Deborah (Deb) Bass, the CEO, and an active board member, of the Nebraska Health Information Initiative (NeHII), continues to be as bullish on the future of health information exchanges (HIEs) as ever. Last month, Bass participated in the annual meeting of the Strategic Health Information Exchange (SHIEC), a national collaborative of more than 40 HIEs, and which was held in Scottsdale, Arizona, Sep. 18-21. More than 250 HIE leaders from around the country attended this year, up from about 100 in 2015. Among other speakers who addressed the gathering were senior officials from the federal Centers for Medicare & Medicaid Services (CMS) and from the Office of the National Coordinator for Health IT (ONC).
Meanwhile, NeHII has been making advances in a number of areas in its seven-year history. Among other things, NeHII was designated in 2011 as a State Prescription Drug Monitoring Program (SPDMP), which means that the HIE is providing critical information to clinicians and public health leaders that is needed in the growing nationwide effort to stem the explosion in opioid abuse.
As summarized in a June 1 article in Health IT Interoperability published on SHIEC’s home page, “Three members of the Strategic Health Information Exchange Collaborative (SHIEC) have come together to form a patient-centered data home (PCDH) initiative, which could better facilitate interstate health information exchange (HIE), the group recently announced. The PCDH initiative works by sending out episode alerts to participants of the program. These episode alerts notify providers that a patient has sought medical care outside of their regional, or “home,” HIE, and will direct providers on where to send patient data. This HIE will be query-based, allowing providers real-time access to the health data. This initiative,” the article, by Sara Heath, noted, “will reportedly help participating providers deliver better patient-centered care by allowing them to consult actual patient data to inform their decisions. The HIEs involved in PCDH are Arizona Health-e Connection (AzHeC), Quality Health Network (QHN), and Utah-based UHIN. According to AzHeC leaders, PCDH will help promote the ‘no wrong door’ policy, which states that health data should be available regardless of where a patient seeks care.”
That article further quoted Dick Thompson, executive director and CEO of QHN, as stating that “The concept is focused on providers having access to real-time data wherever a patient may present for care by providing information across state lines and disparate health care systems.” What’s more, Thompson added, “HIEs share common borders and common patients, and we are able to share information on these patients when they are away from their home zip code, bridging gaps in information and enabling more comprehensive patient records.”
Recently, Deb Bass spoke with Healthcare Informatics Editor-in-Chief Mark Hagland about some of the current issues and opportunities facing the HIE sector in U.S. healthcare, and about her perspectives on things happening at NeHII and nationwide. Below are excerpts from that interview.
What were some of the big-picture issues that you and your fellow HIE leaders discussed and addressed at the SHIEC annual conference last month?
I would say, first of all, we’re looking at answering this need for a nationwide health information exchange solution, because of challenges with interoperability. We believe that HIE is the answer to interoperability. So most of our topics centered around following patients wherever they go. So we discussed this concept of the patient-centered data home. What we do is that we share our zip code data between and among these HIEs inside this trust relationship. Did you see the release yesterday from HHS about the grants? The Heartland Grant they announced was one of those. Meanwhile, NeHII was able to send four people to the conference, and we’ve been discussing since then what was addressed at the conference, of course. And one of the big developments has been the awarding of grants for multi-state HIE development—the PCDH program.
And it appears that someone has trademarked the term “patient-centered data home”?
Yes, SHIEC has. And we’ve had a tremendous response to the concept. The PCDH is now live between Arizona, Colorado, and Utah. There are three different pilots. One is Oklahoma and Arkansas; Dick Thompson is the CO/AZ/UT; and Keith Kelley’s is Indiana, Ohio, and Kentucky.
What are these projects doing, basically?
We’re using our zip codes and ADT messages to alert our neighboring HIEs that we have a patient in your HIE, and we need that patient care summary, that CCDA.
What is your vision of the patient-centered data home?
With the SHIEC organization, we have 46 member HIEs, and we’re beginning to build a national network based on zip codes, and we have very good coverage in a number of areas of the country. So you’ve got the home HIE and the visiting HIE. And when we use our admission/discharge/transfer messages—when a patient is cared for by a patient care organization…
So, for example, a patient from Nebraska might be traveling in Colorado and need care, and the PCDH will facilitate critical communications about that patient’s status and accessing of services?
Yes. Once we have agreed to share zip codes between the two HIEs, then the ADT message will make us aware that this patient came from a zip code in Colorado, so we can then ping Colorado back, and say, this patient is in a hospital in Nebraska now, do you have any information on her? And then they can send a CCD. And we can also contact the primary care physician, and leave it up to him as to whether he wants a CCD from that Nebraska facility.
How many states are encompassed so far?
The three pilots. The Colorado/Arizona/Utah pilot is live and operational. Dick Thompson is chair of the SHIEC board, and QHN is part of this pilot. Meanwhile, we at NeHII are looking to apply for funding so that we can be part of this pilot, because so many of our Nebraskans travel to Colorado and to Arizona. That answers our need for a nationwide HIE system. To build a query-model exchange, we’re going to look at where people travel. I’m speculating that if we can get Colorado, Arizona, Nevada, and Florida, we’ll catch a significant volume of patients. And we’re working with Optum as a vendor, on this. So there’s the Colorado/Arizona/Utah pilot that’s operational. Then there’s the Heartland pilot, which just received funding—that encompasses a number of HIEs in Ohio, Indiana, and Kentucky. And a third one—between Oklahoma and Arkansas—that one was expected to become operational last week. So it involves sharing zip codes and communicating ADT messages. And we can use the same technology to track drug-seekers across state lines. These PDMPs—that’s redundant technology to do the very same things that HIEs are doing. Prescription drug monitoring programs.
There’s been a lot of talk recently about HIEs teetering, and in fact, some have gone out of business. What do the leaders of successful HIEs have to say about that kind of talk?
That’s why I wanted to share the SHIEC conference agenda with you. HIE is alive and well, and some are being very successful. Yes, some states—Wyoming, Montana—have floundered. But many of us have been very successful. And as mature organizations that are successful are continuing to grow, while those that haven’t had a solid position in the marketplace are being absorbed—you’re seeing consolidation in some states, like New York. It doesn’t mean that HIE is going away—it just means people are figuring out the sustainability question. At this conference, more than 45 HIEs were attending this conference, and they all sent people.
What are the critical success factors now, for the HIEs that are doing well?
It certainly involves delivering value to your participants, and at a level that participants are willing to pay for. For example, in terms of the readmission reduction mandates and the alerts—so that providers all know—making sure there is a physician visit scheduled after a discharge, making sure the patient is taking their meds, finding a nursing home bed at the right level, following a discharge—all of these are game-changers. And many of these factors have to do with operationalizing the patient flow. For example, a home health agency here was losing significant dollars by sending visiting nurses out on regularly scheduled visits when patients were being admitted to the hospital. The Visiting Nurses Association here couldn’t exist any longer without NeHII. So weaving information into the fabric of the everyday operations of a participating organization. That’s what cements the deal. Whether it’s a simple license fee, or in Delaware, it’s a usage fee. In Utah, they have a database that indicates secondary insurance coverage, and that’s one of their value-add services. That’s in that PowerPoint presentation that I presented in Denver.
How should our key audience members be looking at this right now?
Particularly as we are looking at MACRA and MIPS [the federal Medicare Access & CHIP Reauthorization Act of 2015, and its component, the Merit-Based Incentive Payment System], it’s very clear that you have to be able to understand where your patient is in the continuum of care. EHRs stop at the hospital door and the private HIEs are usually connecting a certain circle; but until you know your attrition and attribution rates, if you’re in an ACO, if you don’t know where those are, you’re missing pieces of the puzzle. And time is of the essence, when you’re working these quality scores. And that’s true whether you’re in an ACO or not, now, for physicians, once MIPS goes into effect. And it’s just a matter of time before the private payers start following Medicare on this.
So you think that MACRA/MIPS will actually be good for HIEs?
Yes, take a look at some of those quality scores—they’ll have to know where their patient is and if they’re following a care plan, and unless they’re manually tracking patients across the network, the HIE is going to help them with the information and tracking gaps that exist.
What’s going to happen in the next year or two?
Well, this HIP grant—we’re going to look to operationalize this whole exchange. And we of course are looking at the other networks, the eHealth Exchange, for one, to see how we can partner with them—we understand the importance of building some kind of nationwide network—and the DRSA is a good beginning—the agreement that the eHealth Exchange uses that you must sign, but it only handles treatment and payment. So when you go into some of these operational areas—the pilot that’s in Colorado/Arizona/Utah, they’ve enhanced the DURSA [Data Use and Reciprocal Support Agreement] to include some facets of healthcare operations under HIPAA. It is all about risk-based payment, which involves the payer aspect, and that helps manage the patient across the continuum of care.
You sound very optimistic overall about the future of HIE.
You know, there are many HIEs that exist that are delivering value to their participants and stakeholders, and we have become woven into the fabric of their everyday business. And it’s a part of their operations, and without the HIE, they would not be able to accomplish what it is they need to do to meet quality reporting requirements, and the management requirements in risk-based payment models that they are becoming participants in, and HIEs are delivering on that need.