Transcript Realizing the Promise of HIT

Health Information Exchange
Realizing the Promise of Health
Information Technology
20 April 2016
Mark Egge
About Me
• IT Director, Chief Operations Officer
– Arizona Pain Specialists (20 provider, multidisciplinary
pain management group)
– Paper to EHR Transition
• Co-founder (2012 – 2015)
– Atlas Revenue Management (Healthcare RCM and
Consulting)
– Pain Management and Behavioral Health
• Heinz MISM-BIDA
– RA in the Mobility Analytics Center (Metro21)
– HIE research with ClinicalConnect HIE
Agenda
• Introduction to HIE
• HIE from Patient, Community & System
Perspective
• HIE from Provider Perspective
• Value of HIE
– Reduce Duplicative Services
– Improve Emergency Care
– Avoid Preventable Readmissions
• Future of HIE
The Promise of HIT
HITECH Act of 2009 authorizes $35bn for HIT investment
Reduce Costs
• Efficiency
• Reduce
Duplication
Improve Quality
of Care
• Increase
Availability of
Information
• Measure
Outcomes
2005
2015
What is HIE?
• Verb: electronic sharing of health information
• Noun: the entity that supports electronic sharing
of health information (e.g. ClinicalConnect HIE)
– “HIE is a set of services that supports access among
parties who are motivated by common interest and
governed to ensure that the rights of patients and
participants are protected.” (Frisse, 2012)
– Common infrastructure that enables the exchange of
electronic health information between healthcare
providers.
Models of HIE
Personal Health
Record
• Follows the
Patient
• Third-Party
Mediated (e.g.
Google,
Microsoft)
• Patient Centric
Direct
• Local (Usually)
• Provider-toProvider (Push)
• Vendor
Mediated (e.g.
Commonwell
Health Alliance)
• Patient Centric
HIE
• Regional
• Centralized,
Federated, or
Hybrid (Pull)
• HIE Entity
Mediated
• Organization
Centric
Physician Satisfaction
Direct (i.e. Push) vs HIE (i.e. Pull)
(Campion et al, 2012)
A little history…
Community
Health
Management
Information
Systems
1990
Regional
Health
Information
Organizations
90’s
For-Profit
Community
Health
Information
Networks
00’s
Health
Information
Exchanges
2009
10’s
HITECH Act
• $548m in
funding for 56
HIEs via ONC
(Vest and Gamm, 2010)
HIE Entity Functions
Governance
• Member
Recruitment
• Finance
Technical
• MPI
• RLS
• Translation
• Typically VendorSupported
HIE In Theory
Source: IL HIE Authority Data Security & Privacy Committee via AHIMA
HIE Examples
NHIN
HIE In Practice
Providers
Patients
Payers
HIE
Public
Health
Pharmacy
Labs &
Diagnostic
Source: IL HIE Authority Data
Security & Privacy Committee via
AHIMA
7.7m Unique Patients
HIE: Patient & Healthcare System
Perspective
– Better Quality of Care (more information  better
medical decision making)
– Lower Cost of Care (avoided duplicative testing,
inpatient admissions, etc.)
– Public Health Benefits (public health reporting,
drug surveillance)
HIE: A Healthcare Provider
Organization’s Perspective
• Reveal clinical algorithms and outcomes
• Open door to other HCPs mining data for
competitive advantage
• Reduced Revenue
• Pay for the Privilege
Barriers to Adoption
Trust
Incentives
Business
Model
Barriers: Trust
Hospitals may view patient records “as part of their property
and containing proprietary business information. … Detailed
patient records that show interventions and health outcomes
can also reveal sensitive information about hospital practices
and quality that hospitals prefer to keep internal. … these
concerns may limit the willingness of hospitals to freely share
their patient data.”
“Given their competitive nature [hospitals do not] want
someone to be mining their] data, or trying to lure the
patient to another facility.” (Miller and Tucker, 2014)
“‘RHIOs are in the trust business, not the technology
business.’” (Vest and Kaushal, 2013)
Barriers: Incentives
“One hospital … withdrew from a planned exchange effort after the
realization that ‘…they were making too much money on redundant
tests and x-rays to create the RHIO…They were each going to lose $11
million a year in revenue.’”
Likewise, a hospital executive stated: ‘…not from a clinical perspective,
but from a business perspective, HIE is kind of a bad idea. Why would
we send out patient information elsewhere? We want to do it, we
think it’s necessary for better care for the patient, but we’ll lose money
by doing it.’” (Vest and Kaushal, 2013)
“The reality of the situation is that efficient, effective healthcare
primarily benefits the patient, their community, but not necessarily
providers.” (Vest and Gamm, 2010)
Business Models
• “‘In the interests of the public good and to
address a market failure, policy makers are
funding an exchange model that does not
have a clear business case.’” (Vest and
Kaushal, 2013)
• “The main obstacle to increasing the number
of HIEs and RHIOs is the lack of a sustainable
business model.” (McIlwain 2009)
Aligned Incentives
• Integrated Health Delivery Network
• Bundled Payments
– IPPS / DRG
– Capitated Payments
• Capacity Constraints
• Pay for Value reimbursement schemes
HIE Value
Reduce
Duplicative
Testing
Improve
Emergency
Care
Avoid
Readmissions
Many More…
Duplicative Testing
• ~13% of diagnostic tests duplicative (Tierney,
1987)
• Many Radiology Exams are expensive
– 25% of high cost (>$500) radiology procedures
repeated within 14 days (Frisse and Holmes, 2007)
• Radiation is dangerous
• HIE associated with with 30.5% of laboratory
tests avoided, and 47.6% of radiologic studies
avoided (Carr, 2014)
Emergency Care
•
•
•
•
Acute Information Gap
Inpatient Admissions
ED Length of Stay
Drug Seeking Behavior Identification
Avoidable Readmissions
• Patient Modeling
• Transitions of Care & Follow-up
– 7.7% of all hospital admissions are readmissions
which could be prevented by HIE-supported
improvements in post-discharge follow-up, the
transition of care from inpatient to outpatient
setting, and the coordination of care and
communication across the care continuum
(Goldfield, 2008)
Future
Present
Volume
Future of Healthcare
Provider
Incentives
Provider
Incentives
Patient
Incentives
Patient
Incentives
Value
Future of HIE
Personal Health
Record
• Google Health
• Microsoft
HealthVault
Direct
• Effective
• Challenges of
Scale
HIE
• Public Health
Benefits
• Sustainable
Business Model
Challenges
Private “HIE Like”
Companies
Your Idea Here
• Inovalon,
Health Liaison
• PBM & Lab Data
• Trust
• Incentives
• Business Model
References
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Campion, Thomas R. et al. Push and Pull: Physician Usage of and Satisfaction with Health
Information Exchange. AMIA Annu Symp Proc. 2012; (2012): 77–84
Carr, Christine M., Gilman, Charles S., DKrywko, Diann M., Moore, Haley E., Walker, Brenda J., and
Saef, Steven H. Observation Study and Estimate of Cost Savings From Use of a Health Information
Exchange in an Academic Emergency Department. The Journal of Emergency Medicine, Vol 46, No.
2,. Pp. 250 – 256, 2014
Frisse, Mark E., Johnson, Kevin B., et al. The financial impact of health information exchange on
emergency department care. J Am Med Inform Assoc 2012; 19:328-333
Goldfield, Norbert I., McCullough, Elizabeth C., Hughes, John S., Tang, Ana M., Eastman, Beth.,
Rawlins, Lisa K., Averill, Richard F. Identifying Potentially Preventable Readmissions. Health Care
Financing Review. Fall 2008. Vol 30, No 1. Pp 75 – 91
McIlwain, James S., and Lassetter, Kipp. Building Sustainable HIEs. Health Management Technology;
Feb 2009; 30, 2; pg 8 – 11
Miller, Amalia R., and Tucker, Catherine. Health information exchange, system size, and information
silos. Journal of Health Economics 33(2014) 28 – 42
Vest, Joshua R., and Kaushal, Rainu. Challenges, Alternatives, and Paths to Sustainability for Health
Information Exchange Efforts. J Med Syst (2013) 37:9987
Vest, Joshua R., and Gamm, Larry D. Health information exchange: persistent challenges and new
strategies. J Am Med Infom Assoc (2010) 17:288 – 294