A patient shows up at the emergency room unconscious and unable to give a history. Another patient arrives at his primary care physician’s office 3 days after an emergency room visit, and the primary doctor has received no information. A specialist sees a third patient for a consultation and receives none of the critical records needed to help her make the consultation efficient and effective. These scenarios and many others like them, unfortunately, are all too commonplace. The consequences of incomplete information at the point-of-care can be inconvenience, inefficiency, increased costs, and adverse, even life-threatening outcomes for patients.

The major reasons for lack of sharing health information include the fragmented nature of the United States healthcare system and the fee-for-service business model, a model that does not include financial support for health information exchange. Further, most health information technology (HIT) programs are not interoperable, that is, they do not speak to each other.

Health information exchange (HIE), in its current definition, is the electronic sharing of health-related information between disparate partners, based on nationally recognized standards for interoperability, privacy, and security. Without sharing, silos of information persist, physicians function with incomplete information, and tests are unnecessarily  repeated. Information-sharing is particularly important for care coordination of care for older with complicated conditions; chronic disease management; natural disaster and biosurveillance response; and care for a mobile military, veteran, and civilian patient population.

Recognizing these obstacles to sharing, the federal government has taken an active role in promoting HIE as a key component of healthcare reform. In this article, we will describe the
current landscape of HIE in the United States, how different parties are trying to expand it, current obstacles to the expansion, and the future possibilities.

THE HITECH ACT AND HIE
In 2004, President Bush set the goal of an interoperable electronic health record (EHR) system for all Americans by 2014 and established the office of the national coordinator for HIT (ONC). Initial progress towards the goal was slow until the passage of the American Recovery and Reinvestment Act (ARRA) of 2009, which included the Health Information Technology for Economic and Clinical Health (HITECH) Act. The HITECH Act funded multiple federal programs to promote the adoption of HIT, particularly EHR systems and HIE at the local, state, and national level.

The basic building block for this national strategy is the EHR, which inputs, processes, and stores digital health information for hospitals and outpatient practices. Health information organizations (HIOs) are the organizations that provide the governance,technology infrastructure, and security to exchange health information. A regional health information organization (RHIO) is simply an HIO that covers a defined geographic area, such as a city, region, state or multi-state area. HIOs have the ability to collect and aggregate health data from multiple organizations and electronically share information with EHRs.

The HITECH Act included a Medicare and Medicaid reimbursement program for eligible professionals who use certified EHRs and demonstrate “meaningful use.” Stage 1 meaningful use included the general objectives of e-prescribing, structured data collection, quality reporting, clinical decision support, patient engagement, security assurance, and HIE. HIE is necessary to provide a hospital discharge summary, electronically exchange key clinical information among providers, report quality measures to Medicare/Medicaid or states, perform medication reconciliation, transmit electronic immunization data to immunization registries, and submit electronic syndromic surveillance data to public health agencies.

Currently, most HIE occurs as part of an existing HIO. HITECH funded a new option for statewide and interstate exchange known as the State Health Information Exchange Cooperative Agreement Program, discussed in a later section.

CONNECTING PRACTICES, HOSPITALS, AND CITIES
Approximately 234 HIOs exist in varying operational stages, according to a 2010 study by eHealth Initiative, a not-for-profit organization that has conducted annual HIO surveys since 2005. Seventy-three HIOs claimed to be operational (exchanging some type of health data), and 18 claimed to be sustainable (no federal funding in the past year, operational status, and receiving revenue equal to or exceeding costs). More than half of the HIOs offered the following core services: clinical messaging (electronic test delivery of lab and radiology results, medication data, outpatient visits, and emergency room visits), EHR connectivity, clinical documentation, and alerts to physicians. Fewer than half of the HIOs survey offered the following newer advanced services: e-prescribing, Web-based EHR-HIE combination, public health reporting, telemedicine, medication reconciliation, emergency room use data, transcription, voice recognition, business analytics/intelligence, value-based reimbursement (pay for performance), credentialing, research, clinical decision support, consumer portal, claims clearing house, care coordination, and picture archiving and communication systems.

HIOs such as HealthBridge, located in Cincinnati, Ohio, and Indiana Health Information Exchange,located in Indianapolis, Indiana, are performing well financially and have the support of the medical community. On the other hand, failures such as the Santa Barbara County Care Data Exchange have dissolved primarily due to lack of perceived value by the healthcare community.

In 2010, the State HIE Cooperative Agreement Program funded (via $548 million) 56 states, eligible territories, and qualified state designated entities. The overall goal was to promote standards based statewide and interstate information sharing to meet meaningful use, particularly where none exists currently. Statewide HIE will need to be interoperable with existing HIOs, significant data providers and users (such as Medicaid), and the Nationwide Health Information Network (NHIN).

The NHIN is a collection of standards, protocols, and services that enables the secure exchange of health information over the Internet. Instead of being a specific network, it is actually a “network of networks” connecting disparate healthcare organizations, to include HIOs, federal agencies, and integrated networks. The NHIN primarily will provide a means for large civilian and federal health organizations, to include HIOs, to share information securely. As an example, MedVirginia is sharing information with the Social Security Administration via the NHIN to expedite disability determinations.

WHERE’S THE MONEY?

HIE participation for any given healthcare provider is fundamentally a business decision. The expected net benefit to the provider must be positive so that expected benefits exceed expected costs. These benefits can be monetary in nature, accruing through efficiencies in running a practice or a clinic, or through better use of a reimbursement mechanism. They also can be non-monetary, yielding superior health outcomes through better case management while not affecting the bottom line for the business.

Potential models include monthly or annual pricing on a per physician basis (subscription model), pricing on a per-transaction basis, or some combination of the above (for instance, a monthly fee plus per-record usage cost). Approximately half of the operational HIOs charge physicians a user fee as well as an additional fee to create an electronic interface between an EHR and the HIO. Participants must be willing to collaborate, rather than compete, in data exchange and must be willing to pay operating costs. Organizations must have enough participants to create a “network effect” (enough customers to make it worthwhile) and create subsequent economies of scale to be successful.

One of the more immediate benefits for physicians to participate in information exchange would be to comply with meaningful use objectives as part of the Medicare and Medicaid EHR reimbursement program. Very few HIOs can meet all pertinent meaningful use objectives at this time, however.

Participation in successful HIOs likely will mean access to an increasing number of administrative and clinical tools such as business analytics, telemedicine, clinical decision support, centralized credentialing, research opportunities, and a variety of reports.

According to the latest eHealth Initiative survey, many HIOs report reduced staff time spent handling or filing lab and radiology results and handling prescription issues. Another potential benefit would be creating one EHR-HIO interface to receive results, as opposed to multiple EHR interfaces to outside labs,hospitals, and imaging centers.

NUMEROUS TECHNICAL AND FINANCIAL OBSTACLES
Physicians may object to any change in workflow, user fees, and EHR interface charges to participate in HIE. They may believe that the benefits accrue more to others, such as payers and state and federal governments.

The most commonly reported obstacle for HIE is a long-term sustainable business plan that does not depend on federal funding. HIOs must have the trust of multiple partners that traditionally have been competitors in the market place. HIOs must provide services that have perceived value to a wide audience, such as clinicians, hospital executives, and practice managers. The lack of widely proven return on investment may cause some clinicians to choose faxes and mail over electronic sharing.

HIE also is impeded by a lack of a universal patient identifier that would greatly improve retrieval of the correct patient record. Another administrative obstacle for all HIT initiatives is privacy and security. HIOs will store voluminous data for thousands of patients that can be breached without adequate protection. Further, depending on the state, patients will need to sign an opt-in or opt-out agreement to allow record sharing. HIE participation could raise new legal issues regarding responsibility for reviewing all pertinent information on a patient.

For electronic record-sharing to take place, data standards need to be developed and adopted. The current document standard is known as a continuity of care record or continuity of care document. Both are XML-derived patient summaries that are similar to a problem summary list but are in a format that can be both generated and read by most EHR systems.

ALTERNATIVES ARISE
Although the government approach currently favors HIOs and statewide health exchanges, other models have been proposed. Some favor an approach called health record banking. This approach is consumercentric and particularly appeals to privacy advocates. Each consumer (patient) would directly control who can access his or her account. Patients would authorize their providers to “deposit” and “withdraw” information from their secure online personal health information. It has even been suggested that the consumer would bear the cost of a nominal subscription fee. To date, however, patients have shown little inclination to adopt electronic personal health records, even though several systems are now available for free from organizations such as Google and Microsoft as well as health insurers.

Another proposed option is to use a nationwide electronic messaging system that already exists, such as Surescripts. Surescripts is the primary messaging system between physicians and pharmacies used in this country for the transmission of electronic prescriptions. Surescripts proposes becoming a health information service provider that offers the ability to exchange clinical messages and patient encounters over a standards-based network between providers. The company plans to offer this service in 2011 and support it by a subscription fee.

Additionally, the government recently has proposed a simpler alternative to HIOs called the DIRECT Project. In this option, which could be available as early as 2011, physicians will be able to push encrypted clinical messages between healthcare partners. Pilot tests will be under way in early 2011, and further details are forthcoming.

THE FUTURE OF HIE

Some see the role of the HIO as an “infomediary” or information-hosting organization that reuses data for more than clinical medicine, such as public health and research purposes. Several HIE vendors are planning to add Web-based EHRs, practice management systems, and business analytics to allow for fully integrated clinical and financial functions. A few HIOs are offering services such as transcription, credentialing, reporting (public health, quality and pay for performance), and patient access to health data through a portal and personal health records. In spite of approximately a dozen successful HIOs, HIOs remain expensive and complex.

Further, the viability of the new State HIE Cooperative Agreement Program is uncertain. States will be required to charge for HIE use, and it is unknown how this requirement will be viewed by data providers and users.

If you haven’t already done so, you will need to make a business decision whether to purchase a certified EHR to receive federal government reimbursement. As part of that decision and as an aid to achieving meaningful use, you also should determine how you will share medical information in the future. Ascertain whether you can use an existing HIO, a new statewide HIE, or a simpler solution such as the DIRECT project or the SureScripts network.

The degree of uncertainty regarding both EHRs and HIE is substantial, but so are the potential benefits to you and your patients. Mature and successful HIE is a rarity today but likely will be standard operating procedure in the foreseeable future.

2010 Advanstar Communications Inc..

Source:  Modern Medicine.com
View Full Article: http://www.modernmedicine.com/modernmedicine/article/articleDetail.jsp?id=700603&pageID=1&sk=&date=

Why is that important? It gives caregivers the information they need at the time they need it to improve patient outcomes.

“The single most important thing,” said Andrew VanZee, state health IT director, “is to provide information at the point of care.”

Imagine your aging parent falls ill while visiting you from another part of the state. Then think about taking this loved one to your local ER knowing physicians there can call up a medical record and learn about your parent’s chronic conditions, medications or recent surgeries. Or, what if you were that ER doctor; how helpful would the information be in your treatment plan?

Devising a roadmap
Our state has a strategic roadmap for health information technology projects and electronic connectivity, as well as funding to move us down that road over the next five years. VanZee detailed those plans at a CME session offered during the ISMA convention last month.

Strategies encompass the five pillars shown in the diagram, working with Indiana’s current health information exchanges: HealthBridge, HealthLINC, MedWeb, MHIN (Michiana Health Information Exchange) and IHIE or Indiana Health Information Exchange.

Connectivity goals call for helping an additional 30 rural/critical access hospitals to exchange information, as well as 100 federal qualified health centers and rural health clinics, and 50 lab and radiology facilities. Most existing connectivity is in large metropolitan areas and along major highways.

Already efforts are underway to complete data mapping and normalization that will provide preferred standards for data elements. “That is so the various information exchanges around the state can talk to each other,” explained Van Zee.

The standards will cover patient identification, radiology and lab results, and clinical documents.

Privacy and security are part of the plan, too. Funding already granted will help with policy development, gap analyses and planning to address any gaps discovered in the safeguarding of information.

“The goal is to improve the process to help information flow both ways,” VanZee explained. For example, physician offices will send text or exam results to hospitals, as well as receive information from those hospitals.

Read more on the Indiana Health IT website.

View Full ISMA e-Report  
 10/20/2010

Dayton, OH – The Greater Dayton Area Hospital Association (GDAHA) today announced its partnership with HealthBridge, a not-for-profit health information exchange located in Cincinnati, to establish health information exchange services for the Greater Dayton region. This partnership will create one of the nation’s largest secure health information networks connecting hospitals and physicians in Dayton and Cincinnati. Once the Dayton-Cincinnati health information exchange is complete, more than 50 hospitals and 7,500 physicians will be connected across Southwest, Ohio.

“Hospitals in the Dayton region have been innovators and leaders in the national movement to use electronic health information in our community,”   said Bryan Bucklew, President and CEO of GDAHA.  “They are now expanding their ability to share electronic information through secure channels with providers. These connections will improve the quality of care available to patients in our community.” 

The use of cutting edge technology among hospitals in the Dayton region is a continuation of the collaboration on health information technology that began with the adoption of Epic, an electronic medical records system, by Premier Health Partners, the Kettering Health Network, and The Children’s Medical Center of Dayton.  

Electronic medical records and the connection provided by the Dayton health information exchange will transmit a patient’s information through secure networks to improve the quality of care and reduce cost by eliminating duplicative services. A patient’s medical history will be readily available to doctors and nurses in the hospital or the physician’s office.  

Too often physicians do not have the most current information from other providers when they see a patient. The ability of a patient’s health information to follow the patient electronically from hospital to doctor’s office to lab and back will result in better quality of care and lower costs. 

“Technology and connectivity are fundamental to advancing the quality and efficiency of healthcare,” said Keith Hepp, Vice President of Business Development at HealthBridge. “We are delighted to work with GDAHA and the Dayton provider community to rapidly expand the ability to connect and share health information securely to improve patient care.”

Connectivity through HealthBridge will start with nine hospitals that are part of Premier Health Partners and the Kettering Health Network.  By the end of 2011, 80 percent of GDAHA hospitals, CompuNet Clinical Labs, and Public Health – Dayton and Montgomery County will be connected to the Dayton health information exchange. 80 percent of area physicians will be connected by the end of 2012. 

The importance of electronic medical records is  underscored by GDAHA’s commitment to help the Dayton region’s provider community prepare for the “meaningful use” of health information technology.  As part of the economic stimulus legislation passed in 2009, meaningful use means health care providers must demonstrate a wide set of electronic capabilities to qualify for thousands of dollars in incentive payments. GDAHA will work with physicians to ensure that they receive the financial and technical assistance to achieve the meaningful use of health information technology through the Greater Dayton Area Health Information Network Regional Extension Center. 

“We’re very proud to be working with a pioneer in health information exchange like HealthBridge,” said Bryan Bucklew.  “The proximity and patient movement between the Dayton and Cincinnati communities makes working with HealthBridge a natural fit for our provider community.”

The Greater Dayton Area Hospital Association (GDAHA) is a member-service organization representing 23 hospitals and health systems in the Dayton region.  GDAHA collaborates with its members to improve the delivery of healthcare services in Auglaize, Butler, Darke, Champaign, Clark, Greene, Miami, Montgomery, Preble, Shelby, and Warren Counties in West Central Ohio.   GDAHA offers value-added services that help members improve operating efficiency and maintain quality standards.

 About HealthBridge

Since its founding in 1997 as a non-profit community-based organization, HealthBridge has grown to become one of the largest, most advanced and financially successful health information exchange organizations in the United States. Each month roughly 3 million clinical lab tests, radiology reports, discharge summaries and other health information are transmitted electronically to more than 5,500 authorized physicians through HealthBridge’s secure technology network, more than nearly any other collaborative health information organization in the country. Dedicated to helping providers and communities achieve meaningful use of health information technology, HealthBridge also operates the Tri-State Regional Extension Center and the Collaborating Communities Network of health information exchange organizations. HealthBridge has been recognized in many publications for its innovative practices including the Wall Street Journal, eHealth Initiative, and HIMSS, just to name a few.  For more information about HealthBridge, see www.healthbridge.org.

“The basic premise is that there is no one particular thing that if implemented at a community level would produce effective, sustainable quality cost improvements,” McKethan said.

In addition to the 15 communities chosen earlier this year, HHS announced last week the two final communities to participate in the Beacon Community Program: Detroit and Cincinnati. Under the program, the Greater Cincinnati HealthBridge in Ohio and the Southeastern Michigan Health Association (SEMHA) in Detroit will receive $13.8 and $16.2 million, respectively, over three years.

Cincinnati and Detroit were awarded Beacon Community status on the same criteria as the original 15 communities, including performance improvement goals, the vision of the community over the course of the program, clarity around community-specific goals that builds on an existing IT infrastructure and the sustainability of performance improvements over the long haul, said McKethan.

For example, in Cincinnati, the Beacon Community Program funds will enable HealthBridge to build on its health information exchange (HIE) capabilities to improve patient care, McKethan said. This will require HealthBridge to invest in care managers and take additional steps to access data and use them in ways that haven’t been done, he said.

In addition, the Cincinnati Beacon Community wants to sustain its efforts by showing major commercial payors in the region that the HealthBridge program adds “considerable value” to the bottom line of improving healthcare delivery quality and slows the growth of spending for delivery of care, according to McKethan.

Healthbridge hopes to engage Medicare, Medicaid and the major private payors during and after the Beacon Community Program to pay into the system on the basis of quality and value instead of the basis of volume and intensity of services. Hopefully, this will be achieved with a demonstrated track record of improvements in both quality and value, McKethan said.

“One of the critical features of the Beacon program is the belief that producing consistent performance measures at the community level–cost, quality and population of health–can be helpful at the local level to help physicians know on an ongoing basis if their interventions are working and how they might be changed as they go forward,” he said.  “Achieving quality improvement locally is an iterative process.”

Beacon Communities are now establishing a baseline of performance measures data to pinpoint their starting point and to track their communities’ improvements. All program members will be recording performance measures on a quarterly basis to understand how their efforts are translating to better care, and will send those results to each other, their community partners and to ONC as a way to evaluate their project, said McKethan. ONC will report on the performance measures in the future, he said.

Many of the Beacon programs focus on using IT to improve care for chronic conditions such as asthma, heart failure and diabetes. McKethan expects Beacon Communities to develop performance measures for such things as avoidable hospital readmissions for patients who have been hospitalized for chronic conditions, or emergency room utilization.

Other measures might include smoking cessation rates or rates at which smokers are offered cessation therapy, he said.

“We’re going to release the measures each community is collecting or reporting on in a month or so, once they’re finalized, and that will be an open, transparent process,” said McKethan.

In addition, ONC is seeking a scientifically valid third-party evaluator of the Beacon Community Program, and will release an evaluation contract for potential bidders in a few weeks, he said.

After three years, expansion of the program would require further congressional action. Although “we are not anticipating [further congressional action to extend the program], we would be delighted for more communities across the country to take similar steps. We are prepared for other communities to receive benefits from the program even if we don’t expand from the formal program,” concluded McKethan.
a scientifically valid third-party evaluator of the Beacon Community ProgramLast Updated ( Wednesday, September 08 2010 )

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“We are taking initial calls now and are already meeting with small practices,” said Monica Arrowsmith, director of the REC at Purdue.

Todd Rowland, M.D., executive director of HealthLinc, a HealthBridge partner, said “Achieving federal incentives for meaningful use will take time, so it is important to get started.” HealthBridge has several hundred practices already committed.

Here are answers to some questions about RECs as they open for your business.

What exactly is a REC?

Across the country, these centers will serve defined geographic areas to support at least 100,000 primary care physicians and providers (small practices and those serving safety-net populations) to achieve meaningful use of EHRs for nationwide health information exchange.

What can a REC do for me – and what can’t it do?

RECs cannot give you money to purchase an EHR, software or hardware. Also, you can receive federal incentive dollars only if you achieve all 25 meaningful use criteria by specified deadlines.

However, the RECs can help you maximize available funding through direct, on-site support so you can:

• Select the certified EHR product that best meets your needs
• Enhance and expand your use of an existing EHR
• Implement an EHR within federal timelines
• Enhance workflow, maximizing your system to improve quality of care
• Avoid common mistakes and check all the boxes to qualify for incentives
• Comply with legal, regulatory, professional and ethical requirements to protect privacy and security of patient information

Why should I have an EHR system?

While there is little consistent evidence EHRs improve quality or cost, the real promise of EHRs is:

• Practice operations will be more efficient.
• Patient records will be accessible to you anywhere, anytime.
• Medical errors and redundant costs will be reduced.
• Integration of evidence into care practices will be accelerated.

Should my patient referral patterns determine which REC I use?

You should not alter your referral patterns in any way for EHRs or RECs because by 2012, all health information exchanges in the state (currently five) must be able to exchange data with each other. So, no matter where you refer patients, their medical records should be accessible.

See the HealthBridge 19-county target area in the map here.

What do I need to do to get started?

Find information about the Purdue REC here; you’ll need to complete a short survey to get started.

Find information about HealthBridge Tri-State here; an “Interest Form” is available on the site.

Do I have to pay for REC services?

The RECs charge some fees, but they cost far less than other consultants since RECs are non-profit and supported by federal grants. The Tri-State REC does not charge to assist practices already using EHRs attain meaningful use.

I’m a specialist; can the RECs help me?

RECs will provide education to all health care providers about health information technology, EHR and information exchange, as well as process redesign, workforce support and quality improvement.

Will the RECs direct me to certain vendors?

RECs are moving through a vetting process right now to develop a list of preferred vendors that will enable them to offer group discounts on proven, certified products. Vendors are responding to a Request for Proposal issued in early May.

What if I already have an EHR, can a REC help me?

Yes, the REC will assist you to reach the maximum benefit from your EHR system.

What amount am I eligible to receive for reaching meaningful use?

Each eligible professional may qualify for incentives up to $44,000 for Medicare or up to $63,750 for Medicaid (not both) over the next few years for meeting meaningful use of health information technology.

For background on RECs, see the March 8 and April 5 issues of ISMA Reports on the ISMA website.
 

The Tri-State Regional Extension Center (REC) is one of a select group of organizations throughout the U.S. designated as having the experience and capacity necessary to assist health care providers with the task of modernizing their practices with certified EHRs. We have been selected by the U.S. Department of Health and Human Services’ (HHS) Office of the National Coordinator (ONC) for Health Information Technology to serve providers, with a focus on primary care providers, in South Central Indiana.

For providers who do not currently have an EHR system, HealthLINC will help you choose and implement one in your office. For providers who already have a system, we can help eligible providers meet the criteria for incentive payments from Medicare or Medicaid for the meaningful use of EHRs.

What is “Meaningful Use”?

The American Recovery and Reinvestment Act of 2009 specifies three main components of Meaningful Use:

• The use of a certified EHR in a meaningful manner, such as e-prescribing.
• The use of certified EHR technology for electronic exchange of health information to improve quality of health care.
• The use of certified EHR technology to submit clinical quality and other measures.

Simply put, “meaningful use” means providers need to show they’re using certified EHR technology in ways that can be measured significantly in quality and in quantity.

Who’s Eligible?

Eligible Hospitals

Why Use The REC

Hurry! Registration Is Open….

We encourage providers to register for the Medicare and/or Medicaid EHR Incentive Program(s) as soon as possible. You can register before you have a certified EHR. Click her to register.

Preferred Vendor Program

“The process of choosing an EHR can be difficult for physicians,” said David Groves, Executive Director of the Tri-State REC. “We have created this supported vendor list to identify products that meet the functional requirements necessary to achieve meaningful use, offer exceptional usability, and support high-quality patient care. However, we are committed to working with any practice or provider, regardless of which certified EHR vendor they choose.”

• Allscripts – Professional
• Athenahealth – AthenaNet
• Axolotl EMR
• eClinicalWorks – eCW EHR
• GE Healthcare – Centricity
• NextGen Healthcare – NextGen EHR

Additional Resources

• Indiana Medicaid Information
• CMS Overview of EHR Incentive Programs
• Who is Tri-State REC (1 page handout)
• In a Nutshell: Why Electronic Health Records?
• Meaningful Use FAQ
• Medicare and Medicaid EHR Incentive Programs Payment Table
• Timeline
• Measures Overview

To understand the potential of shared health records, consider the Bottone family.

Almost everyone agrees that health information technology could create more effective and more efficient systems in the medical world but we still face a number of hurdles in terms of widespread adoption. Journal News Editor Laura Landro discusses some of the challenges facing the medical industry as they look to digitize health records.

Born prematurely with nonfunctioning kidneys, 4-year-old Jacob Bottone has been through dialysis, angioplasty and a kidney transplant, and seen more specialists than most people will see in a lifetime. His doctors and hospitals had electronic medical-records systems, but no way to access each other’s, so his parents had to collect his growing paper medical records in a large accordion folder, haul it from doctor to doctor, explain his medical history over and over again, and often wait for hours while referrals and test results were retrieved and faxed around to different providers. “It was getting to be a bit of nightmare,” says his father, Jason Bottone.

Enter electronic information exchange.

Three leading health-care providers in Colorado’s Front Range region recently teamed up in an electronic health-record exchange program that will allow them to share data on more than a million Colorado residents, including Jacob. The three—Children’s Hospital in Denver, Kaiser Permanente Colorado’s physician group and Exempla Healthcare, which operates Saint Joseph and two other hospitals in Denver—have agreed to share their records on a secure network that will allow clinics, doctors’ offices and hospitals to exchange data on common patients instantly, including lab reports, radiology images and medical history.

Instead of keeping a tattered list of Jacob’s medications in the boy’s diaper bag, his mother, Heather, knows that his doctors at either Kaiser or Children’s Hospital can call them up instantly on a computer. When the family rushed Jacob to the emergency room in December, fearing a rejection of his transplanted kidney, they called ahead to Children’s, where staffers pulled up notes from his latest doctors’ appointments. (Fortunately, he was suffering only gas pains caused by a virus common to transplant patients.) As for the accordion file, dubbed “Jacob’s Bible” by the family, “we don’t have to carry it around anymore,” says Mr. Bottone.

Unfortunately, programs like this are still a rarity. For starters, only about 10% of the nation’s hospitals and less than 7% of doctors’ offices have full-fledged electronic medical records. And those that have electronic records typically don’t share them with others unless they’re part of the same health system. Among the reasons: With dozens of different vendors, information systems often can’t easily talk to each other. In addition, health-care providers often view their information about patients as proprietary. And concern about violating privacy laws has made many hospitals reluctant to join information-exchange efforts.

But those barriers are expected to come down as the federal government prepares to dole out $19 billion in economic-stimulus funds for health-care providers to adopt electronic medical records. To qualify, doctors and hospitals must not only invest in electronic medical records, but also demonstrate “meaningful use” of the systems, including the ability to exchange information with other providers. If they fail to do so, their Medicare payments will be cut.

By 2015, “Americans ought to be able to expect there will be a relatively widespread exchange of health information in a safe and secure way,” says H. Stephen Lieber, CEO of the Healthcare Information and Management Systems Society, whose members include professionals in health-information technology.

The stimulus funds include about $700 million for states to help create information exchanges that would link multiple providers in a state or region. At present there are essentially two kinds of exchanges—though the terminology is fluid and some arrangements overlap, making it difficult to precisely quantify the extent of record sharing.

Regional Successes
So-called regional health-information organizations, known as RHIOs, typically are overseen by a state or local nonprofit organization that coordinates the exchange of information among competing providers in their area over a common network. The other kind of exchange is an agreement directly between competing health providers to share data. This is often called an HIE, for health-information exchange, though that term is sometimes used more broadly.

The eHealth Initiative, a nonprofit group that promotes health IT, counts at least 193 active initiatives of all kinds to exchange information in the U.S., but not all are off the ground; 57 reported they were operational last year, a 36% increase from 42 in 2008. However, a study published in the journal Health Affairs last year found that most RHIOs were focused on exchanging test results alone, and only 41% reported receiving sufficient revenue from participating providers to cover operating costs. The study concluded that RHIOs’ “scope remains limited and their viability uncertain.”

To be sure, some RHIOs have been successful. HealthBridge, started in 1997 in the greater Cincinnati-northern Kentucky area, includes 24 hospitals and close to 5,000 doctors’ offices. They share lab tests, radiology reports and other results over a secure electronic network that enables different information systems to communicate with each other.

Patients aren’t the only ones to benefit: The system saves its members an estimated $20 million annually just in staff, fax and postage costs for records transfers, says HealthBridge’s policy director, Trudi Matthews. And HealthBridge is extending its reach, working with three other regional exchanges in Ohio and Indiana to connect their systems, so if a baby goes to a hospital in Indianapolis, a pediatrician in Cincinnati can access the test results and radiology notes.

Direct exchanges of data between competing providers also remain rare, according to a recent study by research firm KLAS Enterprises LLC. Jason Hess, the study’s author, says the number is low in part due to technological barriers from incompatible records systems. And several other issues have yet to be fully resolved, including privacy and cost concerns. “If I am a hospital exchanging information with a competing hospital down the street,” Mr. Hess says, “at what point am I not responsible for what happens to that information?”

It also isn’t always clear who would pay for what in an information-sharing system, or whether doctors would be willing to accept images and tests from another hospital. Some doctors might distrust a CT scan, for instance, from another hospital system and be hesitant to base their prognosis on it. And hospitals make money from doing their own tests and procedures, another disincentive to share information.

National Ambitions
The ultimate goal is to move beyond regional efforts and create a national health-information network, says David Lansky, chief executive of the Pacific Business Group on Health, a coalition of large health-care purchasers, and a member of a national advisory committee on health-information technology. Such a network will need a set of “policies, standards and services that allow the Internet to be used for meaningful exchange to improve health and health care,” Dr. Lansky says. “And that is about trust—coming up with rules and agreements that give us the trust to share information with each other.”

The Denver-area providers say trust is largely what helped them agree on their health-information exchange. And they had another big advantage: All three partners happened to have medical-record systems purchased from the same vendor, Epic Systems Corp. of Verona, Wis. There also were personal relationships to draw on; both hospital partners admit many children who are patients of Kaiser pediatricians, for example.

Executives at Children’s Hospital and Exempla say the main hurdles in the deal were administrative and legal, such as developing procedures for obtaining legal consent from patients to transfer their records electronically when they register at a hospital or clinic, and ensuring proper identification of patients, like those with similar names.

Though the electronic medical records were already in place, the partners had to make some new investments. Children’s Hospital spent close to $50,000 to make the transition and invested about 1,000 hours of labor; Exempla spent $200,000 on equipment and labor costs for the project.

“We never batted an eye at the investment,” says Exempla’s senior vice president and chief information officer, David Pecoraro. “The impetus was to provide safer and better care.”

Ms. Landro is an assistant managing editor for The Wall Street Journal and writes the paper’s Informed Patient column. She can be reached at laura.landro@wsj.com.

Source:  WSJ.COM

 
 U.S. Department of Health and Human Services Secretary Kathleen Sebelius today announced awards to help states facilitate health information exchange and advance health information technology (health IT).  Funded by the American Recovery and Reinvestment Act of 2009, today’s  awards are part of the $2 billion effort to achieve widespread meaningful use of health IT and provide use of an electronic health record by every citizen by the year 2014.  Every state and eligible territory has now been awarded funds under this program.

“These critical investments will help unleash the power of health information technology to cut costs, eliminate paperwork, and help doctors deliver high-quality, coordinated care to patients,” said Secretary Sebelius. “States are important partners in improving and expanding our electronic health records system.  By improving the secure exchange of electronic health records between providers and hospitals within and across states, these awards mark a significant step in bringing our health system into the 21st century.” 

The health information exchange HIE awards announced today provide approximately $162 million to 16 states and qualified state designated entities (SDEs) to facilitate non-proprietary health information exchange that adheres to national standards.  Health information exchange is critical to enabling care coordination and improving the quality and efficiency of health care. 

“Today’s announcement of awards to 16 states and SDEs marks a significant milestone with all states now empowered to start their journey towards identifying innovative ways to break down theses barriers that prevent the seamless exchange of information, so that we can give patients the access to care they deserve and expect,” stated Dr. David Blumenthal, national coordinator for health information technology.  “States play a critical leadership role in advancing the development of the exchange capacity of healthcare providers and hospitals within their states and across the nation. Health information exchange will enable eligible healthcare providers to be deemed meaningful users of health IT and receive incentive payments under the Medicare and Medicaid electronic health record (EHR) incentive program.”

These cooperative agreements were awarded under the authority of Title XIII of ARRA, the Health Information Technology for Economic and Clinical Health (HITECH) Act which amends Title XXX of the Public Health Service Act by adding Section 3013, State Grants to Promote Health Information Technology. Section 3013 provides for the awarding of competitive grants to promote health information technology.  On February 12, 2010, HHS awarded $385 million to 40 states and SDEs.  The awards announced today complete the awarding of cooperative agreements funded by this program.  

A listing of the state HIE competitive agreements announced today follow:

State/SDE
Award Amount
 
Agency of Health Care Administration (FL)
 $20,738,582
 
The Maryland Department of Health and Mental Hygiene
 $9,313,924
 
New Jersey Health Care Facilities Financing Authority
 $11,408,594
 
South Carolina Department of Health & Human Services
 $9,576,408
 
Iowa Department of Public Health
 $8,375,000
 
Idaho Health Data Exchange
 $5,940,500
 
State of North Dakota, Information Technology Department
 $5,343,733
 
State of Alaska
 $4,963,063
 
Nebraska Department of Administrative Services
 $6,837,180
 
South Dakota Department of Health
 $6,081,750
 
Department of Public Health, State of CT
 $7,297,930
 
State of Mississippi
 $10,387,000
 
Indiana Health Information Technology, Inc.
 $10,300,000
 
HealthShare Montana
 $5,767,926
 
Texas Health and Human Services Commission
 $28,810,208
 
Louisiana Health Care Quality Forum
 $10,583,000
 
Total
 $161,724,798
 
Additional information about the state HIE program
 
Information about other health IT programs funded through the American Recovery and Reinvestment Act of 2009 can be found here.

In this round, Purdue University was awarded $12 million and HealthBridge, which covers Ohio, Kentucky and 19 southern Indiana counties, was awarded $9.7 million (corrected). Both groups are among 32 initial organizations tasked with developing regional extension centers (RECs).

The mission of RECs will be to help health professionals implement and use health information technology. RECs are expected to provide outreach and support services to 100,000 or more primary care providers and hospitals over a two-year period.

Mary Ann Sloan, director of Purdue’s Healthcare Technical Assistance Program, explained the grant funds will help them reach practices that don’t have access to the resources of larger health care systems and haven’t yet adopted electronic technology. “With this funding, we will help them select products and provide training on how to use the technology to its fullest potential to improve patient care.”

Cincinnati-based HealthBridge already has a partnership with Bloomington’s HealthLINC and the Indiana Health Information Exchange in Indianapolis. The three exchanges connect more than 15,000 physicians, 50 hospitals and 12 million patient records. As a result, physicians adopting EHR systems in the southern Indiana service area will automatically be connected to the health exchange.

“Our center will be unique in that we will be able to feed physician EHRs with external information. They won’t have to scan results into the EHR,” explained Trudi Matthews, director of Policy and Public Relations for HealthBridge.

Matthews said that HealthBridge would provide the same kind of EHR adoption assistance as Purdue; both plan kick offs in April.

“This grant gives us the opportunity to work with small practices of 10 or fewer doctors to achieve meaningful use,” noted Todd Rowland, M.D., executive director of HealthLINC. “Basically, the federal government is funding regional extension centers to help physicians get started, but this is strictly on a voluntary basis.”

Other grant funds are intended to help people acquire the skills needed for information technology jobs. In Indiana, Ivy Tech Community College and the Indianapolis Private Industry Council will receive about $5 million each to help with training and employment services particularly for careers in health care settings, including nursing.

What does this mean to you?

Regional extension centers will provide physician practices with on-site technical assistance to:

• Select a certified electronic health record (EHR) system
• Implement a system so it can be used effectively
• Enhance workflow in a way that improves the quality and value of care provided
• Comply with any legal or regulatory requirements in place to protect patient privacy and security

The education grants will assure there are enough skilled technology workers to provide the assistance needed for medical practices – here and nationwide.

Source ismanet.org