Mark W. Stevens, Principal, ARRAHealth Consulting, and President-Elect, Central PA HIMSS
Health Information Exchange – Past, the present and future
Health Information Exchange (HIE) allows healthcare professionals and patients to appropriately access and securely share a patient’s vital medical information electronically, according to the definition identified by the Office of the National Coordinator for Health Information Technology (ONC).
Efforts to establish HIE has been underway for the past two decades, beginning with similar initiatives – known as Community Health Information Networks (CHINs) – that began in the mid-1990s. In the past ten years, more progress and “buzz” has surrounded HIE in part to the Health Information Technology for Economic and Clinical Health Act (HITECH Act), part of the American Recovery and Reinvestment Act of 2009 (ARRA) that was signed into law, and designed to accelerate the adoption and assist healthcare providers to obtain meaningful use of health information technology (HIT), including electronic health records (EHRs) and care coordination through HIE through funding incentives for the adoption of these tools.
The goal for HIE is to bring together a large array of healthcare information and records about the patient from across the entire continuum of care, and to improve the quality and coordination of care for patients while reducing healthcare costs. Those records include lab results, medications, allergies, conditions and various reports that are generated by physicians, hospitals, and specialists at the time of care. HIE brings together all the patient information and clinical records from a variety of disparate systems in a complete, timely and accurate record – in order to provide a comprehensive and collaborative care over time.
Today, the overall operational maturity of HIE initiatives continues to evolve, according to the eHealth Initiative 2014 HIE Annual Survey. While electronic exchange of health data appears to be on the rise, survey results show that HIEs continue to face technical challenges and financial constraints. These challenges remain to be the biggest barriers to interoperability. Managing relationships with participants, sustainability, and interoperability remain the key barriers to widespread data exchange. Per the report, as in 2013, respondents continue to struggle with interface development as they work to stitch together disparate systems.
“Stella has been called the most important interoperability company no one has ever heard of…”
– Salim Kizaraly, Stella Technology Founder
Stevens: How are Stella’s interoperability services enabling healthcare organizations to better communicate, collaborate and share clinical information? In other words: Why Stella?
Kizaraly: Stella has been called the most important interoperability company no one has ever heard of, but the Stella Technology team has been building clinical data integration software solutions for over 17 years, starting with our work with the Axolotl HIE platform back in 1998. We truly understand the challenges associated with deploying an integrated network which, if implemented well, allows a team of providers to communicate, collaborate and improve patient care.
An example of our expertise can be found in the work we did for the New York eHealth Collaborative (NYeC). On behalf of the Interoperability Workgroup (IWG), NYeC engaged Stella to design and build the IWG Testing Tool, a modular, extensible and comprehensive testing platform which allows HIE and EHR vendors to certify their compliance with IWG interoperability standards. Now known as the Interoperability Testing tool (ITT), the technology is used by the new ConCert by HIMSS vendor interoperability certification program, the ITT is advancing the interoperability of EHR vendors such as Cerner and Medfx, two of the more than a dozen vendors participating in the ConCert pilot program which concludes in December, 2015.
In addition to its work with HIMSS and at the national level, at the state and regional levels, Stella has worked with the State of New York in implementing the Statewide Health Information Network of New York (SHIN-NY) – the largest health information interconnectivity project in the U.S. – helping design and build out its core infrastructure (which had its first “Go-Live” this summer). Stella has also worked with Michigan, Nebraska, Utah, Idaho, Tennessee and California in defining their interoperability standards and platforms, as well as deployed multiple regional HIEs in those states and elsewhere in the Country.
Clinical information exists in multiple HIEs and systems within healthcare systems. The first challenge we need to solve is connecting and bringing together the information from the disparate systems, and to be able to connect the information highway across a community, region or statewide HIE for complete interoperability, so that physicians can collaborate on patient care.
The next critical HIE step is the need to clean, de-duplicate, standardize and aggregate the data, and there are number of technologies and solutions that currently exist and are able to do that today.
Since its founding, Stella Technology has been focused on its mission to build technologies for the next generation, “healthcare-connected” network for providers, payers and healthcare stakeholders to access meaningful data, such that informed clinical, administrative or financial decisions can be made at the right place, at the right time, and most important in a fully collaborative and coordinated fashion. They include:
The Integration Toolkit is the connected network’s foundation and infrastructure. It allows the extraction, validation and collection of clinical, administrative and financial information from a host of disparate systems.
The Clinical Staging Database is the “holder” of the data aggregated by the Toolkit. By unlocking the data that organizations have in their various systems and making it openly available to them is a significant benefit. Because all the aggregated data is one place, an HIE, health system or ACO can conduct either care management initiatives or analytics to identify the population of diabetic patients that are in their community to manage their care prior hospitalization.
Caredination is an innovative medical communication and collaboration platform, which focuses on ensuring that the care team is always informed of patient/member events as he/she navigates the complex healthcare system. Critical information is never lost during transitions of care, as Caredination facilitates multi-directional dialogue among providers and payers by incorporating collaborative elements of social networking.
Healthcare organizations now have a unique tool to measure the quality of clinical data in a quick, efficient and automated way. Developed in partnership with Buffalo, NY HIE HEALTHeLINK, iQHD (Quality Profiler for Healthcare Data) “measures” the quality of data from various source systems based on configurable validation rules. Organizations can work collaboratively with their partners and stakeholders to improve the overall quality of the clinical healthcare data in their community, and save a substantial amount of time, resources and costs in collecting, analyzing and leveraging data for integration projects and population health management initiatives.
Stevens: Looking through your crystal ball, what does the future look like for Interoperability?
Kizaraly: As we look ahead, we predict that care provision will be even more centered on the patient. A shift towards new technologies, tools and models of care will be the next frontier for interoperability, which will seamlessly include inpatient devices, remote patient monitoring solutions, and wearable device technologies. The patient-consumer will be more involved and engaged in their own healthcare.
As the healthcare world becomes interconnected, the need to scale the infrastructure will be critical, as more and more data will flow in and out of more systems and devices, in a more real time fashion as ever before. While Big Data has been present in some areas of healthcare (e.g. biotech or genomics), we are, as an industry, just starting to scratch the surface of how to process, make sense and optimally utilize the vast amount of information coming our way.
Lastly, telehealth is another big trend that is much talked about, especially following the Centers for Medicare and Medicaid Services (CMS) new funding and reimbursement model for telemedicine services for 2015. Health systems will be able to integrate new telemedicine solutions and technologies to decrease hospitalizations and re-admissions for their patients with chronic illness or diseases, and in the long run improve the experience and quality of healthcare for their patients, while significantly reducing healthcare costs.
Stevens: And in conclusion…
Kizaraly: OK, so in closing, and based on our own experience and what we have seen over the past 17 years, the sharing of clinical information is more than ever vital and necessary. If someone is in the business of providing care, it is a matter of survival, because without collaboration and sharing of information, your organization may not be around to compete in the new healthcare marketplace.
We also need to remember that no matter how excited we get about technology, people and process are equally critical to making your interoperability business case successful, so make sure to make them an integral part of your organization’s healthcare transformation journey.
Read the entire article, including case studies about interoperability in action here.