HIEs innovate around providers' lack of standards

By Mary Mosquera
03:01 PM
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Inland Northwest Health Services has been exchanging information for 15 years one way or another, and as it tries to ramp up the degree and efficiency of sharing information, the hurdles erected by disparate systems and a lack of standardization have made it time-consuming to establish itself as a unique regional information hub.

Inland, which serves the eastern Washington and northern Idaho region and is also a “beacon” or healthcare model community, has concentrated on integrating the various vendor systems of participating providers and moving away from costly interfaces and provider-specific data towards a population care approach to share the data, said Tom Fritz, CEO of Inland Northwest Health Services.

The goal now is to support common metrics and secure care coordination. “In the year since we’ve been a beacon, we’ve analyzed 130,000 patient records and built integration with physician practices,” he said. 

Inland offered its experiences to describe the practical barriers that health information exchanges (HIE) face in an April 2 webinar sponsored by the National eHealth Collaborative to support its report, “Health Information Exchange Roadmap: The Landscape and a Path Forward.”

NeHC is a public-private partnership that advocates for secure and interoperable nationwide health information exchange. NeHC plans to launch the HIE Learning Network to collect and share the knowledge and experience of current exchanges “to help those that may not be as far along to avoid some of the pitfalls that others have gone through and for networking and to learn from each other,” said Kate Berry, NeHC CEO.

[Related: ONC to stand up NwHIN-Exchange as non-profit HIE in October.]

Inland’s Fritz said that integrating outpatient clinical data from primary care physician offices has been difficult. Providers have implemented and customized electronic health records (EHRs) “in a thousand different ways with no standardization of data sets and data definitions," he said. "So it’s taken us longer to figure out how to map that data to assure data integrity and the ability to do something from the perspective of population health."

To overcome the hurdle, Inland has developed a software package that enables analytics, tracking specific care management pathways for patients and exchanging patient information with the providers that are taking care of the patient.

Fritz also learned that many providers’ view of their clinical care practices as being state of the art care pathways and evidence-based protocols was, in reality, often not the case. So Inland wants to build those standard care practices into the HIE.

Laura Adams, CEO of the Rhode Island Quality Institute, said that “our challenges and opportunities overlap about 80 percent with Inland’s, even though we’re across the country from each other.”

Adams described how Rhode Island worked around providers’ lack of experience to supply patient analytics using Direct Project or secure messaging.

“We know how difficult it is for provider offices to use their EHRs in an optimal format,” she said, adding that many practices don’t know how to generate a report out of their EHRs and need assistance.

“We’re not going to achieve transformation very quickly unless we can lift that data to the HIE, and we use Direct to do that,” Adams said.

The process that the Rhode Island HIE uses is that a line of embedded code is triggered, for instance, when the EHR closes and locks a document. Behind the scenes, Direct will send that data to the HIE if the patient has consented.

“Once we have a number of clinical care data coming from a practice, we are able to do analytics on their own patients and help them to look at that data in standard and creative ways to provide reports,” she said. Direct gets the information out of the EHR up into the HIE to a sophisticated analytics platform that then sends the information back to the practice via Direct, which notifies the provider.