Health Information Exchanges: Some Community Practices Are Benefitting, Many Are Not
By John McCleery
Electronic health information exchange (HIE) continues to grow, but only in certain areas of the country and only within certain health systems and practices, according to a forum recently held in Chicago by The Association of Community Cancer Centers (ACCC) Institute for the Future of Oncology. The Institute convened to explore key issues impacting community cancer centers with HIE systems and to gain perspective on how to help community cancer centers better meet the challenges facing the oncology community.
While ACCC stakeholders believe that HIEs have the potential to improve patient care, reduce duplication of services, lower costs, and improve quality of care, the oncology community is experiencing “uneven adoption” of HIEs across the country.
An HIE is a technology platform that allows for the electronic exchange of data in a secure manner, where patient information can be accessed when it is needed across organizational, vendor, and geographic boundaries. An HIE can include services such as physician web portals, patient health records, clinical messaging, and data exchange from electronic medical records or electronic health records, among others. However, the ACCC Institute reports that surprisingly, many within the oncology care community are unaware of the opportunities or services that HIEs offer.
ACCC experts report that practices implementing HIEs are benefitting from their use. For example, at the conference one provider who represents a large private practice with 6 locations and participates in an HIE service that serves the Midwest area said that they have a network that stores data, text, images, and voice dictation from provider sources. The sources include inpatient and outpatient lab results, radiology reports, discharge summaries, and any other hospital surgeries or emergency services provided to the patient. The information automatically feeds into the practice’s EMR. In turn, the practice out bounds to the HIE, lab reports, radiology reports, and other pertinent patient information. In this respect, the HIE becomes an integration engine.
If the practice sends patients to a tertiary center, that center can upload directly from the practice's EMR. “If one of our patients walks into the ER, their system queries anything done in the last 90 days from a provider in the exchange,” the provider informed. The system informs the ER what scans have been done, and which labs were done. This rich exchange of information results in the potential for elimination of duplicative tests, which reduce costs, which is in everybody’s favor.
Other benefits of HIE participation include information being made available to a practice as it is being transcribed at the hospital, lab, or imaging center; clinical information such as physician notes and treatment medication are included as are notes concerning phone messages and alerts to medication refills. The HIE also helps to streamline processes and conduct internal benchmarking.
Benchmarking elements such as hospitalization rates of a practice’s patients receiving chemotherapy versus oncology medical home metrics can be achieved through an HIE. Every ER visit and hospitalization is captured and the reason for the visit is documented. As payment models shift to value-based from volume-based, benchmarking becomes an increasingly important tool in demonstrating cost-effective, quality care for oncology practices.
However, there is currently no single dominant HIE model in place: private institutions, such as hospitals, have developed their own HIEs, and some HIEs are developed for public use. In addition, the ACCC panel finds there is geographical variance in availability of HIEs, how they work, the services they provide, and their cost. HIEs are market driven so providers need to identify HIE options available within their geographic region. According to a forum participant, Pam Matthews, RN, MBS of HIMSS, “what works in one state may not work in another.”
“Quite a few pockets across the country do not have access to HIEs. Some states only have one viable HIE in the state. Others may have a statewide HIE with several regional HIEs. Several states have HIE network-to-network availability where several HIE networks tie into a larger one. Some HIEs may offer a wide variety of exchange services; some may offer much less,” said Matthews. The goal, she said, is to freely exchange data across multiple organizations, regardless of politics or the market.
The challenge of privacy and security while exchanging health data across geographic areas was a primary concern of the attendees. Both patients and providers want their privacy protected, but they also want to be able to access their information seamlessly. Federal and state laws apply to the privacy and security of patient information, but HIEs are not covered entities under the Health Insurance Portability and Accountability Act (HIPPA). As HIEs are considered “business associates” of HIPAA-covered entities, they must enter into contracts or other agreements with the covered entities to safeguard the privacy of protected health information.
Public, state, and regional collaborative HIEs are currently active in all states, with vendor-specific or customer-to-customer availability. Costs are a variable that practices are faced with, as some HIEs require implementation fees and monthly maintenance fees. However, some oncologists or practices may not have to pay HIE development fees or to join an HIE, as one cancer program executive in attendance explained, their local exchange was funded by two local hospital systems, a lab, and from federal grant money to start up. “The only thing we pay for is if we do some hybrid programming.”
The forum concluded that HIEs offer value to the oncology community as they can easily transmit information across broad stakeholder groups and large geographic areas. As cancer patients receive treatment from a number of specialists at different locations and from a number of healthcare professionals, much of their information needs to be shared between specialists, nurses, social workers, primary care and providers. HIEs potentially can streamline access to all this information, cutting down on costs, and savings in time for the patient.
Forum participants were in agreement that implementing comprehensive data gathering systems could create opportunities to develop large databases of outcomes, provide comprehensive comparative effectiveness data, and improve upon quality of care; however, there was still the reality that while some community practices are benefitting from HIEs, many are not.
Details of the forum can be found in a white paper titled, “Cancer Care in the Age of Electronic Health Information Exchange”, which can be accessed here: http://www.accc-cancer.org/institute/pdf/2013-WhitePaper-HIE.pdf