Jessica Kim
Cohen October 28, 2019
As HHS gears up to finalize
long-awaited rules on interoperability and information-blocking, much of the
industry has focused on their likelihood to spur development of new patient-facing apps. But the rules will also open new
opportunities for some long-standing interoperability players: health
information exchanges.
HIEs have been key players in
facilitating healthcare interoperability to date, with about 70% of hospitals
participating in at least one nationwide network, according to a data brief released late last year by the Office of the
National Coordinator for Health Information Technology. eHealth Exchange, a
nationwide health information network that was incubated as a federal program
under the ONC in 2006, is one of those groups.
"I think they're giving HIEs a
nice little nudge to mature faster," said Jay Nakashima, executive
director of the eHealth Exchange.
The ONC handed off the eHealth
Exchange to the Sequoia Project in 2012, where it has continued as a
private-sector effort. Last year it spun out into an independent
not-for-profit.
About half of hospitals participate
in a state, regional or local HIE, in addition to a national one, according to
the ONC brief.
"The biggest change that we've
seen is the demand for reach," Nakashima said of providers' evolving
expectations for HIEs.
With a growing focus on care
coordination, providers need to share data with their neighbors and have the
option to connect with a wider range of organizations.
"Their patients travel; their
patients work," Nakashima said. "Their patients certainly go outside
of their various providers' networks."
The ONC's and CMS' proposed rules
will likely shake up the interoperability landscape and change how providers
and health plans exchange data with patients and each another. That could open
new opportunities for HIEs beyond aggregating patient data.
Figuring out a core business case
is imperative as some HIEs have struggled to establish a sustainable business
model.
Many HIEs were stood up with the
help of government funding from the American Recovery and Reinvestment Act of
2009, said Mari Greenberger, senior director of informatics at the Healthcare
Information and Management Systems Society. Since then, many smaller HIEs have
shuttered. The exchanges will need to find a new funding source to avoid that
fate, which might involve relying on subscription fees from members.
That may mean providing a business
case beyond traditional data-sharing. HIEs should assess what the
"impactful services" are for their specific members and patient
population, and then create solutions around those core competencies, according
to Greenberger.
The interoperability and
information-blocking proposals released early this year would require providers and insurers
to set up a new infrastructure for data exchange—standardized application
programming interfaces. APIs are sets of protocols that connect IT systems like
electronic health records and third-party apps, allowing them to communicate
and share data with one another.
But it can take time for
provider-facing IT systems to individually adopt new technologies like APIs,
according to Claudia Williams, CEO of Manifest MedEx, an HIE that connects
healthcare organizations across California. Williams also served as HHS'
director of health information exchange during the Obama administration.
That leaves an opening for HIEs to
help hospitals and health plans get data that meets the Fast Healthcare
Interoperability Resources, or FHIR, standards in place.
"We can bring in data from any
sources, FHIR-ify it—turn it into a FHIR resource—and then be the kind of
middleware that can help providers connect to the innovators they want to work
with," Williams said.
Manifest MedEx charges hospitals a
subscription fee based on net patient revenue. It doesn't charge physician
practices and physician-led accountable care organizations for its services, to
encourage them to participate.
There's also the potential for HIEs
to turn toward the patient population.
"There's an evolving role that
some HIEs are contemplating, where they themselves might become the destination
for consumer-designated apps to connect," said Aneesh Chopra, former U.S.
chief technology officer under the Obama administration and president of CareJourney,
a healthcare analytics company.
Instead of a patient linking up an
app of their choice to each healthcare organization they visit, the HIE could
continue to corral their information. The patient could then connect their app
to just one central organization—the HIE.
"That might reduce some of the
friction for consumers," Chopra said.
But perhaps the most promising
foothold for HIEs to target is providing ADT—admission, discharge and
transfer—alerts to providers.
Under the CMS' proposal, many
hospitals would be required to electronically notify other healthcare
facilities or community providers when a shared patient is admitted, discharged
or transferred. It could be a heavy lift for hospitals to establish which
physicians at which facilities have a treatment relationship with each patient.
"The hospital may choose to
delegate to the HIE the responsibility of validating that the doctor is
entitled to the notification, as opposed to manually handling that
internally," Chopra said.
Those types of clinical event
alerts are a capability that ClinicalConnect HIE in Western Pennsylvania is
working to implement, based on demand from its members.
ClinicalConnect HIE's membership
fees are based on an organization's operating revenue.
Alerts about patient admissions can
help physicians intervene sooner if needed, said Chris Carmody, president of
ClinicalConnect HIE and senior vice president of enterprise infrastructure at
UPMC, one of the HIE's founding members.
"We're seeing a lot more uses
and a lot more opportunities to leverage the data," Carmody said.
It's not enough to exchange data
between providers anymore, Williams said.
"Pretty quickly, we're moving
from a world of data scarcity to data abundance," she explained. "I
think the job of HIEs is transitioning from just the pipe to exchange data … to
the job of turning massive amounts of information into insights."
That's likely why HIEs cite the
shift to value-based care as an asset for their businesses. That echoes
findings from a recent survey from consulting firm Deloitte, which found most
technology executives at healthcare organizations—51%—cited the move toward
value-based and risk-based contracts as one of the biggest drivers for
interoperability.
Growing interest in population
health has created new opportunities for HIEs, said Kelly Thompson, CEO of the
Strategic Health Information Exchange Collaborative, a national group that
represents roughly 80 HIEs, since much of a successful value-based care and
population health strategy rests on "people talking to each other who may
not have been talking before."
"It seems like such a
no-brainer to think that people who are caring for the same patients should be
talking to each other," she added.
Regulations like the
interoperability rules can only move the industry so far, Chopra said. That's
why the biggest push for interoperability—and for businesses like HIEs,
third-party apps and more—will likely come from providers and payers seeking to
improve care coordination after striking value-based contracts.
"Being compliant with
regulations is one thing, but signing an agreement that is the lifeblood of the
enterprise, that's a high-order priority," he said. "That may have
the fastest effect on accelerating interoperability."
No comments:
Post a Comment