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Maine HIE Prepares For Pay-For-Performance World

HealthInfoNet and Arcadia Solution's new partnership will marry insurance claims to clinical data in Maine's health information exchange.

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Nonprofit organization HealthInfoNet, which operates Maine's health information exchange, recently announced a partnership with Arcadia Solutions, a provider of data-driven health IT solutions, to develop a platform for clinical data warehousing. The platform will also test the linkage of clinical data from the state HIE with claims data from the state's All-Payer Claims Database. Although the project will prove whether or not this can be done effectively, the goal is to give the state's HIE organization access to integrated clinical and claims data, which in turn will support new models like accountable care organizations (ACOs) and Share Savings contracts.

"We're testing this -- it's not something that's going live tomorrow -- but this is the beginning stage to see if we can do this, and if we can, figuring out what may need to change in the state of Maine as far as regulations," said Devore Culver, executive director and CEO of HealthInfoNet. "Right now, it's a pilot process."

Michael Gleeson, vice president of quality improvement and analytics at Arcadia Solutions, said they need to address two main challenges to make the platform a success. For starters, he and his team need to take what's essentially a transactional database in the HIE and normalize it. Then they need to put that information into a data structure capable of offering "longitudinal access," he said. "HIEs are really good at saying, 'Hey, I want some information about this event' -- they capture information and send it to someone who asks about it. But there's a lot of work in taking data structures that excel at that process and turning them into data structures that allow for deep analysis, trending, and things along those lines," Gleeson said.

[ For more on the role of EHRs in clinical research, see Health IT's next challenge: Comparative Effectiveness Research. ]

The second challenge, according to Gleeson, is matching the data within the payer claims database, or other claims data sources, with clinical data. "That linking and match up process can get difficult in terms of finding the right identifiers," he said. For example, the challenge comes with deciding whether the information needed is a name, age, or date of birth, or whether you have to go further and match up clinical history in the HIE with encounter and claims history within the claims data files? Additionally, Gleeson and his team need to make sure they're not duplicating transactions within data sets and that they're truly getting a more complete picture from linking the data sets together.

Ralph Johnson, CIO at Maine-based Franklin Memorial Hospital, said that from an organizational perspective, he hopes this process will "take healthcare informatics to the next level…. [I]f you think about it, data has always been siloed within the provider organization, where they can see all the clinical data." Or, he continued, data is siloed in the payer model, where you can only see the "payment side" of the data. "You're not able to see across providers and across payments. This is going to bring this together for us."

Culver said HealthInfoNet and Arcadia Solutions will begin work on the warehouse in January and February, validating the matching of data across the claims and clinical databases. "At the same time, we'll do work on the early reporting functionality," he said. "There's a set of data that hospitals contribute to the state [regarding] inpatient and outpatient discharge, and that data is flowing into the exchange…. [W]e want to make that available as soon as we can in 2013 so hospitals can use that."

The problem with the [current] data structure is that it's delayed as much as a year, Culver said. "We think hospitals can get to that data within days of it being generated. So there's opportunity to start building some early return on this effort by spring."

Clinical, patient engagement, and consumer apps promise to re-energize healthcare. Also in the new, all-digital Mobile Power issue of InformationWeek Healthcare: Comparative effectiveness research taps the IT toolbox to compare treatments to determine which ones are most effective. (Free registration required.)

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User Rank: Apprentice
12/31/2012 | 8:03:46 AM
re: Maine HIE Prepares For Pay-For-Performance World
Paul, I couldn't agree more. This is clearly the way to go, by combining clinicial data and insurance claim data. Data alone isn't enough to improve quality of care; there must be integration and analysis from several sets of data and networks.

Jay Simmons
Information Week Contributor
User Rank: Apprentice
12/20/2012 | 7:47:14 PM
re: Maine HIE Prepares For Pay-For-Performance World
Once again, combining clinical data, from EHRs for instance, with insurance claims data, seems to be the way to go. Several thought leaders I've spoken to in 2012 believe this will provide a new level of intelligence and insight, and ultimately improve the quality of care.

Paul Cerrato
InformationWeek Healthcare
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