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Health Information Exchange Case Studies

Vendors and Communities Working Together: A Catalyst for Interoperability and Exchange

Through the Beacon Community-EHR Vendor Affinity Group [PDF - 1.29 MB] (AG), 17 Beacon Communities and 7 electronic health record (EHR) vendors are tackling some of the most pressing health IT-related issues impacting the ability to improve patient care and population health management.

The Challenges of Interoperability

Safely and securely exchanging protected health information among providers or organizations is critical to delivering coordinated, accountable, and patient-centered care, while achieving better health and better care at lower costs. The reality is, however, that patient records are often housed in disconnected and dissimilar electronic systems in varied settings across a community: offices of primary care and specialist physicians, clinics, hospitals, long-term care facilities, and home health agencies.

As pointed out in the 2012 Health Information Exchange (HIE) Market Report published by Chilmark Research , “The blame for the lack of true interoperability, however, does not truly rest with the vast majority of HIE vendors … and it is not because these ambulatory practices have not adopted an EHR … rather it is due to the lack of adoption and deployment of interoperability standards by many EHR vendors who service the ambulatory market. This continues to significantly delay the go-live of HIEs of all sizes, whether in the public market or private enterprise market, subsequently delaying time to value.”

Vendor Collaborators

  • NextGen
  • Greenway
  • Allscripts
  • GE
  • Vitera
  • Cerner
  • SuccessEHS

The Solution

To meet this challenge head on, and to address some of the technology-related difficulties in meeting aggressive program goals, Beacon Community awardees reached out directly to EHR vendors in November 2011. Within one month, seven vendors (NextGen, Greenway, Allscripts, GE, Vitera, Cerner and SuccessEHS) comprising approximately 45 percent of the market , and 12 Beacons formalized an Affinity Group and:

  • Defined the highest priority data elements needed to be exchanged in support of a limited number of focused use cases
  • Performed a technology assessment of where EHR vendors stood in terms of ability to produce these data elements
  • Reached consensus on how EHR vendors could best improve their respective versions of a Continuity of Care Document (CCD) to support Beacon efforts.

Today, the AG is working with more than 100 primary care practice sites nationwide to transition to a form of health information exchange where a consistent set of discrete and structured data are appropriately made available with minimum interruption to provider workflow.

Immediate benefits from this work include:

  • Moving the Information: Silos of patient information exist across communities making it nearly impossible for providers, payers, patients, and community-based caregivers to access the information they need when they need it; however, often the barriers to information exchange are not just technical. EHR systems need to support the provider’s workflow and enable patient information to move seamlessly, minimizing additional steps and/or clicks.
  • Creating Market Efficiencies: Countless one-off solutions to obstacles around interoperability brokered between single EHR vendors and single provider practices have created pockets of inconsistent, incomplete, and insufficient exchange across the country. New relationships between providers and their health IT vendors (perhaps replicating group purchasing organizations) need to be explored in order to rapidly achieve consistent approaches to common challenges faced in the field.
  • Taking Action: The inability to collect and present complete and actionable patient information from across the community often leads to inappropriate and/or unnecessary care, drives up the cost of the overall delivery system, and greatly inhibits efforts around quality improvement and population health management.
"With 50,000 office visits a month, the exchange of clinical data for our group was an overwhelming task in the paper world. Our first step was the implementation of a group-wide electronic health record. The next step in the process was the integration with a community based HIE through which we are beginning to exchange clinical information with the many health providers in our community. Data exchange is not an end in itself, the data must be comprehensive, timely and patient-specific to be valuable. CCD-based data exchange meets these criteria. I feel medicine has entered a new era with potential that few have yet to realize. I am once again excited to watch as my practice evolves and my patients experience proactive evidence driven healthcare from my office."

- Jeffrey Galles, DO, Chief Medical Officer
Oklahoma Physician Group/Utica Park Clinic

Benefits to Physicians

In their recent report, Clinician Perspectives on Electronic Health Information Sharing for Transitions of Care , the Bipartisan Policy Center calls out that a clear majority of the clinicians surveyed believe that the electronic exchange of health information across settings will have a positive impact on improving the quality of patient care (80%), the ability to coordinate care (80%), and the ability to meet the demand of new care models, such as patient-centered medical home and accountable care (78%). The successful implementation, adoption, and interoperability of health IT and EHRs through the AG pilots will lead to:

  • Information flow at the right place and the right time – Needed to achieve the objectives of Patient Centered Medical Homes (PCMH), Meaningful Use (MU), and Accountable Care Organizations (ACOs).
  • Seamless transitions in care – Absence of important care transition information becomes a barrier to effective and efficient care for patients accessing services across the community.
  • Time savings – Ambulatory practices continue to have additional non-clinical tasks added to their workday. In order to assure that critical patient information is made available to other members of the care delivery system, sharing that information must be easy and integrated into the practice’s workflow.
  • Improvements in quality and lowering the cost of patient care – Access to aggregated patient information and community registries enables the proactive management of chronically-ill patients, reduces duplicative testing, and creates a safer and more efficient healthcare system overall.

Outcomes and Next Steps

As of May 2012, participating EHR vendors had nearly the entire Beacon consensus data set in production and are able to automatically send the electronic patient summary to an HIE to support a patient referral and/or the populating of a community registry or data repository. These product enhancements make the EHR a resource of important information from which the entire provider community can benefit, shifting away from use as a tool leveraged just in a single provider site. The AG has achieved an unprecedented level of consensus on the use of health IT in facilitating management of an entire community’s health and has brought upgrades to EHR technology in the most expedited and economical manner.

Prior to the AG pilot implementation, staff from several of the health information exchanges that existed before the Beacon Community Program, often commented that their ability to present a comprehensive longitudinal patient record was significantly compromised by their inability to extract structured data out of primary care practices’ EHR systems. In fact, the typical standard set of data flowing from primary care was a free text blob which made it difficult for providers viewing information through the HIE to easily glean a complete view of a patient’s status and best assess what was needed at the point of care.

David Groves, VP for Grant Programs and Executive Director of the Tri-State Regional Extension Center at HealthBridge, recently stated, “In all of Cincinnati, the affinity group pilots around CCD-enabled exchange will represent the ONLY instances in which structured data is being shared across disparate primary care EHR platforms. This work moves well beyond the current reality of human readable patient summary documents and pushes the ball significantly down the court toward true interoperability.”

Twenty CCD-enabled exchange pilots are live across six Beacon Communities and four vendors, and an additional 15 pilots are scheduled to go live by the end of 2012. These pilots will serve as repeatable examples for other Beacon Communities and other communities across the nation and position practices to implement the refined aspects of interoperability called out in Meaningful Use Stage 2. Although launched in advance of the final Stage 2 rule, the C83 patient summary document specified through the AG supports 21 of the 36 data elements required via the consolidated CDA specified in Stage 2. Clearly, providers who are quick to adopt the approach supported through the work of the AG will be well positioned to meet many of the implementation challenges related to the standards around interoperability found in Stage 2 Meaningful Use.

The AG has also drafted two documents, which will be finalized in the coming months:

    • Post-Live Implementation Playbook: Achieving Meaningful Use and Preparing for Health Information Exchange – This playbook offers next steps and information to adopt best practices and to support providers and organizations that have adopted EHR technology, and are looking for what is next. Additionally, the playbook provides an overview of how to achieve MU, process adjustments for organizations and providers to consider when contemplating next steps for HIT/workflow integration, as well as information on interoperability. Examples are included to illustrate real-world examples of EHR implementations and working with vendors.
    • Glide Path from HITSP C83 to C-CDA: Informed Decision Making for Health Information – The purpose of this document is to provide a straightforward summary of the history and current state of standards and specifications for clinical document exchange in health care, the implications that Stage 2 Meaningful Use will have on prior interoperability work efforts, and guidance to health IT decision makers and implementers on a pathway to use new standards promoted by Centers for Medicare and Medicaid Services and Office of the National Coordinator for Health IT (ONC).
    • Subsequent efforts of the AG collaboration will result in both a more expansive data set to be regularly included in the vendors’ patient summary clinical documents, and closer alignment with the ONC’s Standards & Interoperability Framework around content and transport. More vendors will be sought to embed technologies in their products that will make sharing and accessing patient health information by providers easier in the future. This group is also working to ensure alignment with Stage 2 Meaningful Use and use pilot findings to inform discussions around Stage 3 Meaningful Use.
  1. CapSite for Healthcare, CapSite 3rd Annual U.S. Ambulatory EHR & PM Study, June 2011.