Health information exchange

Raymond Scott of Axolotl Corp and RelayHealth’s Jim Bodenbender talk to EHM about interoperability solutions.

“Without a HIE, full interchange of clinical data between the partners in a medical trading area would require a large number of point-to-point interfaces between each hospital, lab and physician practice”
-Raymond Scott

With only a year for hospitals to qualify for front-loaded stimulus dollars, how will they be able to demonstrate 'meaningful use' in such a short time period?
Raymond Scott. Hospitals need to evaluate their existing CPOE and EHR infrastructure, determine where gaps exist and begin the work required to make them interoperable with the systems used by the ambulatory care partners. The use of health information exchange (HIE) technology provides a fast and simple mechanism to connect to third party EHRs and to receive orders from them. Hospitals should look to SaaS based solutions, which will significantly reduce the implementation time and eliminate application maintance for your IT staff. Hospitals can be operational with HIE technology in as little as two months - exchanging discrete data elements between existing HIS and ambulatory EHR systems. Also, CCHIT certified EHR Lite applications provide a very affordable solution for ambulatory physicians that don't already have an EHR, enabling a complete medical trading area to be fully connected in the required timeframe. It is important to remember, however, that while ARRA's goal is to remove cost as a barrier to adoption, changes to workflow will require planned training.

Jim Bodenbender. First, according to McKesson's interpretation of the timing for receipt of federal incentive payments under the HITECH Act, we believe a hospital would be eligible for full reimbursement if they demonstrate meaningful use of a certified EHR by the end of the government's FY2013 and continue to meet subsequent phase criteria. However, the payments would be delayed accordingly. So, unless things change before the requirements are finalized, eligible hospitals can qualify as late as September 2013 and still receive maximum stimulus incentive funding.

Hospitals planning for stimulus incentives during this period need to focus on gaps between current capabilities and meaningful use criteria, despite the criteria being in draft form. One likely gap for many hospitals is interoperability. The HIT Policy Committee's Information Exchange Workgroup estimated 45 percent of meaningful use criteria are supported by health information exchange. It is critical for hospitals to establish plans for connectivity to physicians, patients and the community at large.

With the ONC's focus on providing money through state-designated entities and regional extension centers, the establishment of statewide health information exchanges (HIE) has become important. What is your company doing at state levels with regard to HIE?
JB. RelayHealth and its parent company, McKesson, are actively involved at both the federal and state levels providing guidance and real-world experience on topics including meaningful use criteria, certification standards and interoperability approaches. For HIE specifically, we are working with several states shaping strategic plans and driving strategies to enable sustainable connectivity in their communities.

One specific attribute historically lacking in state-level HIE initiatives is a sustainability model that enables the HIE program to continue and advance long after the grant funding ends. RelayHealth's approach to HIE incorporates a long-term sustainability structure proven to yield tangible return on investment for hospitals, physicians and ancillary providers. Our patient-centric SaaS design affords extended leveraging for broader state to interstate and ultimately nationwide connectivity. The result is actionable health information when and wherever stakeholders need it, be it in local communities across the state, regionally or throughout the nation.

RS. Axolotl is the statewide designated HIE vendor for Utah, Idaho and Nebraska and has connected many regions within Indiana, New York, California, Washington, Texas, Ohio and Colorado, among others. These HIE customers are clinically networking hospitals, labs, public health, payers and physician practices - the entire healthcare continuum with SaaS applications. Patient information is securely shared and made available when and where it is needed. A virtual health record provides authorized users with complete patient data, displayed from all connected facilities. In addition, Axolotl's CCHIT certified EMR Lite provides any physician not already using an electronic medical record, with an affordable web-based solution to immediately connect the state's HIE.

What is your view on the statement that full interoperability for hospitals and physician practices can only be achieved by connecting to a health information exchange?
RS. Most physician practices use more than one hospital or lab, with different internal information systems, to provide care for their patients. Hospitals and labs provide services to a variety of physicians, some owned or affiliated and some independent, all potentially using different EHRs. Without a HIE, full interchange of clinical data between the partners in a medical trading area would require a large number of point-to-point interfaces between each hospital, lab and physician practice, which would be prohibitively expensive to build and maintain. A HIE provides comprehensive interchange of data between all the parties through a single connection to each.

JB. It is important to understand hospitals, physicians, pharmacists and other stakeholders can perform the act of HIE without joining a formal health information organization such as a RHIO. In fact, over 50 health systems and hospitals have contracted with RelayHealth to engage in HIE with limited HIO formalization. One area that formal exchanges have poorly addressed is patient engagement - because RelayHealth is fundamentally a patient-centered model, providers can perform clinical and financial HIE activities with their patients and other providers.

As the nation expands clinical connectivity, we should look at RelayHealth's established networks for financial and pharmacy transactions as an example. Over 95 percent of providers and 90 percent of retail pharmacies, providing ample lessons on interoperability, uses these exchanges. These levels of adoption enable RelayHealth to provide services such as a secure data feed on retail prescriptions every four hours to the CDC to assist them in tracking viral outbreaks and other healthcare emergencies.

How are your physician customers achieving interoperability in their practices, and how does that help them towards achieving meaningful use?
JB. Currently, RelayHealth provides all the necessary functionality for our customers to demonstrate the current meaningful use interoperability requirements for the 2011 phase, based on the draft meaningful use criteria. Our customers are also already capable of demonstrating many of the other current meaningful use criteria for the 2013 and 2015 phases, including real-time population of a patient's personal health record and secure messaging between patients and their providers.

Enrolled physicians on the RelayHealth network have access to its connectivity services either directly within their EMR workflow or online via a browser using our modular, cloud-based applications. A key goal of meaningful use is to drive care collaboration and this approach ensures all physicians can participate, including those not ready for an EMR.  Furthermore, this low-cost, scalable and highly networked solution doesn't require a costly infrastructure and assures providers a predictable cost structure, lower total cost of ownership and a quick return on investment.

RS. Axolotl's Elysium EHR Lite is the first fully interoperable solution on the market - able to plug into an HIE and connect to all of it's HIS and EHR systems without point-to-point interfaces. Data from all sources is sent and received in a standard format with discrete data elements. As one of only six Gold Surescripts certified vendors our integrated eprescribing solution provides complete medication lists and fully automated renewal processing. In addition active, electronic reporting of quality measures can be established and maintained with minimal physician or staff intervention. Axolotl anticipates that almost 25,000 physicians currently using the CCHIT certified Elysium EHR Lite, will be able to apply for full incentive payments.

Raymond Scott is CEO of Axolotl Corp., co-founding it in 1995 to provide collaborative electronic workflow solutions for communities of health care providers. Scott has established Axolotl as a leader in health information exchange (HIE), today providing the technology and services to support many fully functioning hospital, regional and state-wide HIEs across the US.

Jim Bodenbender is a group president of RelayHealth, a division of McKesson. He has responsibility for the business' operational management and strategic direction, which includes R&D, sales and channel management, business development, product management, customer support, and account management. Mr. Bodenbender has more than 25 years experience in healthcare information systems and services.