Using HIE for Enhancing Healthcare

Using HIE for Enhancing Healthcare

By Deborah E Hammond, VP & Medical Director, Healthfirst

Deborah E Hammond, VP & Medical Director, Healthfirst

I am a physician leader for Healthfirst and the executive sponsor for our health information exchange (HIE). For the past 35 years, I’ve created opportunities for people to obtain needed care and advance their health.

In that time, my central focus has remained the same: Ensure the delivery of timely, succinct, focused information into the hands of either the doctor or healthcare professional at the point-of-care. I have found this improves the dialogue with the patient, and leads to improved prevention, diagnosis, and treatment actions.

My company, Healthfirst, is a not-for-profit, provider-sponsored health insurance company that serves more than 1.2 million members in downstate New York.

"By partnering with all the individuals and entities that play a role in the delivery of care, you can help us achieve better outcomes"

As a health insurer that is uniquely linked to our healthcare providers and our community, we strive to provide affordable government-sponsored and commercial health plans that offer the best quality and experience of care in our market in a way that sustains both the company and the regional delivery system.

Our unique model relies on population health management efforts by our hospital partners and provider network. They participate in a risk sharing financial structure, with funds saved through higher quality and better care management returned directly to the provider delivery system.

We focus on population health activities to advance healthcare outcomes for our members via the sharing of information with our doctors, hospitals, and other providers. Our strategy is to phase out legacy methods of sharing data and clinical information (e.g., spreadsheets, faxes, etc.) about a member through the continued implementation of our HIE and the Healthfirst system infrastructure.

Using InterSystems’ HealthShare platform, Healthfirst has established a private electronic Health Information Exchange (HIE) to facilitate the bi-directional, timely, and efficient exchange of clinical information about our members with our hospital partners and providers. HealthShare’s ability to capture the HL7 standard Admission, Discharge and Transfer (ADT) events, scheduling events and the XML based markup standard Clinical Data Architecture (CDA) documents and combine these with X12 EDI based health plan data allows our partners to share information in real time or near real time to enhance care coordination, quality activity and improve the operational efficiency of cross organizational processes.

The initial use cases for our HIE include:

•Clinical data for HEDIS and other quality measures
•ADT and clinical event notices for enhanced care coordination
•Exchange of pharmacy data
•Sharing of laboratory results from reference labs to providers
•Sharing of claim and encounter data with providers taking risk
•Coordinating urgent clinical actions (real-time) between the provider and Healthfirst staff

Healthfirst and our hospital partners use our HIE data to identify people at risk for admission with prospective and concurrent action such as arranging for discharge from the emergency room to the home-based services (instead of admission). We collaborate with our partner hospitals to fuel innovation integrating mobile applications into end-to-end care workflows. We provide key clinical data such as pharmacy services and non-financial claim and encounter data to provide a single view of a member’s care over time.

What can technology leaders do for us? As an organization on the forefront of using HIE and technology to impact service at the point of care for a member, Healthfirst sees a significant gap. Too many of the proposed technology solutions for managing healthcare do not consider each part of an end-to-end process that takes the member from the first steps of accessing care to the follow-up after the episode of care. The designs tend to lack a complete pathway of practical use that includes each provider, person or organization (including the managed care organization where applicable) who has to do something to facilitate the patient’s care. I would urge you to spend more time gathering the business needs for each participant in the process to design step-by-step processes that more closely meet their needs.

Other priorities include:

•Aggregating disparate and overlapping sources of clinical information and dynamically teasing out and presenting the most important data at the point-of-service for a particular scenario of care;
•Solving the problem of alert fatigue from indiscriminate notices which desensitizes doctors and providers and increase risks for patients;
•Integration of approved validation methods for EHR data for use in standard measures such as HEDIS and Stars to decrease manual review of clinical information; and
•Advancement of standard two-directional formats for complex processes such as care management which requires collaboration across many parties.

As regulatory and market needs continue to transform healthcare, and as we move toward a value-based model that demands clinicians to have a more complete view of their patients, it is vital that we improve the ways we share data. By partnering with all the individuals and entities that play a role in the delivery of care, you can help us achieve better outcomes and better satisfaction for the people we serve.

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