Creating a sustainable health information exchange

By Earl Jones

Health Information Exchanges (HIEs) are a reality in the healthcare sector today. Connecting and sharing clinical information throughout a healthcare community simply makes sense. Information transparency, better and more timely clinical insight, and removing analog workflows (e.g. phone, fax, mail) reduce cost, reduce medical errors, and improve the quality of care and patient satisfaction.

The federal government is making an unprecedented investment to modernize US health systems. Under the Health Information Technology for Clinical Health Act (HITECH), providers and states are receiving billions of dollars in economic incentives and grants to modernize their health IT infrastructure. The recent $547 million in Beacon Communities grant funding by the federal government will help showcase thought-leading connected care solutions. Industry investment in HIE technology development is also growing rapidly. According to the eHealth Initiative's 2009 HIE survey, the number of operational HIE's grew nearly 40 percent from 2008[1]. 

Despite this growth in investment, a key concern for operational HIEs is creating a sustainable solution once they are operational. GE Healthcare IT is working with a diverse group of operational HIEs, from RHIOs covering wide geographic areas and connecting numerous hospitals, physician practices, labs and other stakeholders, to enterprise-wide HIEs focused on a smaller set of commonly owned hospitals, their various departments, practices and clinics.  While there are many aspects to sustainability, a short list of key recommendations for building sustainable HIEs keep elevating as prominent considerations.

Robust HIE infrastructure. A bi-directional, standards-based, semantically interoperable HIE infrastructure provides the connectivity backbone for connected care communities. Automating community workflows through simple secure messaging will see quick adoption and will absolutely have a place in a healthcare community's information management, but will not support more complex use-cases and workflows.

Pay attention to adoption. Without strong physician engagement, any significant change effort in healthcare will fall short of its objectives - and HIE adoption is no different. Focus on early physician involvement and change management, and pay careful attention to making workflows as efficient and simple as possible. Clinicians want to see data that is timely and relevant, and be able to consume information from an HIE in a fashion that is appropriate to their workflow - which could mean within their EMR, or from a portal solution that enables mobility. Whether they use an EMR or portal, the presentation of information must be quickly presented and easy to interpret - our care providers simply do not have time to wade through disorganized information.

Move from information to knowledge exchange. Health information exchange is a means to an end. While the first step is information exchange, it is important to move rapidly to leveraging the HIE infrastructure to deliver performance applications that provide insight that supports action. Applications such as clinical decision support, chronic disease management, quality and performance reporting, and proactive patient engagement are all examples of solutions that can leverage the HIE infrastructure. The value created from these and other performance applications is what will ultimately drive HIE sustainability.

Looking to the Future - an ACO model

Starting in 2012, Accountable Care Organizations (ACOs) will be created with a mission to deliver more efficient health care at a lower cost. The Patient Protection and Affordable Care Act of 2010 directed the Centers for Medicare and Medicaid Services to create a national voluntary program for ACOs with three main attributes: organized care, performance measurement and payment reform.

With ACOs, the payment structure will migrate from a fee-for-service model where doctors are reimbursed for the procedures they perform, to a performance-based system that pays for outcomes and for managing the overall health of a community. The focus will move from the volume of services provided to payments based on outcomes achieved, which is the mission of healthcare to begin with. Advocates believe that with an integrated approach for primary care physicians (PCP) and specialists, hospitals will put patients at the center of care and achieve the improvements in cost, quality and access that our nation needs and our citizens deserve.

Creating an Accountable Care Organization in and of itself will not improve care at all - action must be taken. Population health must be understood and quantified, metrics must be developed and measured, and ultimately care coordination and workflow changes must materialize. The need for information sharing and transparency within a healthcare community has never been greater.    

A health information exchange is a critical enabling technology investment for these ACOs.  Transparency of information, performance and outcomes reporting, workflow digitization, and enabling care coordination are all aspects of what an HIE can provide to a healthcare network today.  Combine those advantages with a system that pays for the actions patients truly want - effective healthcare at a lower overall cost - and the opportunity for a transformed healthcare society is possible.

Biography

Earl Jones is Vice President, GE Healthcare eHealth Solutions. Earl has been at GE for six years, bringing a wealth of experience from previous roles. Earl earned an MBA from MIT, a Bachelors of Science from the United States Naval Academy and served with distinction as an Officer in the United States Navy's Submarine Force.

12009 report in the Journal of medical Internet resource:  http://www.cmio.net/index.php?option=com_articles&view=portal&id=publication:68:article:23890:phrs-power-to-the-patients