Friday, August 12, 2011

Health Information Exchange - A US Status Report With Lessons for Australia I Suspect.

Both the eHealth Initiative and the National eHealth Collaborative have provided recent updates and ideas about the state of play of Health Information Exchange (HIE) in the US.

This has provoked a number of articles

First we have

6 Secrets To A Successful Health Information Exchange

Many health information exchanges have had a hard time remaining in business, but a new report from the National eHealth Collaborative spotlights winning strategies.

By Marianne Kolbasuk McGee, InformationWeek

August 04, 2011

Health information exchanges have yet to become the darlings of most hospitals and medical practices, but despite their frostly reception, two recent studies suggest you can launch and maintain a viable HIE.

These health data sharing organizations will undoubtedly play an important role as the HITECH Act's Meaningful Use programs continue to take shape. So it's time to take a closer look at lessons learned from such success stories.

A new report released this week by the National eHealth Collaborative (NeCH), a public-private cooperative funded by the Office of National Coordinator for Health IT, outlined some of the" secrets" uncovered by 12 successful HIEs.

Many HIEs can learn from these lessons--especially considering that there are at least 255 HIEs in the U.S. right now, a 9% increase from 234 HIEs last year, and up significantly from only a few dozen in 2004, according to the eHealth Initiative, another coalition that studies HIEs and which recently completed its own annual report.

For those of us that have been following HIEs over the last decade or so, it's been pretty clear that success--and sustainability--has been elusive for many of these organizations. There have been failures along the way, most notably the once promising Santa Barbara County Care Data Exchange in California, which launched in 1999 and lasted only a few difficult years before shutting down in 2006.

I would argue that the Santa Barbara effort was a visionary for its time--and that proved to be one of its biggest problems. Unfortunately their effort was launched several years before the HITECH Act was signed into law--meaning before EHRs appeared on the radar screens of large numbers of healthcare providers in the region. When the Santa Barbara exchange launched, few healthcare providers were open to the idea of using and sharing digitized patient data--especially among competing doctors and hospitals.

Of course, most of the 12 successful HIEs studied by NeHC in its "Secrets of HIE Success Revealed, Lessons from The Leaders" report have also been around for quite some time, launching pre-HITECH Act, but none as early as the Santa Barbara effort.

Although most of them have no doubt struggled with their own stumbling blocks--big and small--they've been able to recover. That's evident from the "secrets" revealed by the National eHealth Collaboratives report.

Here are some of keys to success among top HIEs:

1 -- An HIE needs to make sure stakeholders see the value of participating in the HIE--and then make sure they deliver on those promised services. That value includes reduced data distribution costs and increased staff productivity, which are "the major reasons why participants are willing to pay for the services offered by these HIEs," according to the NeHC report.

2 -- HIEs must collaborate and align with stakeholders about their priorities for the group. Because stakeholders of an HIE are diverse--they can include payers, competing hospitals, doctor groups and solo practices--their needs differ. So, successful HIEs need to engage the stakeholders in coming up with "win-win" collaborations.

"Once the major two competing [healthcare provider] entities joined from a data sharing perspective, it was easy to get the other hospitals and providers in the area" to join, said Mike Smyly, chief business development officer of Inland Northwest Health Services [INHS], a HIE based in Washington state and one of the 12 organizations spotlighted by NeHC.

Having the two big competing entities finally feel comfortable about sharing data made it easier for others in the region to see value in joining INHS, said Smyly during a NeHC webinar this week discussing the NeHC report. "It became more of a value equation for new folks joining," he said. "Once we got over the hump, it was great."

4 more tips for success are here:

For more insights and "secrets" to running an HIE, be sure to read the full NeHC report.

Second we have a long review for those planning to move down the HIE path.

5 Considerations on Health Information Exchanges: What Your Hospital or Health System Needs to Know

Written by Bob Herman | August 01, 2011

Hospitals and health systems are scrambling to become meaningful users of certified electronic health record technology within their own entities, but what's the next step to share health information after that step? The answer for many organizations will be health information exchanges.

HIEs mobilize patient healthcare information electronically across multiple member organizations, hospitals and other stakeholders. In many ways, it's like an EHR for an entire geographical region or, on a smaller scale, a health system that gives physicians and other healthcare professionals secure access to patient data when it might be needed in critical moments. The following five considerations can give hospitals and health systems more insight on what a HIE is and what the benefits and drawbacks of joining or creating one are.

1. Nuts and bolts. For a HIE to work, hospitals and health systems must first have functioning EHR systems, preferably ones that satisfy the Office of the National Coordinator for Health Information Technology's requirements for meaningful use. Federal grants through the HITECH Act are helping hospitals and health systems adopt EHRs, and the ONC has been funding states to implement HIEs. The State HIE Cooperative Agreement Program has awarded more than $547 million to 56 states, eligible territories and qualified state designated entities, according to the ONC website. Providers wanting to join a HIE look for a basic starting point: where is there a HIE geographically closest? Health systems wanting to create their own must decide if it is financially and logistically feasible to interlink member hospitals.

With EHRs in place, the HIE organization can recruit different providers, hospitals and health systems to join the exchange in order to share patient information. For example, Tom Penno, chief operating officer of the Indiana Health Information Exchange, says patients can go to a physician, have blood work completed and that information can be uploaded if they see other physicians or specialists within the HIE. This gives the provider a new way to obtain patient information quickly and securely at crucial points of care, he says. Joy Grosser, vice president and chief information officer of Iowa Health System, says HIEs make it possible for clinicians and physicians to have all the information they need to give the best possible care to patients, be it in a clinical, ambulatory or hospital setting.

"HIEs are really an infrastructure necessity to change the way we're doing healthcare across regions, states and the nation," Ms. Grosser says. "Most people don't spend their entire life at one hospital or one physician. It's integral to help manage the healthcare of a population to be able to share this info. We're on the first step of a stairway through this process."

2. Implications of health IT vendors. According to a recent eHealth Initiative survey, HIE initiatives are up nine percent from last year, so there is a demand when it comes to HIEs and vendors to build their infrastructures. Consequently, hospitals wanting to join a HIE or build their own are at a time of both early adoption but, as the survey shows, a growing demand. There are dozens of HIE vendors, many of which are similar to a hospital's EHR vendor, but John Hendricks, IT director for interoperability and web programming for Iowa Health System, says knowing the right certified system within the HIE is key. The HL7 Clinical Document Architecture is a standard that all lays out the specific structures and meanings for clinical documents to be exchanged. The Continuity of Care Document is the main document within the HIE and EHR systems, and some include different subject areas of patient health, such as allergies, family history, results, vital signs, payor details and others. Hospitals entering or creating HIEs must be cognizant of the information that is actually being shared and how a vendor handles the sensitivity of the information. Mr. Hendricks notes that not all vendors support the different subject areas and CCDs, and there is not complete interoperability among all different hospital EHR systems.

Ms. Grosser adds that choosing vendors and implementing HIEs is still very new and proprietary for each organization's core IT systems. However, putting certified systems and coding in place is one of the best practices an organization can do, she says. Standardizing those systems with certified nomenclature will lead to less overall confusion between participating providers while sharing information.

Lots more here:

and last we have a discussion or a quite advanced HIE here:

Mature HIEs build trust to share data, IT

August 03, 2011 | Mary Mosquera

Oklahoma health information exchange SMRTNET has managed to build a network of seven networks and has attracted a broad range of 3,000 providers in 2011 that share data between hospitals, Native American tribes, community health centers, labs, universities and private physicians.

The individual networks exchange data statewide using a shared set of common resources and privacy policies.

The Secure Medical Records Transfer Network (SMRTNET), a statewide non-profit organization, is one of the examples that the National eHealth Collaborative (NeHC) highlighted in its report of case studies of 12 sustainable and mature health information exchange (HIE) organizations across a variety of geographic regions.

The HIEs follow a number of business and marketing models, according to NeHC, which is a public/private partnership that promotes secure health information exchange, in “Secrets of HIE Success Revealed: Lessons from the Leaders,” released Aug. 2.

Exchange efforts are emerging around the country in order to meet requirements for meaningful use of electronic health records (EHRs) and to improve care coordination.

“While every HIE project is unique, they all share the same problems of participation, value, security, growth and especially sustainability,” said Mark Jones, COO and principal investigator of SMRTNET.

The report extracts critical characteristics that are common to all of the exchanges and offers real-world success stories that may “contribute to a cohesive national roadmap for nationwide HIE” so others can learn from them, said Kate Berry, CEO of NeHC, in an announcement.

For SMRTNET, broad representation in the HIE planning in the beginning was important for future expansion. “Then every potential participant knows that there has been ‘someone like you’ at the table from the beginning,” Jones said in the report.

Among steps the report listed as important for an HIE’s success:

• Bring together many interested organizations that represent industry, health care, technology, consumers and public sectors and other local interests who will agree on shared objectives to foster trust and learning.

• Establish and maintain a consistent set of policies and procedures for data use and data integrity so that “no stakeholder gains a competitive advantage at the expense of others.”

• Sharing IT infrastructure and patient information benefits outweigh risks for HIE provider participants who compete with each other in service area markets, especially in rural areas, where health IT resources are often sparse.

• To identify revenue streams, many HIEs are evolving from just data exchange to application solution providers. SMRTNET offers a master patient index and access to a community record through an online portal. The community record includes demographics, diagnoses visits, medications, provider, labs and data to support meaningful use, such as electronic prescribing and secure messaging, such as the ability to forward reports.

• HIE technical and training personnel work with physicians and office staff to understand and even integrate exchange applications into their workflow to get them online quickly and improve operations.

More here:

A key reason for raising these reports it that I have a feeling that when we see when the Infrastructure Partner for the PCEHR announced what we will actually be seeing is a US HIE system provider working with a systems integrator to deliver some custom code to provide a log-in and links to the Health Identifier Service and then the HIE components used to deliver a range of linkages to various information sources - starting with Medicare information and then slowly (over years) creating something very much like a national Health Information Exchange for Australia.

You can all see how close I am in due course, but I suggest close reading of the two reports linked in these articles.

Of course a key issue is that all these HIEs are designed to facilitate provider to provider exchange and not provider to consumer or provider under the control of the consumer to provider exchange. It will be fun to see whatever is selected be ‘shoe horned’ into working in Australia.

Another small issue is that no-one has ever tried an HIE of the proposed size of the National PCEHR. It is planned to be very, very big!


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