Health Information Exchange Organizations - Essay Example

Health Information Exchange Organizations Introduction Healthcare practitioners acknowledge that having full information on a patient during the point of care is crucial for effective and efficient medical care. In view of this, policy makers, researchers and healthcare experts recognize health information exchange (HIE) as a key element in improving patient care (Brailer, 2005; Acker et al, 2007; Hripcsak et al, 2007; eHealth Initiative, 2005). Finn (2011) defines health information exchange (HIE) as the making available of health-related patient information electronically between different organizations found in a region or community. It allows the electronic sharing of health information between different health information systems while maintaining the integrity of the information being passed across. HIEs connect healthcare providers such as hospitals, pharmacies, labs, ER physicians to access patient information in a resourceful manner to improve the quality of care. HIE also refers to those organizations that facilitate the electronic sharing of health information across systems and organizations. HIE organizations manage and provide support for the commercial and legal issues that can arise during the exchange of information. These organizations come in several forms and may be private, national or state firms; information can thus be shared only with a single hospital network, across many hospitals in one region or across the state. Another difference between the different HIE organizations is seen in what information is shared e.g. some may share only lab results, or only emergency room records. HIE organizations are key to facilitating the implementation of health information technology to provide quality patient care. In the United States, a number of such organizations exist that perform several important functions. In this discourse, we will examine the Indiana Health Information Exchange. By exploring the profile of this HIE organization; the author aims to show the core capabilities of this technology, the importance of electronic information systems and the necessity of understanding that technology. Indiana HIE The Indiana Health Information Exchange (IHIE) is one of the largest HIE in the United States, and also the oldest. It is a non-for-profit organization that connects more than 80 hospitals and over 19,000 doctors in Indiana, including long-term care facilities and rehabilitation centres to share health information on more than 10 million patients as and when needed (Finn, 2011; Biever, 2013). The organization administrates the Indiana Network for Patient Care (INPC), which is a protected network that shares electronic health records to involved physicians and other healthcare providers. Launched by the Regenstrief Institute (which specializes in medical informatics research), local hospitals and other partners, IHIE provides useful health information technologies and tools to patients in Indiana as it aims to mitigate the high costs of quality healthcare. For instance, if a patient is admitted to a hospital, the INPC presents a clinical abstract of the patient’s medical history-provided the patient had ever visited a networked hospital- even if the patient has never received treatment from that hospital before. This saves time in treatment and avoids duplicate testing thus saving costs. The INPC contains records of more than 80% instances of medical care provided within participating hospitals. Additionally, it also holds radiology images, discharge summaries, operative notes, pathology reports and medication records. This wide range of information enables doctors to make informed and accurate medical decisions, especially during critical times. Figures 1.1 and 1.2 below show how IHIE improved information flow. Figure 1.1: Former system which fragmented patient information and created redundant, inefficient efforts Source: Indiana Health Information Exchange Figure 1.2: HIE system that consolidates information and provides a foundation for unifying efforts Source: Indiana Health Information Exchange With respect to legislation passed in 2009 (Blumenthal, 2009) on provision of incentives to hospitals and physicians who adopt and meaningfully use electronic health records (EHRs), IHIE has managed to overcome the potential challenges for hospitals involved in meeting the set criteria for meaningful use. Of the 3 set criteria outlined by the government for meaningful use, namely:- Electronic prescribing with decision support Automated quality measurement Health information exchange (Blumenthal & Tavenner, 2010); it is worth noting that IHIE provides a network that meets all criteria. The success of this HIE can be attributed to its vision and ability to provide benefits to providers which encouraged community participation. The benefits it provides include:- Workflow efficiency through interoperability IHIE has improved access to test results and information on patients from outside the healthcare facility to save time on duplicate tests and referral procedures and also reduce costs. Timely access to health information from outside the practice is of great benefit in giving quality care (Adler-Milstein et al, 2008; Terry 2006). Improved quality of patient care The vast information resources from various healthcare facilities available on IHIE have aided in the prevention of errors e.g. medication errors (Marchibroda, 2008; Simon et al, 2008). This HIE has facilitated better patient outcomes, reduced prescribing errors and better disease management. Privacy and security IHIE takes into consideration patient concerns about the privacy of their personal health records (PHRs). As such, only users with authorized access can access the HIE, and for physicians, such access is allowed in critical events e.g. admittance to the emergency section. Access to patient records is also strictly monitored and is determined by the patient level e.g. emergency department, inpatient or outpatient in order to maintain patient confidentiality. The organization observes the privacy and security standards set by the Health Insurance Portability and Accountability (HIPPA). Access to the network is only possible by authorized users, who have to use passwords and use authorized computers that have also been authorized by member organizations to hold and view patient information (Biever, 2013). In addition, the organization also offers secure messaging service called Docs4Docs which allow doctors to get lab, radiology and pharmaceutical information from multiple sources and locations in a timely manner. EHR Functionality Standards and Certifications In implementing health information technologies, such as electronic health records (EHRs), it is essential that those systems and tools are secure, can maintain data integrity and enable interoperability with other information systems in order to share information and perform effectively. In a move to promote adoption of EHRs by practitioners and healthcare providers, the government passed legislation in 2009 to offer more than $30 billion incentive payments to those doctors and healthcare facilities that adopted and made meaningful use of electronic health record systems (Blumenthal, 2009). To carry out this law, the US Department of Health and Human Services (HHS) issued a number of regulations and standards. These included regulations to define what meaningful use entailed and policy to give certain organizations authority to give certifications to EHRs that complied with government standards. Hospitals and doctors who used certified EHRs could then benefit from the meaningful use incentive payments. Therefore, adoption of any EHR should be assisted by informed awareness of required functionality standards and certification criteria to guide the selection process. Standards and certification facilitate the meaningful use of EHRs through interoperability, usability and security of health information.  The Certification Commission for Healthcare Information Technology (CCHIT) was the first organization authorized by the federal government to issue certification to those EHRs that met the standards of meaningful use. In order to get CCHIT certification, EHR products should meet the following criteria (CCHIT, n.d.):- a) Functionality The EHR should demonstrate the ability to create and manage electronic records of all of a facility’s patients and also automate various tasks of the office. CCHIT uses about 350 functionality criteria to test an EHR. The areas considered include:- How the EHR organizes patient data-medical history, operational notes, personal information Making lists-medication, allergies, diagnosis Recording and retrieving information- test results, medical history, from other sources outside the practice Placing orders-generating medication and lab tests Value- added tasks-alerts, reminders Managing workflow- automating routine tasks b) Interoperability To meet basic CCHIT standards for this, EHR products should be able to send and receive all types of medical information from other actors in the healthcare field through connectivity to other health information systems. It should facilitate access to accurate lab test results from outside sources, allow e-prescriptions, and allow outside exchange of patient health information. These represent the most important medical activities carried out by doctors and can thus improve patient care. c) Security EHR products should provide sophisticated technical abilities to maintain the security and confidentiality of patient information. CCHIT has 50 security criteria, and an EHR must meet all of them to get certified. These criteria include:- User authentication Controlled user access Reviewing access and use of patient records Encrypted data transfer Data recovery protection Additionally, there are many more standards applicable to health systems and health data operations. Table 1below gives examples of important ones to consider in choosing an EHR. Table 1: Standards for Transaction Standard Meaning Comment Message Formats HL7 Health-Level Seven X12 (or ANSI ASC X12) Official designation of the U.S. national standards body for the development and maintenance of Electronic Data Interchange (EDI) standards A family of standards used in many aspects of health data exchange NCPDP National Council for Prescription Drug Programs Includes many XML standards for healthcare and insurance DICOM Digital Imaging and Communication in Medicine Standard for handling, storing, printing, and transmitting information in medical imaging. Both a transaction and a semantic standard. IHE Integration Profiles Integrating the Healthcare Enterprise Integration Profiles IHE developed a family of interoperability profiles by utilizing HL7 standards for specific purposes. HITSP Interoperability Specifications Health Information Technology Standard Panel HITSP has developed a whole system of specifications including creating processes to harmonize standards, certify EHR applications, develop nationwide health information network prototypes and recommend necessary changes to standardize diverse security and privacy policies. CDA Clinical Document Architecture XML-based “standard” intended to specify the encoding, structure and semantics of clinical documents for exchange CCR Continuity of Care Record Patient health summary standard developed by ASTM, several medical societies and a number of vendors. CCD Continuity of Care Document XML-based markup “standard” intended to specify the encoding, structure and semantics of a patient summary clinical document for exchange. The CCD specification is a constraint on the HL7 CDA (further limits it). HITSP has selected the CCD (not the CCR). Message Transport SOAP Simple Object Access Protocol Protocol specification for exchanging structured information in the implementation of Web Services in computer networks. Used with XML. XML Extensible Markup Language Data exchange language using tags to designate variables. Simple and powerful. Source: Healthcare Information and Management Systems Society (HIMSS, 2009) Hawaii Pacific Health The Health Information and Management Systems Society (HIMSS) awarded Honolulu-based Hawaii Pacific Health (HPH) the 2012 Enterprise HIMSS Davies Award of Excellence (Mianos, 2012). Similar to Indiana EHI, it is a nonprofit organization that is Hawaii’s largest healthcare provider. Hawaii Pacific Health manages 4 hospitals, 49 outpatient clinics and over 1300 practitioners in the region (Boeke, 2013). It is a leading adopter of health information technologies and is ranked among the top hospitals in the nation to adopt EHR to their healthcare delivery. In April 2007, after a negative healthcare services review in the Honolulu Advertiser, HPH set out to roll out major improvements in its processes. The board of the healthcare system set ambitious goals to achieve 100% on its Core Measures of providing quality care in heart-related illnesses, pneumonia, surgical care, perinatal care and paediatric asthma care utilising a pilot EHR that was mainly an electronic surveillance system and later expanding its scope to infection prevention (Ashton, n.d.). The investment of HPH in EHR has been the foundation of it reaping several benefits. These benefits include:- Workflow efficiency HPH implemented an EHR system that coordinated its various departments such as radiology, pharmacy, patient management systems, accounting and scheduling. Doing so enabled it to reduce its support staff and thus cut costs. Before implementing the EHR, HPH had been losing money in write-offs that were mainly from workflow inefficiencies and this reduced significantly after they introduced the EHR (Boeke, 2013). Quality patient care The EHR improved all facets of the healthcare system greatly (HPH, n.d.). The EHR’s features such as electronic dashboards, alerts, disease management, surveillance and scheduling made positive changes to the level of patient care. Medical care improved in quality in areas such as cancer screening, central line infections and diabetic care. Notably, it was observed that doctors tended to forget that patients had urinary catheters placed and through the EHR reminders catheter-associated infections reduced. The system also allowed patients to participate in healthcare measures. They could access their lab test results, appointment schedules and other reminders or even communicate with their healthcare providers which aided a lot in improving healthcare (Ashton, n.d.). This patient-centred approach is a unique model of HPH that contributed to its success. Meaningful Use Incentives The successful implementation of a patient-centred EHR in HPH saw its medical care improve greatly, and also generate considerable revenue in stimulus funds and avoidance of unnecessary costs such as write offs, late charges or filing late claims. The EHR has enhanced efficiency and effective service delivery. In the year 2011, net revenue was $850, 550 and in 2012, it netted at almost $2.6 million (Fratt, 2013). References Ashton M. (n.d). HIMSS Davies Enterprise Application. Hawai‘i Pacific Health. Retrieved on March 13 2013 from http://apps.himss.org/davies/docs/HPH_CaseStudy_2_Clinical_Value.pdf Boeke E. (January 15, 2013). Does implementing health IT add value? Retrieved on March 13 2013 from http://blog.himss.org/2013/01/15/does-implementing-health-it-add-value/ Fratt L. (March 05 2013). HIMSS: EHR delivers ROI & population health for Davies award winner. Retrieved March 13 2013 from, http://www.clinical-innovation.com/topics/ehr-emr/himss-ehr-delivers-roi-population-health-davies-award-winner?page=0%2C1 Mianos D. (September 13, 2012). Hawai'i Pacific Health lands Davies Award. Healthcare IT News. Retrieved March 13 2012 from, http://www.healthcareitnews.com/news/hawaii-pacific-health-lands-davies-award Blumenthal D. (2009). Stimulating the adoption of health information technology. New England Journal of Medicine, 360:1477-1479[PMID:19321856] CCHIT (n.d.). CCHIT Certification – what does it require? Retrieved March 13 2013, from http://mycourses.med.harvard.edu/ec_res/nt/930820C0-27CB-4D8D-92CA-C5C152738BD9/cchit.pdf Healthcare Information and Management Systems Society (2009). A HIMSS guide to participating in a health information exchange. HIMSS Healthcare Information Exchange, HIE Guide Work Group White Paper. 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