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5 Ways To Improve Healthcare Information Exchanges

Define the problem you want to solve with an HIE -- and be ready for incompatibility headaches, say experts.

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Recent comments made by a number of leaders throughout the industry show clear discontentment with the state of health information exchanges. As William Yasnoff, MD, PhD, president of the Health Record Banking Alliance, recently pointed out, the current nationwide network of health information exchanges is an "unmitigated disaster," due primarily to obstacles in privacy, stakeholder cooperation and financial stability.

Four experts sat down to discuss current data exchange trends and best practices at the eHealth Initiative Annual Conference. Among the panelists were Chris Hobson, MD, CMO at Orion Health; Arien Malec, VP of strategy and product marketing at Relay Health; David Horrocks, president of Maryland HIE Chesapeake Regional Information System for our Patients (CRISP), and Eric Thieme, VP at the Indiana Health Information Exchange.

[ How has the election affected HIEs? Read Obama Victory Re-Energizes Health Information Exchanges. ]

Here are five ways ways to improve healthcare data exchange, according to these experts.

1. Keep It Simple.

Health information exchange is a difficult domain, said Relay Health's Malec. EHR adoption is making the HIE challenge harder because prior to the implementation of electronic records, connections from hospital to hospital were few and far between. "You could spend more time on connections," said Malec. To share data related to electronic health records, a hospital or physician's practice today needs an average of five to seven connection points -- between physician offices, payers and hospitals -- he said. "We need to figure out how to standardize … and keep it simple."

2. Have A Clinical Governance Board.

A clinical governance board is typically used to maintain quality throughout an organization. According to Hobson, a clinical governance group is key to a functioning HIE. Some of the most successful HIEs have similar groups that have been in place for years, he said. "You want to … add more things to keep users interested," he said, and a clinical governance group can help make this happen. "It has to be dynamic," he added.

3. Determine Best Data To Pursue.

Horrocks suggested when first deploying an HIE, talking to peers and figuring out what uses of data to pursue is a good place to start. Based on his experiences at CRISP, there was more value than expected in getting the discharge and ADT data complete from every hospital they were working with. It wasn't the highest priority when they started, Horrocks said, but it "proved to be the easiest to pull off and delivered more value to participants."

4. Define The Problem You're Solving.

Indiana Health's Thieme and his team decided a top problem to address was getting people to use a primary doctor instead of the emergency room for routine healthcare. The solution included emergency department alert notifications, which sent admission alerts and discharge summaries to primary care physicians. Over a year, ED visits decreased by 50% and primary visits went up 60%.

A key issue CRISP's Horrocks is still wrestling with is readmission rates. "One of the things we're asked [to do] is predictive analytics and risk scoring: figuring out who's most likely to be admitted, but [we] can't do that," Horrocks said. Right now, an encounter notification system is the most valuable service they're providing, he said. "It's simple and straightforward," he said.

5. Recognize EMR Incompatibility Is Real.

Thieme said getting data out of EMRs is one of the biggest components of Indiana Health's service. "To map it into common language takes effort; lab interfaces coming out of one vendor is different than another, and we spend a lot of time whipping interfaces into shape so we can consume data." If he were to ask one thing of EMR vendors, Thieme said it would be to have interfaces "looking the same." The other panelists agreed that a turnkey, well-documented standard for all EMRs is needed. "It's like pulling teeth to get that standard and configure an interface," said Malec. "We need people on the ground to get that done."

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