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Innovative Collaboration on Medication Management and Community Resources

Posted on April 23, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://radar.oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Although experts agree that the future of health is coordinated care, it is sorely lacking in the US health care system now. This article focuses on the single, relatively simple issue of medication management. Patients are prescribed barrels of pills, but there is little coordination other than looking for contra-indications and drug interactions–and these often suffer from the caretaker’s not knowing the patient’s full complement of drugs.

Sandra Raup, president of Datuit, points out that all kinds of subtleties get lost when patients are simply told how often to take a medication. For instance, if medications are spaced out throughout the day instead of being being taken all at once when we remember to take them (as so many people do), they may be absorbed more effectively and tolerated by the body. Patients–especially those with lower incomes and less education, who are more likely to be on multiple medications in the first place–need all sorts of support.

Here we come to an interesting twist: coordinated care does not have to be initiated by doctors. Given the doctor shortage and the forces keeping clinicians from adopting new models of treatment, other professionals can take on the long-term goals of improving patient health.

In a pilot ramping up in a residence for low-income seniors and the disabled in Maryland, Connected Health Resources is working with Alfa Specialty pharmacy using its Community Health Gateway to help patients straighten out their medications and keep to their schedules. This works because the pharmacy is in a somewhat unusual position: they have supported this community for some time and have built relationships with patients informally. The Gateway pilot has created a service, using Datuit’s SafeIX public API, that can potentially fulfill these needs with less work on the pharmacist’s part. The service is designed for easy navigation by the patients and their family caregivers, making it attractive to the patients and the pharmacists.

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The SafeIX Platform is designed using modern programming technologies to integrate data from multiple sources (including EHRs and HIEs) into a patient record for both patients and healthcare providers to use, based on their rights to access and share it. In the Gateway implementation, the pharmacist uses the SafeIX Platform to receive CDA documents from the HIE and to auto-assist medical data reconciliation between the various documents.

This information, along with the pharmacist recommendations, are organized into a daily medication calendar using an application from Polyglot Systems Incorporated, a company that offers medication regimen summaries in 18 languages. Low health literacy and the estimated 50 million people who do not speak English at home result in many patients not understanding their medication instructions. The plain language and multilingual, easy-to-use daily calendar can make the difference between understanding and total confusion.

Datuit’s SafeIX Platform uses interoperability standards (including, in test mode, the next-generation FHIR standard) to create a patient record that can show patients everything seen by multiple clinicians and allow a patient’s self-selected care team to view and add to a shared care plan. Datuit is encouraging app developers to build mobile apps for SafeIX that would prompt patients to take medications and record whether they did so, but that’s outside the scope of the pilot. There are plenty of challenges just fulfilling the tasks they have already taken on.

First, Connected Health Resources has to break down the clinical data silos that make it difficult for patients to collect their information. According to co-founder Shannah Koss, Maryland has a relatively advanced Health Information Exchange (HIE) called CRISP. However, it is defined as a provider-to-provider exchange, so it was only after a long-term relationship and negotiation that Connected Health Resources could collect medical data on behalf of the patients. This is the first time CRISP has allowed data to be retrieved for a patient-facing organization that is not a provider.

When enrolling, the patient gives the Gateway permission to get data through CRISP. Family and friends can be invited by patients to be part of their health community and enroll in the Gateway. The invitation includes a unique code that allows the Gateway to securely share records and help with health and social services navigation. If the patient wants help or is incapable of managing the medication list, a caregiver can do so.

CRISP transmits data primarily from hospitals. To round out a more comprehensive listing of medications from clinics and other healthcare providers, CRISP has enabled the ability to query Surescripts, which provides prescription fill data from chain pharmacies and pharmaceutical benefit management companies.

Pilot participants authorize the Gateway and the Alfa pharmacists to access their medication information and maintain, share, and augment the information in the secure SafeIX Platform. The CRISP data gives more complete medication records for the pilot participants. CRISP also provides an event notification system that let’s the pharmacist know whether a patient has been admitted to a hospital or visited the emergency department. These types of transition are precisely when medications get changed, but the clinicians at those crucial junctures often don’t know all of a patient’s current medications.

Finally, over-the-counter (OTC) medications can play an important role in a patient’s care. This has to be added to the daily calendar. The Alfa Pharmacist is helping round out the complete medication picture by working with the patient and family to identify OTC medications, supplements, and the medications that are actually being taken through the medication therapy management (MTM) program. The Gateway provides the means for everyone to better understand and manage the medicines for the best outcomes.

Further, the Gateway Community Resource Finder has enabled information about important resources such as transportation, meal delivery, social services, and home nursing. The MTM pharmacist knows that patients without food or transportation to their physicians cannot adequately manage their health or medications. The underlying SafeIX Platform also allows the Gateway to offer secure messaging that looks like email and lets the pharmacist, patient, friends, and family exchange messages about the patient’s care.

Traditional EHRs don’t accommodate treatment plans of the specificity designed by the pharmacy for patients in the pilot. This is where Datuit is pushing the EHR to new horizons: its SafeIX Platform helps multiple clinicians (including long term care providers), patients, and family caregivers contribute data. For example, patients can enter their own healthcare problems, such as fear of falling. The patients, families, and clinicians can then add interventions to address them.

Like other new organizations I’ve spoken too in health care, Connected Health Resources has grand plans beyond the current pilot. They are taking it slow, because Koss believes personal health records (PHRs) have tried to do too much at once and have overwhelmed their users with too many possibilities. But she would like Connected Health Resources to grow in response to what patients and families say they need. The Gateway tools already include the ability to generate multi-lingual discharge instruction from Polyglot. The initial pilot purposefully focuses on the more narrow scope of medications along with the health and social services support. The next step will be to engage hospitals to provide the plain language multi-lingual discharge instructions.

Chronic care ultimately goes beyond medications to things supported by a patient-centered medical home (PCMH), community health workers, and the many community-based service providers. The Gateway in partnership with the Datuit SafeIX Platform are poised to allow all participants identified by the patient and families to contribute to and be part of their health community.

Assessment Released of Health Information Exchanges (Part 1 of 2)

Posted on January 6, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://radar.oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Like my Boston-area neighbors who perennially agonize over the performance of the Red Sox, healthcare advocates spend inordinate amounts of time worrying about Health Information Exchanges (HIEs). Will the current round of exchanges work after most previous attempts failed? What results can be achieved from the 564 million dollars provided by the Office of the National Coordinator since 2009? Has the effort invested by the government and companies in the Direct project paid off, and why haven’t some providers signed up yet?

I too was consumed by such thoughts when reading a reported contracted by the ONC and released in December, “HIE Program Four Years Later: Key Findings on Grantees’ Experiences from a Six-State Review. Although I found their complicated rating system a bit arbitrary, I found several insights in the 42-page report and recommend it to readers. I won’t try to summarize it here, but will use some of the findings to illuminate–and perhaps harp on–issues that come up repeatedly in the HIE space.
Read more..

What is Direct?

Posted on June 10, 2014 I Written By

Julie Maas is Founder and CEO of EMR Direct, a HISP (Health Information Service Provider) whose mission is to simplify interoperability in healthcare through the use of Direct messaging EHR integration and other applications. EMR Direct works with a large developer community to enable Direct for MU2 and other workflows using a custom, rapid-integration API that's part of the phiMail Direct Messaging platform. Julie is passionate about improving quality of care and software user experience, and manages ongoing interoperability testing within DirectTrust. Find Julie on Twitter @JulieWMaas.

John’s Update: Check out the full series of Direct Project blog posts by Julie Maas:

The specialist down the street insists he wants to receive your primary care doctor’s referrals, but only if it’s digital: “Sure, I’ll take your paper file referral sent via fax. But the service will cost an extra $20, to pay the scribe to digitize the record so I can properly incorporate the medical history.”

Does it really sound that far off? Search your feelings, Luke…

Will getting medical treatment using paper records soon be like trying to find somewhere to play that old mix tape you only have on cassette?  Sound crazy?  Try taking an x-ray film to a modern radiology department, and see if they still have a functioning light box anywhere to look at it.  It’s all digital now.

There are, of course, other factors.

Because MU2.

Because nobody, and I mean no small company and no large company, wants to be referred to as a data silo anymore.

Direct Exchange is a way of sending and receiving encrypted healthcare data, and certified EHRs must be able to speak it, beginning this year.  Adoption of Direct is increasing rapidly, and its secure transfer enables patient engagement as well as interoperability between systems that were previously dubbed silos.  Here is a brief overview of where Direct is currently required in the context of MU2 (please refer to certification and attestation requirements directly, for full details):

Certified ambulatory and acute EHRs need to use Direct for Transitions of Care (170.314(b)(1) and (b)(2)). They have to be able to Create a valid CCDA and Transmit it using Direct, and they have to be able to use Direct to Receive, Display, and Incorporate a CCDA. In the proposed MU 2015, the Direct piece may be de-coupled from the CCDA piece and modularized for certification purposes, but the end to end requirement would remain the same.

EHRs or their patient portal partner additionally need to demonstrate during certification that patients can View, Download, and Transmit via Direct their CCDA or a human readable version of it.  Yes, you heard correctly, I said patients.  As in patient engagement.

So, how does a healthcare provider get Direct?

1. Get a Direct account through your Direct-enabled EHR vendor

One way HIT vendors offer Direct is through a partnership with one or more HISPs (OpenEMR, QRS, Greenway, and others).  Others run their own HISPs (Cerner, athenahealth, and others).

2. Get a Direct account through an XD* HISP that’s connected to your EHR

HIT vendors alternatively enable access to Direct through an XD* plug-and-play (mostly) connector.  These “HISP-agnostic” EHRs allow healthcare organizations a choice between multiple XD*-capable HISPs when meeting MU2 measures (MEDITECH, Epic, Quadramed, and other EHRs have implemented Direct this way).  EMR Direct, MaxMD, Inpriva, and a few other HISPs offer XD* HISP services; not every HISP offers XD* service at this time.  Of course, there is a trade-off between this flexibility and the extra legwork required of the practice or hospital in setting up Direct.

3. Get a web-based or email client-based Direct account not tethered to an EHR or Personal Health Record (PHR)

 

Direct doesn’t have to be integrated into an EHR to transfer information digitally. Non-tethered accounts cannot attest to the sending side of (b)(2) nor the receiving side of (b)(1) on their own, but they can be Direct senders and receivers nonetheless, participating in Transitions of Care or data transfer for other purposes.  They may also be used to exchange health data with patients, billing companies, pharmacies, or other healthcare entities who are Direct-enabled. In fact, some very compelling use cases involve systems who may not have their own EHR, but want to receive digital transitions of care—one such example is skilled nursing facilities.

By the way, patients are also an integral part of the Direct ecosystem.  Several PHRs are already Direct-enabled, and more are on the way.

So, go digital and get your Direct address, and begin interoperating in the modern age!

HIE Study Finds That Failure To Use Data Cost $1.3 Million Over 18 Months

Posted on March 3, 2014 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

You can put an HIE in place, but you can’t make doctors drink. That fractured moral was demonstrated recently by an HIE in Western New York, which found that many doctors were failing to use data available in the HIE, and thus ordering CT scans that were unnecessary — wasting about $1.3 million over an 18 month period.

The HIE, HEALTHeLINK, recently conducted a study intended to put a specific value on how many potentially unnecessary duplicative tests were being ordered by providers in its region, as well as a potential savings to the health system.

The sample audience was comprised of patients who had received more than one CT scan within a six-month period on the same part of the body. Scans were then sorted into the three most common categories of CBT groupings — head and neck, chest, and abdomen.

The duplicate scans were divided into three separate categories: 1) studies in which the CT report clearly reference to previous CT scan, 2) inconclusive studies in which researchers were able to tell if the previous study was known prior to ordering the scan and 3) unknown studies in which the CT report clearly stated that no previous study was known of.

Some findings include the following:

* During the 18 month study, which drew on claims data from three major insurance carriers in the area, researchers found about 2,763 CT scans which were considered to be potentially unnecessary.

* About 90 percent of the potentially needless CT scans were ordered by physicians who never or infrequently used the HIE. And more than 95 percent of the identified potentially unnecessary CT scans were done in a hospital,

* About 50 percent of the patients who had a duplicate CT scan had already consented to have their data accessed (so patients weren’t the obstacle).

While the analysis is complex, the lesson seems to be fairly simple. HIE’s are missing out on producing cost reductions when doctors aren’t accessing them prior to ordering tests.

#HIMSS14 Highlights: the Snail’s Pace of Interoperability

Posted on February 26, 2014 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

Ah, HIMSS. The frenetic pace. The ridiculously long exhibit hall. The aching feet. The Google Glass-ers. As I write this, day three for me is in full swing and I’ve finally managed to find some time to reflect on what I’ve seen, which includes a ridiculously long taxi queue at the airport, more pedicabs than I can count, beautiful weather and lots of familiar faces, which is what makes HIMSS so much fun. I’ve heard lots of buzzwords and sales talk, and seen only about an eighth of the exhibit hall, barely scratching the surface of what’s out there on the show floor.

Several common themes stand out based on the sessions and events I’ve been to, and the passions of those I’ve encountered. Whether it’s vendor breakfasts, social networking functions, exhibit elevator pitches or educational sessions, interoperability and engagement are still the buzzwords to beat. This particular HIMSS has given me a different perspective on each, and offered new insight into what’s happening with the Blue Button Connector. I’ll cover each of these in HIMSS Highlights posts over the next several weeks, starting with interoperability.

The industry seems far more realistic this year regarding interoperability – downright frustrated by the slow pace at which such a lofty goal is proceeding. Industry experts Brian Ahier and Shahid Shah perhaps expressed it best during a lively panel discussion at the Surescripts booth:

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Putting vendors’ feet to the fire will certainly initiate a quick and painful reaction, but probably not a sustainable one. True momentum will occur only when providers get singed a bit, too. Panelist comments at a Dell / Intel breakfast on analytics for accountable care brought this into sharper focus for me. The fact that too many disparate EMRs (and thus too many vendors poised to cause inertia) are making it hard for analytics to successfully be adopted and utilized at an enterprise level, highlights a bigger problem related to hindsight and strategy.

From my perspective – that of an industry observer and commentator – it seems many providers felt compelled to purchase EMRs because the federal government offered them money to do so, and hopefully just as many were optimistic about the role technology would play in positively affecting patient outcomes. Vendors saw a great business opportunity and moved quickly to develop systems that met Meaningful Use criteria (not necessarily going for best-fit as related to workflow needs and usability). Neither group truly knew what they were in store for, especially regarding longer term plans for health information exchange.

Providers now find themselves wanting to move forward with health information exchange and greater interoperability, but slowed down by the very IT systems they were so insistent on purchasing just a few years ago. Vendors (some more than others) are hesitant to crack open their products to allow data to truly flow from one system to another, and who can blame them? The EMR market, in particular, is poised to shrink, which begs the question, who will survive? What companies will be around at HIMSS 15 and 16? Those who keep their systems siloed, like Epic? Or those who are trying to break down the silos, such as Common Well Alliance members like athenahealth and Greenway?

It makes me wonder if providers wouldn’t have been better served with just had a handful of EMRs to choose from around the time of HITECH, all guaranteed to evolve as needed and play nicely with each other in the interest of health information exchange. Too many options have caused too many barriers. That’s not just my opinion, by the way. I’m willing to bet that a sizeable chunk of the 37,537 HIMSS 14 attendees would agree with me.

Do you disagree? Are providers (and patients) better served by more IT options than less? Let me know your thoughts, and impressions of interoperability advancement at HIMSS, in the comments below.

HIE Cuts Back On Excess Imaging, But Savings Aren’t Huge

Posted on January 21, 2014 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

For years now, we’ve been told that HIEs would save money and reduce redundant testing by hospitals and doctors.  Until recently, such has mostly been the stuff of anecdote rather than hard results.  But a new study comparing hospitals on an HIE with those that were not seems to offer some of the hard evidence we’ve been waiting for (though the cost savings it finds aren’t spectacular overall).

According to a piece in Healthcare IT News, a new study has come out which demonstrates a link between HIE participation and the level of imaging performed in hospital emergency departments.

The study, which was done by Mathematica Policy and the University of Michigan, found that when hospitals were joined in an HIE, the number of redundant CT scans, x-rays and ultrasounds fell meaningfully, generating savings in the millions of dollars.

To conduct the study, Mathematica and the U of Michigan compared the level of repeat CT scans, chest x-rays and ultrasounds for two groups.  One group consisted of 37 EDs connected to an HIE; the other group was 410 EDs not connected to an HIE.  Researchers collected data on the two groups, which were based in California and Florida, between 2007 and 2010, using the state emergency database and HIMSS Analytics listing of hospital HIE participation.

The researchers found that hospital EDs participating in an HIE reduced imaging across all the modalities compared with hospitals not participating in an HIE.  For example, EDs using an HIE worth 13 percent less likely to repeat chest x-rays, and 9 percent less likely to repeat ultrasounds.

Ultimately, the study concluded that if all of the hospital EDs in California in Florida were participating in HIEs, the two states could save about $3 million annually by avoiding repeat imaging.  This is just fine, but this translates to $3 million in lost revenue for those hospitals. Once you split up $3 million across that many hospitals, you don’t end up with an impressive amount per hospital, but it’s still a cut to revenues. A cut in revenue isn’t a strong motivator to implement an HIE even if it does help to lower healthcare costs.

This is why it’s a real challenge to get many hospitals on an HIE. When you throw in the technical issues involved in HIE membership, it could be quite some time before the majority of hospitals jump on board without more external incentives.

CommonWell Announces Sites For Interoperability Rollout

Posted on December 13, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Nine months after announcing their plan to increase interoperability between health IT data sources, the CommonWell Health Alliance has disclosed the locations where it will first offer interoperability services.

CommonWell, whose members now include health IT vendors Allscripts, athenahealth, Cerner, CPSI, Greenway, McKesson, RelayHealth and Sunquest, launched to some skepticism — and a bit of behind-the-hand smirks because Epic Systems wasn’t included — but certainly had the industry’s attention.  And today, the vendors do seem to have critical mass, as the Alliance’s founding members represent 42 percent of the acute and 23 percent of the ambulatory EMR market, according to research firms SK&A and KLAS.

Now, the rubber meets the road, with the Alliance sharing a list of locations where it will first roll out services. It’s connecting providers in Chicago, Elkin and Henderson, North Carolina and Columbia, South Carolina. Interoperability services will be launched in these markets sometime at the beginning of 2014.

To make interoperability possible, Alliance members, RelayHealth and participating provider sites will be using a patient-centric identity and matching approach.

The initial participating providers include Lake Shore Obstetrics & Gynecology (Chicago, IL), Hugh Chatham Memorial Hospital (Elkin, NC), Maria Parham Medical Center (Henderson, NC), Midlands Orthopaedics (Columbia, SC), and Palmetto Health (Columbia, SC).

The participating providers will do the administrative footwork to make sure the data exchange can happen. They will enroll patients into the service and manage patient consents needed to share data. They’ll also identify whether other providers have data for a patient enrolled in the network and transmit data to another provider that has consent to view that patient’s data.

Meanwhile, the Alliance members will be providing key technical services that allow providers to do the collaboration electronically, said Bob Robke, vice president of Cerner Network and a member of the Alliance’s board of directors.  CommonWell offers providers not only identity services, but a patient’s identity is established, the ability to share CCDs with other providers by querying them. (In case anyone wonders about how the service will maintain privacy, Robke notes that all clinical information sharing is peer to peer  — and that the CommonWell services don’t keep any kind of clinical data repository.)

The key to all of this is that providers will be able to share this information without having to be on a common HIE, much less be using the same EMR — though in Columbia, SC, the Alliance will be “enhancing” the capabilities of the existing local HIE by bringing acute care facility Palmetto Health, Midlands Orthopaedics and Capital City OB/GYN ambulatory practices into the mix.

It will certainly be interesting to see how well the CommonWell approach works, particularly when it’s an overlay to HIEs. Let’s see if the Alliance actually adds something different and helpful to the mix.

One-Third of Chicago-Area Hospitals Come Together Into HIE

Posted on December 4, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Thirty-four Chicago hospitals have decided to come together into a health information exchange, with plans to begin exchanging data early next year, according to a story in Modern Healthcare.

The group, which calls itself MetroChicago HIE, considers itself to have critical mass, given that it embraces about a third of the region’s 89 hospitals.

To exchange data, the HIE is using Direct protocols permitting basic, encrypted clinical messaging, such as the transmission of referral letters between providers which have established authentication and business relationships, Modern Healthcare notes.

Even with Direct protocols in hand to streamline data sharing, the hospitals will face significant challenges in tightening communications between their various EMRs, which include a number of Epic and Cerner installations, as well as a few Meditech shops. Planners will also face issues when they set out to link the HIE to office-based physicians.

To address the problem of communicating between multiple interfaces, the HIE has hired technology firm SandLot Solutions, a company launched by North Texas Specialty Physicians.

To date, many hospitals have been reluctant to sink big bucks into HIE development. But participating hospitals in Chicago seem confident that there is a business case for spending on an HIE.

The truth is, this may just be a tipping point for hospital-run HIEs generally. For example, a recent study by HIMSS Analytics and ASG Software Solutions concluded that almost 70 percent of the 157 senior hospital IT execs surveyed were involved in HIE efforts.

Now, let’s see how these Chicago hospitals handle data exchange when they move beyond Direct into more advanced sharing. That will really be where the rubber hits the road.

Hospitals Still Struggling With HIE Data Sharing

Posted on September 30, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Hospitals are trying hard to make HIEs work, but establishing robust data exchange remains a major challenge, particularly given the difficulty involved in processing paper records, a new study by HIMSS Analytics suggests.

The report, sponsored by ASG Software Solutions, draws on a survey of 157 senior hospital IT executives.

More than 70 percent of respondents to the survey reported that they participated in an HIE with other hospitals and health systems.

The thing is, the facilities reported that they’re having difficulty exchanging patient information in meaningful, powerful ways. Also, survey respondents noted that sharing information outside of HIEs is held back by budget concerns and staffing problems.

Juggling electronic and paper-based data is still a major issue, the study suggests:

* 64 percent of health information organizations reported that they shared data with nonparticipating hospitals via fax
* 63 percent of the same organizations converted faxed information into digital form via scanning
* 84 percent of respondents integrated their output/print environment directly into their EMR/HIS system
* 42 percent of survey respondents said their output/print environment was “high effort”

Unfortunately for HIE fans, coordination and management of paper records is far from the only issue standing in the way of making them work acceptably in a hospital environment.

According to a study by Chilmark Research, the focus of most HIEs is still on secure clinical messaging, which doesn’t do the job for cross-enterprise care coordination. The Chilmark research estimates that queries of databases for patient information needed at the point of care account for just 2 percent to 10 percent of HIE transactions overall.

As Chilmark CEO John Moore recently told Information Week, the problem is particularly acute in ambulatory care. Most ambulatory EMRs haven’t been able to generate CCDs that other EMRs can consume or execute queries using a record locator service. This is a pretty serious weakness in the HIE space, given that 80 percent of care takes place in ambulatory setting.

Given their importance, it’s troubling to see how many obstacles remain to robust HIE use by hospitals and physicians. Let’s hope the next 12 months see some breakthroughs.

HIEs Unable To Keep Up With User Demands

Posted on August 7, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

While HIEs are expanding their offerings to include analytic and care coordination functions useful for population health management, they aren’t doing it quickly enough to meet market demand, according to a piece in Information Week.

The IW story, which outlines the conclusions of a new report from Chilmark Research, notes that the focus of most HIEs is still on secure clinical messaging, which is not adequate for cross-enterprise care coordination. The Chilmark report estimates that queries of databases for patient info needed at the point of care account for just 2 percent to 10 percent of HIE transactions overall.

Information Week also drew attention to a study appearing in Health Affairs noting that the most common functions of the 119 operational public HIEs were transmitting lab results, clinical summaries and discharge summaries. While there’s been a large increase in the number of HIEs that can exchange Continuity of Care Documents, few EMRs can integrate the data components of CCDs in to structured fields, the Health Affairs piece noted.

The problem is particularly acute in ambulatory care. As Chilmark CEO John Moore told Information Week, most ambulatory EMRs haven’t been able to generate CCDs that other EMRs can consume or do queries using a record locator service. “The value that HIEs provide to the ambulatory sector, where 80 percent of care takes place, is pretty limited,” Moore told IW.

Still, despite their weaknesses, public HIEs continue to hold onto life. For example, as various industry stats have shown, hospital CIOs increasingly see participation in an HIE as a key initiative, if nothing else because Meaningful Use will eventually demand interoperability.

But as the Chilmark study emphasizes, HIEs have a long way to go before they’re making a major contribution to patient care. And getting enough momentum to address these problems seems elusive. All told, while HIEs are clearly an important movement, getting them to the point of true usefulness could take years more.