx, about 50 to 60 and even up to 70 percent of patients are accessing care outside their system. For other providers, it’s only 20 percent, so 80 percent of the case, for that provider, they are not finding data outside the system so they routinely access the HIE and 80 percent of the time, they are not getting a hit. The data availability flag allows them to go in when they need to go in.”
“The value of single sign on," Scaglione said, "is recognizing that where the providers are going to live in the future is their EHRS. Any value proposition where you are pulling eyeballs out of EHRs, you need to think about that.”
Scaglione also highlighted Bronx RHIO’s participation in SHIN-NY which enables a statewide patient lookup. “Implementing a statewide interoperability has been a big challenge. You need a very collaborative effort to do that. You need to start in small chunks, as with the statewide patient lookup. We’re moving onto a statewide alerting system that crossing boundaries so the providers can be alerted if there is activity outside of their region. We are moving to other functionality, but it’s incremental.”
Neiswender highlighted CRISP’s care alerts registry, “a by-product of our work on notification services,” he said. “We need a small, lightweight platform to store things to notify people to take action, such as ‘Is the patient in a care management program? Who is the care manager and what is their phone number? Has the patient had a discharge from hospital in past 30 days? These can be small little flags embedded in the patient care overview and available in the query portal, and also available in an API platform.”
He continues, “It’s about small, little use cases. So, I’m an ED registrar and when I see that patient, I call the care manager at that time and avoid some utilization and it’s a completely scalable platform. The care alerts registry tells you who the care manager is, who the PCP is, is this patient taking prescription opioids? A provider can type a two sentence note and say, ‘this is a patient of mine, I know he frequents the ED often, give me a call.’ Things like that. We don’t need to do the heavy lift of C-CDAs, we can extract the data until the standards catch up. In some cases, we’re utilizing the standards,” he said.
In an ongoing effort to provide value and meet the needs of the market, Neiswender said the strategy is more about incrementalism as opposed to long-scale HIE solutions. “I think what has worked for us has been going back to an agile mentality. We ask, ‘who is the user? What is the user story? What am I building a service for? How do we get something small done to show value?”
“We talk a lot about home runs and base hits,” Kansky said. “In our 10-plus year history, we are figuring out what our market wants and needs and will pay for. We need to get away from just wanting to hit home runs. Something that’s talked about in the tech start-up world, and less in the HIE world, is “fail fast,”— if you try to hit a home run and you bet so much resources and two years of development on this huge thing and screw that up, that’s an existential threat. If you do incrementalism, add small value, and figure out which pieces work and not work quickly. And, it needs to be okay to fail. With more things coming into the marketplace to add value, it’s okay to have some failures.”
