Pam Matthews, RN, MBS
Electronic health information exchange (HIE) continues to grow, but only in certain areas of the country and only within certain health systems and practices, according to a forum recently held in Chicago by The Association of Community Cancer Centers (ACCC) Institute for the Future of Oncology. The Institute convened to explore key issues impacting community cancer centers with HIE systems and to gain perspective on how to help community cancer centers better meet the challenges facing the oncology community.
While ACCC stakeholders believe that HIEs have the potential to improve patient care, reduce duplication of services, lower costs, and improve quality of care, the oncology community is experiencing “uneven adoption” of HIEs across the country.
An HIE is a technology platform that allows for the electronic exchange of data in a secure manner, where patient information can be accessed when it is needed across organizational, vendor, and geographic boundaries. An HIE can include services such as physician web portals, patient health records, clinical messaging, and data exchange from electronic medical records or electronic health records, among others. However, the Institute reports that surprisingly, many within the oncology care community are unaware of the opportunities or services that HIEs offer.
ACCC experts report that practices implementing HIEs are benefitting from their use. For example, at the conference one provider who represents a large private practice with 6 locations and participates in an HIE service that serves the Midwest area said that they have a network that stores data, text, images, and voice dictation from provider sources. The sources include inpatient and outpatient lab results, radiology reports, discharge summaries, and any other hospital surgeries or emergency services provided to the patient. The information automatically feeds into the practice’s EMR. In turn, the practice distributes the information to the HIE, lab reports, radiology reports, and other pertinent patient information. In this respect, the HIE becomes an integration engine.
If the practice sends patients to a tertiary center, that center can upload directly from the practice’s EMR. “If one of our patients walks into the emergency department (ED), their system queries anything done in the last 90 days from a provider in the exchange,” the provider indicated. The system informs the ED what scans have been done, and which labs were done. This rich exchange of information results in the potential for elimination of duplicative tests, which reduce costs, which is in everybody’s favor.
Other benefits of HIE participation include information being made available to a practice as it is being transcribed at the hospital, lab, or imaging center; clinical information such as physician notes and treatment medication are included, as are notes concerning phone messages and alerts for medication refills. The HIE also helps to streamline processes and conduct internal benchmarking.
Benchmarking elements such as hospitalization rates of a practice’s patients receiving chemotherapy versus oncology medical home metrics can be achieved through an HIE. Every ED visit and hospitalization is captured and the reason for the visit is documented. As payment models shift to value-based from volume-based, benchmarking becomes an increasingly important tool in demonstrating cost-effective, quality care for oncology practices.
One Size Does Not Fit All
However, there is currently no single dominant HIE model in place: private institutions, such as hospitals, have developed their own HIEs, and some HIEs are developed for public use. In addition, the ACCC panel finds there is geographical variance in availability of HIEs, how they work, the services they provide, and their cost. HIEs are market driven, so providers need to identify HIE options available within their geographic region. According to a forum participant, Pam Matthews, RN, MBS, of the Healthcare Information and Management Systems Society, “What works in one state may not work in another.
“Quite a few pockets across the country do not have access to HIEs. Some states only have 1 viable HIE in the state. Others may have a statewide HIE with several regional HIEs.
Several states have HIE network-to-network availability where several HIE networks tie into a larger one. Some HIEs may offer a wide variety of exchange services; some may offer much less,” said Matthews. The goal, she said, is to freely exchange data across multiple organizations, regardless of politics or the market.