Virtual Information Exchange: Healthcare’s Present and Future HIE Solution

By Steven M. Wasson, VP of Clinical Solutions, RelayHealth

Increasingly, states, communities, healthcare organizations and a host of public and private entities are establishing secure networks to facilitate the exchange of clinical and financial patient information.

As business demands and government incentives accelerate establishment of these networks, healthcare organizations must quickly choose whether they are going to take a leadership role in coordinating patient care across multiple setting of care delivery. Is now the time for us to create a connected community? The challenge: Finding an economical and scalable way to connect and support physicians and other caregivers to facilitate the exchange of patient information.

HIE: Action or entity?
Health information exchange (HIE), at its most basic, is the provisioning of healthcare information within or across organizations. Examples of such provisioning—which can happen at the community, regional, and/or national level—include interacting with a lab for ordering tests/receiving results, transmitting prescriptions from physicians to pharmacies, sharing patient health history between physicians, relaying data from patients’ home medical devices to physicians and giving patients access to their health information.

However, the term ‘HIE’ sometimes is used interchangeably with the term RHIO, which stands for regional health information organization. In an effort to clarify terms, the National Alliance for Health Information Technology suggests the following definitions of HIE and RHIO—and adds a third term, Health Information Organization (HIO): HIOs are oversight organizations and RHIOs are a type of HIO. [1] HIE is process. And it’s process that is most beneficial—and most challenging—when automated.

Automated HIE: Benefits, challenges, opportunities
The benefits of automated HIE are significant. Inaccessibility of paper records and inoperability of legacy systems contributes to medical error, which, according the Institute of Medicine’s To Err is Human report, kills as many as 98,000 Americans every year. [2] Adoption of digital health record systems—made viable by health information exchange—could reduce the number of deaths due to medical errors by at least 70 percent. [3]

Healthcare data exchange also reduces costs. Studies project its potential annual savings for the nation between $81 billion and $162 billion. [4] According to The Center for Information Technology Leadership (CITL), widespread use of personal health records (PHRs) via healthcare information exchange could save the U.S. healthcare industry as much as $21 billion a year. [5]

Individual and community level organizations also have demonstrated significant savings. One Indiana RHIO saw a $562 million savings for emergency room visits; $300,000 reductions both in annual software costs and in annual courier costs; and a 90 percent reduction in incoming calls for a single hospital’s radiology department: [6]

Harder to measure: The subjective benefits of increased patient involvement in care and clinician alignment. Health information exchange makes it possible to extend and expand data sharing to consumers directly. By giving physicians simplified access to data and applications, health information exchange also gives organizations a valuable way to retain physicians in an increasingly competitive environment.

Unfortunately, however, health information exchange historically has been a challenging and costly venture. According to a Harvard University study, one out of every four RHIOs – or 36 out 145 — surveyed in early 2007 were considered defunct. Of the remaining 109, only 20 “were functioning at even a modest scale” as of Jan. 1, 2007. Myriad reasons exist for these results, from lack of resources, technological limitations and interoperability challenges to issues of governance, privacy and data ownership.
However, three factors are changing the equation:

1. Business demands, from lowering transaction costs to retaining physicians and increasing referrals.
2. Government’s role at all levels: Grants are funding regional HIEs and development of a robust set of interoperability standards. HITECH provisions in the American Recovery and Reinvestment Act of 2009 (ARRA) are motivating healthcare organizations to achieve “meaningful use” of electronic health record (EHR) systems and the requisite health data exchange.
3. The advent of virtual delivery models: ‘Cloud-sourced’ health information exchange is emerging as a low-cost, scalable and highly networked solution.

With business demanding it, government funding it and innovation supporting it, health information exchange is fast becoming a reality at the most decisive strata—the individual and community levels. Virtual delivery models leverage the Internet to give healthcare organizations what they need most in health information exchange: Capability, connectivity, affordability, interoperability and scalability.

RelayHealth Virtual Information Exchange
Satisfying both current and future data exchange requirements calls for an affordable, effective virtual information delivery model. A model comprising the appropriate platform, comprehensive applications, connectivity solutions and proficient services. A model that meets most of an organization’s current health information exchange needs, while enabling connectivity to other HIEs or such entities as RHIOs, government facilities and health plans. A successful example of just such a model is the Virtual Information Exchange™ (VIE) from RelayHealth.

The RelayHealth platform for virtual information exchange offers a robust suite of interactive financial and clinical solutions built around a patient-centric, provider connected and actionable health record. By leveraging the applications and connectivity solutions provided on the platform, RelayHealth customers are deploying an HIE solution today without a separate expenditure for exchange infrastructure.

RelayHealth's ability to create the virtual information exchange model is done through the combination of our platform, applications, connectivity solutions and services to create a powerful, scalable and cost-effective foundation for all levels of health information exchange: patient, community, regional and national:

The VIE platform offers a SaaS technology infrastructure upon which RelayHealth and our partners deploy workflow and connectivity solutions. It is a strong technical foundation built on an open health architecture that scales with an organization’s needs. Platform functionality includes:

• RelayRecord™: Centralized clinical repository of patient health records across all RelayHealth customers and solutions. RelayRecord aggregates data from all points of patient care and gives clinician and patients online access to the resulting record.
• Connect Once: Connected solutions can exchange data with any other participant on the network.
• Network Identity Management (NIM). Customers can use their own identity schemes for patients, physicians, practices and other entities. The platform manages interoperability between the schemes.
• Standards-based interoperability. All applications and connectivity solutions can be integrated through a set of standards-based APIs based on web services.
• Consumer privacy. All data in RelayHealth is protected by a data authorization security framework. Patients can designate data related to a specific physician as private. This protects any data from that practice from being shared with any other physicians.
• Terminology mapping. Supports interoperability between different vendors’ coding schemes for drugs and allergies.
• User management: VIE applications share a single user management solution supported by an API layer for single sign-in scenarios.

The platform also provides built-in interoperability with a growing number of business partners, adding additional value to connected applications. These include:

• Reference labs, to transmit clinical documents and results
• Hospital or health system enterprises to transmit documents, results, reports and health summaries
• Radiology and laboratory departments for orders management
• Electronic prescriptions and renewals and to receive drug eligibility, formulary, active medication and medication history data elements
• Microsoft® HealthVault™, for data feeds from personal monitoring devices
• Health plans, to determine patient eligibility

RelayHealth has established standards-based connectivity to the testing and demonstration environment of the National Health Information Network (NHIN), the nationwide network-of-networks that includes such federal medical databases and organizations as Veteran's Administration, Armed Forces Health Longitudinal Technology Application (AHTLA), Indian Health Services and the Social Security Administration. RelayHealth’s cloud-based service model means our connectivity to the NHIN will be available for all participants on the network, which, in turn, can provide what National Coordinator for Health IT, David Blumenthal dubbed “a path for meaningful use” under ARRA.

VIE Applications include a set of robust, browser-based provider and patient clinical and financial services, including:

• Actionable and connected Personal Health Records
• Comprehensive patient messaging services to aid in coordination of care, including webVisit online consultations
• Colleague messaging, including the ability to share patient health records in referral workflows
• Orders management to standardize the flow of orders into lab systems
• Online results manager to radiology reports and other hospital reports with ambulatory physicians and the patient
• Electronic prescribing including formulary and renewal processing with the ability for a patient to select a preferred pharmacy
• Automated eligibility aimed at encouraging patient financial advocacy
• Online pre-registration to increase intake efficiency by starting the financial qualification process before the patient has presented
• Online business office services include account management which increase the efficiency of collecting revenue from patients

While these applications are powerful as stand-alone services, they are unique in their ability to connect to a variety of ambulatory and acute care platforms. This connectivity includes data exchange, through HL7, for clinical and administrative data and the ability to seamlessly embed a connected application within an existing practice workflow. This strategic advantage allows rapid deployment and helps the organization create a deeper partnership with physicians invested in varied electronic medical record (EMR) solutions. And this interoperability is included in the subscription price (other vendors may charge additionally for the interfacing logic into their applications).

Currently, connected applications interoperate with more than 20 different EMR and practice management system products. Hundreds of practices have embedded eScript in their EMR solutions to provide ePrescribing within their existing practice workflows.

VIE Connectivity Services additionally facilitate clinical data sharing between hospitals and practices in a network-based connectivity model with several different lab and hospital systems. The solutions include:

• Distribution of lab results from lab systems to ordering physicians
• Distribution of clinical documentation from hospitals to ambulatory physicians
• Aggregation of orders from ambulatory physicians to hospitals and labs
• Exchange of codified health summary information

VIE Services comprise all datacenter operations, servers and networks, as well as application maintenance including regular service upgrades. RelayHealth’s experienced services team employs a mature, SaaS-based implementation methodology. Services include 24/7 technical support, end user support for both clinical and patient users, education services, developer support and professional services.

Some HIE infrastructure solutions comprise hardware, software and service/support. Point-to-point connectivity solutions provide strong integration capabilities but lack a cohesive solution for physicians with no clinical infrastructure. Other HIE solutions connect clinical workflows from a provider portal perspective but lack integration and patient connectivity.

Unique in its perspective of HIE as a capability, RelayHealth creates a complete connectivity solution by placing the patient in the center of the solution surrounded by a set of practice/hospital workflow and interoperability tools. RelayHealth’s ambulatory and acute care functionality don’t require patients to be users of the service—until they choose to be. However, every workflow takes patient access into account, the result of our roots as a consumer portal connecting patients and their dependents to all of their physicians across independent practices.

VIE: The HIE solution for today and tomorrow
From the hospital CIO’s office to the Oval office and beyond, HIT has gone mainstream and the federal government has finally put its money where its mandates are.

The clearer the connection between HIT and such benefits as decreased costs, increased access and enhanced quality, the greater the demand for things that enable that connection, from EHRs and PHRs to electronic prescribing and patient portals. And the prerequisite for all of them? Health information exchange.

Unfortunately, the challenges—cost, ownership, interoperability—are significant, as the many failed implementations of HIE show. Fortunately, just as business demands and increasing governmental involvement make HIE an imperative, the virtual delivery model has evolved to make it possible. And as healthcare organizations weigh current needs for internal and community data exchange against imminent demand for regional and national connectivity, established VIE providers like RelayHealth will prove the best solution for feasible, reliable, affordable and scalable HIE.

References:
[1] U.S. Department of Health & Human Services National Alliance for Health Information Technology. (2008) Report to the Office of the National Coordinator for Health Information Technology on Defining Key Health Information Technology Terms. pp 21. Retrieved 13-Jul-09 at http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_10741_848133_0_0_18/10_2_hit_terms.pdf
[2] Kohn LT, Corrigan JM, Donaldson, M. (2000) To Err Is Human: Building a Safer Health System, Institute of Medicine.
[3] Klein M. HHS Secretary calls for $550 million health care fund to reduce deaths caused by medical errors. Wisconsin Technology Network. Jun 08, 2004. http://www.wistechnology.com/article.php?id=905
[4] Taylor R, Bower A, Girosi F, Bigelow J, Fonkych K, Hillestad R (September 14, 2005) “Promoting health information technology: is there a case for more-aggressive government action?” Health Affairs, 24, no. 5: pp. 1234-1245. Retrieved 15-Jul-09 at http://content.healthaffairs.org/cgi/content/full/24/5/1234
[5] Kaelber DC, Shah S, Vincent A, Pan E, Hook JM, Johnston D, Bates DW, Middleton B. (2008) The Value of Personal Health Records, CITL. pp. 3. Retrieved 15-Jul-09 at http://www.citl.org/_pdf/CITL_PHR_Report.pdf
[6] California Regional Health Information Network. Measuring HIE/HIT Savings. Retrieved 15-Jul-09 at www.calrhio.org/crweb-files/docs-project/Fact_Sheet_HIE_Savings.pdf.