Solving the HIE Sustainability Challenge: 3 Strategies for Survival
Fragmented patient information continues to be a significant barrier to tackling rising healthcare costs and improving the quality, safety and delivery of care. As health information exchange proliferates, a longitudinal view of an individual’s medical record sets the foundation for informed clinical decision-making, healthier populations and improved patient experiences.
HIEs that have built a vast network of contributors that include patients, providers, payers, labs and pharmacies are invaluable to organizations that cannot easily access information about one’s health status or medical history themselves, such as previous tests and treatments. In fact, a recent study by researchers at Brookings, SUNY Buffalo and the University of Connecticut estimates Medicare could save $63 million annually by reducing redundant testing in outpatient settings if physicians had access to cross-community HIE data.
HIEs with the established data infrastructure and relationships in place to collect, reconcile and disseminate patient information make population health management and quality interventions possible. Semantic interoperability is also required to allow machine interpretation of aggregated data to identify preventive care targets and implement proactive treatments. For ACOs, laboratory results and medication mapping are crucial elements in tracking preventive care, member outreach and follow-ups.
As healthcare reform accelerates, HIEs are pressed to provide a longitudinal patient record while developing a sustainability model that attracts data sources and sites of care. Those expectations require the information to be formatted consistently and to map related patient data in real-time. If the HIE data isn’t valuable, adoption and participation decline.
Successfully sustainable HIEs require stakeholder participation, first and foremost, as well as a supportive technology infrastructure. Without the technology in place, HIEs cannot function with the dexterity needed to survive. Those that have excelled, are extending their data capabilities for more advanced analytic functionalities including precision medicine, public health reporting and clinical trial recruitment.
Here are three technology approaches HIEs are utilizing to achieve greater adoption and to facilitate the necessary exchanges of information for cost and quality improvements.
- Identity Management. Robust information exchange can only flourish when patients are accurately and consistently matched with their data. To ensure HIEs are providing a complete view of patients across the care continuum, records within the system must be free of errors, duplicates and incomplete information. Identity management technology, such as an Enterprise Master Patient Index (EMPI), facilitates quality of care and patient safety by accurately de-duplicating and reconciling patient medical records. EMPI integration across an HIE yields immediate value in data access and integrity to support the requirements of coordinated, accountable, patient-centered care. The same patient matching algorithms can also be applied to provider record cleanup, giving HIEs an edge in population health management and analytics.
- Relationship Registries. Sophisticated mapping of an individual’s relationship with their provider, care team and associated events can improve continuity of care across settings and transitions. A relation between a provider and patient registry can reveal which providers are engaged in care provisioning, and allow providers to notify each other about diagnoses even without and beyond an HIE infrastructure. A relationship registry can also model stated relationships between patients (for example, caretaker, parent-child, spouse) and between providers (organization to person, specialty, or services) that cannot necessarily be derived automatically. Such relationship information can be useful for notifications, consent, and patient activation.
- Best of Breed Approach. When the HITECH ACT was introduced in 2009, many HIEs flocked to single source vendors to manage and solve all their IT needs. Adapting to emerging healthcare models and standards requires vendors to accelerate product development which requires more flexibility in implementation and workflow processes. This becomes taxing on single vendors that cannot adapt quickly. A single source vendor that can meet all the technology needs for HIEs is near impossible, which is why many are turning to a best of breed approach.