This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.
Wednesday, November 23, 2011
Health Information Exchange Some Lessons from The Real World and Some Legislative Comments and Legislation on the PCEHR!
It is interesting to read of the barriers faced by others to get Health Information Exchange really humming along!
Just as young businesses of most any sort must circumvent myriad challenges to succeed, health providers are encountering multiple roadblocks in the implementation of HIEs. At the core of those: financial sustainability. The root of many, perhaps, money is neither the only problem, nor the most trying.
“The most important obstacles facing HIEs depend on the perspective of who is looking at them – the patients, the providers, etc. So as we move forward, we have to make sure to address all these stakeholders,” said Benjamin Stein, MD, president and CEO of HIE Long Island Patient Information eXchange (LIPIX). “There is no one-size-fits-all answer to the problems of HIEs.”
Indeed, many healthcare professionals have raised doubts about HIEs living up to their potential. A survey of healthcare providers, vendors and experts found five issues that constitute the top concerns.
1. Data sharing
The groundwork already in place, with federal incentives for EHRs, HIEs, telemedicine, and related projects available, the goals of HIEs are straightforward: Reduce administrative costs associated with manual data and paper-based systems, reduce costs related to improved information access by decreasing redundant testing, avoidance of unnecessary hospitalizations due to missing information, more efficient visits, improving co-ordination of patient care with timely and accurate information across providers, and more effective medication reconciliation.
That all comes down to actually exchanging health data.
As HIEs now stand, however, much of their operations still occur in narrow sets of silos. Data exchange between EHRs and exchanges through organized state and regional HIEs is decidedly uneven in delivery. Electronic reporting for public and population health measurement is lacking.
2. Patient consent
Patient authorization and consent is often cited as one of the first challenges to HIEs, because authorization is a true test of the ability of EMR systems to work across healthcare and technology platforms as data is exchanged.
At Geisinger Health System, a Danville, Pa.-headquartered provider, Jim Younkin is program director of IT, leading development of the Keystone Health Information Exchange (KeyHIE), a regional HIE.
“Our legal counsel reminds us of the risks, and to make sure we don’t share information with anyone unless we have patient authorization allowing it to be shared,” Younkin said. “So we have increased our efforts in obtaining authorization, but that’s not easy.”
KeyHIE includes 12 hospitals, more than 90 clinics, skilled care, long-term care, and home health organizations. More than 385,000 patients have signed authorizations, allowing their information to be shared for treatment purposes through this exchange. Nonetheless, Yonkin says patient authorization and consent remain a hurdle to further development of HIEs.
“Because we have a large footprint,” Younkin adds, “a lot of doctors see patients who have records from other hospitals, where in some cases the information comes back in faxes. That’s been a difficult issue for us.”
Having started an EMR system in 1996, Geisinger is a seasoned user of technology platforms to facilitate date exchange, and is continuing its search for best practices in patient authorization, Younkin added
Likewise, Patty Dodgen, CEO of Tampa, Fla.-based Hielix, which provides HIE implementation services, sees difficulties in adopting patient authorization on the large scale contemplated by HIEs.
“There is a maze of EHR vendors touting, not an HIE system, but an interface. You have to have functionality that includes a mechanism for verifying and authenticating individuals and a record location service,” Dodgen explained. “You have to build an HIE that includes functionality that can go into a variety of settings and pull information back into the user.”
What I find interesting with this is the similarity between the US and here. It is only point five where I think we probably have a good deal less of an issue. Certainly I think there is a level of denial about the Standards and complexity issues.
The following also explores the issues from a different point of view:
Laura Landry can tell you exactly why health information matters.
Landry, the interim CEO of Cal eConnect, California's newly created entity to oversee health information exchange, had a story to tell during the organization's annual stakeholder summit last week in Sacramento.
"It's not my government background that qualifies me for this job," Landry said. "It's not my tech background. And it's not my policy background." What qualifies her for the job, she said, is much simpler.
"I went blind in my left eye," Landry said.
About 10 years ago, Landry had vision problems during a weekend. "All of my health information was all locked up," she said. So Landry went through a battery of tests she'd already had, she said.
"About 12 hours later, after taking all those tests again, they came to me and told me they knew what they were going to do. They said, though, there was only one problem," she said. "They couldn't complete the therapy they wanted to do within the 12-hour window that was most effective for that therapy."
You could call it a moment of vision. When her eyesight was threatened and time was so short and critical, Landry said, it became crystal clear just how important health information exchange can be.
"How can we improve health care?" she asked. "We could make data necessary."
Reliable communication of health data could streamline patient care on both an individual and public health level. Identifying where patients with like conditions are within a geographic area could trigger more services for those conditions where they're most needed and most effective.
But tracking down and using that information can be a nightmare, according to many of the stakeholders at the conference.
"From an HIE perspective, many times we don't know if anyone has direct control over the data, sometimes it's co-hosted, it's not clear who can access it," said Alex Horowitz of Believe Health, a community health consulting group. "It's so hard to sort it out, even just in one county."
The state medical system has been built piecemeal, Horowitz said, like a stack of Jenga blocks. It's hard to pull one piece of information without involving multiple agencies and multiple denials of help.
Horowitz had an idea for Cal eConnect. Building a map of which state agencies control what information would go a long way toward solving real-life health information exchange problems, he said.
"We deal with Stanislaus, Fresno and Kern counties," he said. "But it turns out that 12 of the 13 [sets of data] we need are at the state level, and no one really knows how to get that data. It's just this incredible spider web."
'We Want Ideas'
Dozens of ideas and suggestions were floated at the stakeholder conference.
"Many state agencies need data from health care providers for public health data," Landry said. "And it would make life easier if that data could flow. We want ideas about how to do that. We are pretty sure that we could improve quality of care, reduce duplicative or multiplicative data entry, improve quality of data and reduce reporting time."
Right now, for instance, the state health care system spends money on surveys to help identify health trends and needs in an effort to determine in geographic and financial terms where the state should spend its energy and effort.
If you could track trends over time by using electronic clinical and community indicators, such as tobacco use or body mass index numbers, that would make the whole evaluation process smoother, Landry said.
"The aggregation of data, that's the public health benefit," she said, "and doing that would be saving a lot of money on surveys."
She said there are cost savings and streamlining opportunities throughout California. "Transportability of data allows us to get the data to providers, and public health is just one user of that data," she said.