Building a HIE Roadmap to Sync with the VA-DoD iEHR

June 20, 2012 - Uniting VA-DoD iEHR Capability Sequencing with HIE Services Prioritization

The VA-DoD Integrated Electronic Health Record (iEHR) has a set of key core elements required as a foundation for the iEHR — like the Common Enterprise Service Bus, the Common GUI, a Master Patient Index and Provider Index, and Identity and Access Management Control. Community-based HIEs require a similar implementation of HIE technology the core of which is a services broker, a provider portal, an MPI, a Provider Index, and identity and access management tools.

Coordination and sharing of best practices in the development and implementation of this foundation for iEHR could surely help the community-based HIEs and HIE technology firms developing and implementing these solutions for the private sector. The VA and DOD MHS would benefit because the enhancement of these systems could be refined through this vast user groups’ input.

Building a HIE Services Roadmap that syncs in part with the iEHR’s Capability Sequencing Plan would create an initial target of services to include;

1. ePrescribing to sync up with the iEHR’s plan for a Pharmacy selection and implementation,
2. Lab Results to sync up with Lab and AP,
3. Immunizations,
4. Care Management,
5. Orders Services, and
6. Consults and Referral Management.

These potential six HIE services and their respective modernization/development projects within the iEHR project would support the VA and the DOD MHS in ensuring a continuity of care by aggregating health information in a way that supports coordination of care, patient-centered medical home, and accountable care. The six services are all services that are high on a provider’s list of HIE services that deliver immediate value. They are services that have a direct impact on patient safety, quality of care, and, through the coordination of care offer a reduction in overall health care costs.

If indeed we have this unique opportunity to unite the development of an integrated EHR that is leveraging two systems that have supported over 250 hospitals and over 2000 clinics with efforts at the local level to execute health information exchange, we should be doing a better job of it.

Synching Community-based HIE’s with VA-DoD iEHR

June 19, 2012 - A Unique Opportunity To Think Globally and Act Locally

An effort is underway to develop an Integrated Electronic Health Record (iEHR) that would be used by two federal agencies in support of a common constituency. This effort in which the federal government is targeting over $4 billion to modernize more than 125 functional modules currently part of the Department of Veterans Affairs’ VistA or the Department of Defense Military Health System’s AHLTA into a single Integrated Electronic Health Record used by both agencies is unprecedented. Long desired, the effort is now supported by an Integrated Project Office, designated funding, an envisioned architecture, and a development roadmap.

Meanwhile, the Office of the National Coordinator of Health IT advances the adoption of electronic health records by private providers and supports the goal of robust health information exchange at a local, state, and national level. Health information exchange activities at the local and state level are struggling as stakeholders strive to find the use cases that will deliver real value to the providers, patients, and payers (private and public). Consensus has not developed as to what the prioritization of HIE services should be in order to drive adoption, deliver value, and impact community-based care by lowering costs and improving quality.

However, maybe an opportunity exists to bridge these two issues. The recipients of care within VA and the MHS receive 40-60% of that care from private providers. Even though that care constitutes only approximately 10% of the care provided by a private provider, very few providers would decline the opportunity to share health information on patient visits with the VA and DOD MHS. The Integrated Project Office has developed an iEHR Capability Sequencing Plan through 2014 to get to iEHR Capability in Norfolk, VA and San Antonio, TX. As we seek to figure out what HIE services should be prioritized within community-based HIE’s, we should consider synching the services with those capabilities that are key components of the iEHR that drive coordination of care for our military servicemen and women, veterans, and their families. They deserve no less!

Teaching Providers to do Health Information Exchange

May 15, 2012 - Health Information Exchange (HIE) as a Discipline

If we’re going to cement health information exchange as a way of conducting business in the delivery of health care to patients, we need to further define Health Information Exchange (HIE) as a discipline that applies to the practice of exchanging health information in order to coordinate care and support the real-time health and wellness of patients.

HIE is a potential attribute of healthcare systems (just as patient safety and quality are attributes) that aims to ensure that an interoperable, longitudinal, real-time flow of patient information is available for the patient and his caregivers so that knowledge from this information can support wise choices on behalf of the patient.

As a discipline, we have to teach providers how to do HIE, thus we must develop a HIE Cookbook approach to HIE education and learning. As we develop HIT workforce initiatives, we should be training workers as HIE Specialists so that they can be brought into hospital and provider organizations to ensure that health IT systems are developed, implemented, and deployed with health information interoperability ensured so that robust health information exchange is achieved with external parties.

This enablement of health information exchange in the healthcare delivery process will have the antecedent benefit of creating data repositories that will permit the secondary uses of data that can drive population health, patient safety and quality improvement. But, the focal point of HIE in the context of health care reform is transforming the delivery of care from episodic patient care to the health, wellness and care management of the patient. The movements toward patient centered medical home and accountable care will be best facilitated if we institutionalize health information exchange in our hospitals, physician practices, and with patients fully engaged in the information flow. Health Information Exchange must be integrated into the new models of care that are emerging and we need to make sure that we are empowering our IT workforce and our line health care workers to make HIE a transparent component of the clinician workflow and the patient’s daily life.

HIE resources to explore:

• NeHC HIE Learning Network
• HIMSS HIE
• HIMSS HIELights
• eHealth Initiative HIE Toolkit
• State HIE Programs
• Sustaining State HIE Toolkit
• AHIMA HIE

Health Information Exchange and Healthcare Apps

May 2, 2012 - The Rapid Proliferation of Healthcare Apps and Health Information Exchange

This innovation explosion in healthcare-related smartphone applications via standards-based distributed platforms (Android, iOS, WindowsMobile) presents great opportunity, but is fraught with the same risk of information fragmentation and segmentation that has haunted the healthcare industry for years. Apps present an opportunity for patient engagement, but the type often feared by providers. Apps present data and/or information to patients, often without context or knowledge, and disconnected from other data and/or information that could be important as the patient responds to app data or information and makes decisions to engage providers.

As we see the proliferation of thousands of healthcare apps for the iPhone and Android platform, very few of these are integrated into an accountable, coordinated, wholistic approach to patient care based on the most complete information on the health and care of patient. We’re building new information flows without the appropriate connections to ensure that it is ultimately consumable by the people who need the information most; those who actually are accountable for the health and care of patients.

That’s why health information exchange is so critical. There must be a business and technical construct for the consolidation of patient data proliferated from mobile apps, provider systems, payer systems, government systems to benefit all of the stakeholders from the patient, to the care giver, to the payer, to the government. Our systems must be connected and the mediums that populate those systems must be standards based and interconnected.

We have to view the broad healthcare ecosystem and re-engineer that ecosystem and the systems that support it, while we apply new technologies to it. Otherwise, it will remain fragmented at the systems level and the business level. So, marvel at the slick app if you like, but ask the important question? How does this fit in the patient health and care continuum?

Concentric Circles of Health Information Exchange

April 24, 2012 - HIE Through the Eyes of Provider and Patient

While the health information exchange (noun) market continues to develop, providers’ needs for health information exchange (the verb) becomes ever more pervasive and urgent. A dialogue has emerged recently that has separated the HIE market into public and private. However, the way HIE needs to be viewed is through the eyes of the provider and patient – both of whom are at the core of a series of concentric circles, and whom generate data during a visit or an episode of care.

These circles represent various geographic layers indicative of society’s organizational frameworks. The data must flow for multiple purposes at various levels, but the point is it starts from the center of the circle (patients and providers in geographic proximity) and moves to the local, state and national levels.

At the local level, this information (generated by a hospital or provider) is perhaps exchanged within an IDN or hospital system, or among multiple independent hospitals or systems – all of which constitute private HIE. It’s even possible that at this layer of HIE is performed within an accountable care organization. However, care is delivered locally and often not within the same IDN, hospital system or physician group. Therefore, community-based HIE may be necessary to facilitate robust coordination of care across unaffiliated community providers. The state, meanwhile, has a need for health information at an aggregate level for its Medicaid population, and to manage public health concerns. Finally, the federal government needs health information to manage care delivered to Medicare patients, for third-party care delivered to veterans and military beneficiaries, or for federal agency program needs like social security disability determination.

HIEs may be described as private and certainly the organizational structure can be private, but the data is no less unique than information that can be aggregated within a public HIE. And, certainly, where private HIEs are currently flourishing, there is even a greater chance that a public HIE can flourish as well – one that serves the needs of the local community and not just those of private HIE stakeholders.

The important thing to recognize, however, is that there is a core set of data that needs to be compiled in order to be consumed at various stages in the concentric circles. While there are discrete purposes for the data today, there is also a breadth of unknown possibilities, as various organizations begin to compile and act upon this data to further care coordination, population health and public health; as well as reduce costs and increase quality patient outcomes. Just as circles know no end, so too are the possibilities of HIE without limit. It is the effective and interoperable “overlapping” of these shapes that will ultimately transform care delivery and patient health.