Defining a Health Information Exchange
The united states is facing the largest scarcity of healthcare practitioners in our place’s history which is compounded by an rising geriatric population. In 2005 there existed จัดฟัน one geriatrician for every 5, 000 US residents over 65 and only nine of the 145 medical schools trained geriatricians. By 2020 the is estimated to be short 200, 000 medical professionals and over a million nurses. Never, in the history of us healthcare, has so much been demanded with so few personnel. Because of this scarcity with the geriatric population increase, the medical community has to find a way to provide timely, accurate information to those who want it in a uniform fashion. Imagine if flight controllers mention the local language of their country rather than the current international flight language, English. This example captures the emergency and critical nature in our need for standard communication in healthcare. A healthy information exchange can help improve safety, reduce time hospital stays, eliminate medication errors, reduce redundancies in lab testing or procedures and make the health system faster, thinner and more productive. The aging US population along with those impacted by chronic disease like diabetes, heart problems and asthma will need to see more specialists who will have to discover a way to communicate with primary care providers effectively and efficiently.
This efficiency can only be attained by standardizing the manner in which the communication occurs. Healthbridge, a Cincinnati based HIE and one of the largest community based networks, could reduce their potential disease episodes from 5 to 8 days down to twenty four hours with a regional health information exchange. Regarding standardization, one author noted, “Interoperability without standards is like language without sentence structure. In both cases communication may be accomplished but the process is cumbersome and often ineffective. inch
United states retailers transitioned over two decades ago in order to automate inventory, sales, accounting controls which all improve efficiency and effectiveness. While uncomfortable to consider patients as inventory, perhaps it’s been the main reason for the lack of changeover in the primary care setting to automation of patient records and data. Imagine a Mom & Pop hardware store on any sq in mid America packed with inventory on shelves, ordering duplicate widgets based on lack of information regarding current inventory. See any Home Depot or Lowes and you get a view of how automation has changed the retail sector in terms of scalability and efficiency. Maybe the “art of medicine” is a barrier to more productive, efficient and better medicine. Standards in information exchange have existed since 1989, but recent interfaces have evolved more quickly thanks to increases in standardization of regional and state health information transactions.
History of Health Information Transactions
Major urban centers in The us and Australia were the first to successfully implement HIE’s. The success of these early networks was associated with an integration with primary care EHR systems already in place. Health Level 7 (HL7) represents the first health language standardization system in the united states, beginning with a meeting at the University of Philadelphia in 1987. HL7 has been successful in replacing antiquated connections like faxing, mail and direct provider communication, which regularly represent copying and inefficiency. Process interoperability increases human understanding across networks health systems to integrate and communicate. Standardization will ultimately impact how effective that communication functions just as that sentence structure standards foster better communication. The united states National Health Information Network (NHIN) sets the standards that foster this delivery of communication between health networks. HL7 is now on it’s third version which was published in 2004. The goals of HL7 are to increase interoperability, develop coherent standards, educate the on standardization and team up with other sanctioning bodies like ANSI and ISO who are also concerned with process improvement.
In the united states one of the earliest HIE’s started in Portland Maine. HealthInfoNet is a public-private partnership and is considered the largest statewide HIE. The goals of the network are to improve patient safety, enhance the standard of clinical care, increase efficiency, reduce service copying, identify public dangers more quickly and expand patient record access. The four founding groups the Maine Health Access Foundation, Maine CDC, The Maine Quality Forum and Maine Health Information Center (Onpoint Health Data) began their efforts in 2004.
In Tennessee Regional Health Information Organizations (RHIO’s) initiated in Memphis and the Attempt Cities region. Carespark, a 501(3)c, in the Attempt Cities region was considered a primary project where physicians interact directly with each other using Carespark’s HL7 compliant system as an intermediary to translate the data bi-directionally. Veterans Affairs (VA) clinics also played an important role in the first stages to build this network. In the delta the midsouth eHealth Alliance is a RHIO connecting Memphis private hospitals like Baptist Commemorative (5 sites), Methodist Systems, Lebonheur Healthcare, Memphis Children’s Clinic, Saint. Francis Health System, Saint Jude, The Regional Hospital and UT Medical. These regional networks allow practitioners to share with you medical records, lab values medicines and other reports in a extremely effective manner.
Seventeen US communities have been designated as Beacon Communities across the united states based on their development of HIE’s. These communities’ health focus varies based on the patient population and prevalence of chronic disease states i. e. cvd, diabetes, asthma. The communities focus on specific and measurable improvements in quality, safety and efficiency due to health information exchange improvements. The nearest geographical Beacon community to Tennessee, in Byhalia, Mississippi, just south of Memphis, was granted a $100, 000 grant by the department of Health and Human Services in September 2011.
A healthcare model for Nashville to imitate is found in Indianapolis, IN based on geographic distance, city size and population demographics. Four Beacon awards have been granted to communities close by Indianapolis, Health and Hospital Corporation of Marion Local, Indianapolis Health Centers Inc, Raphael Health Center and Shalom Health care Center Inc. In addition, Indianapolis Health Information technology Inc has received over 12 million dollars in grants through the State HIE Cooperative Agreement and 2011 HIE Challenge Grant Supplement programs through the government. These awards were based on the following criteria: 1) Achieving health goals through health information exchange 2) Improving long term and post serious care transitions 3) Consumer mediated information exchange 4) Enabling enhanced query for patient care 5) Encouraging distributed population-level analytics.
Regulatory Facets of Health Information Transactions and Healthcare Reform
The department of Health and Human Services (HHS) is the regulatory agency that oversees health issues for all Americans. The HHS is divided into ten regions and Tennessee is part of Region INTRAVENOUS headquartered out of Atlanta. The Regional Director, Anton J. Gunn is the first Charcoal selected to serve as regional director and brings a wealth of experience to his role based on his public service specifically regarding underserved healthcare patients and health information transactions. This experience will serve him well as he encounters societal and market challenges for underserved and chronically ill patients throughout the southeast area.
The National Health Information Network (NHIN) is a division of HHS that guides the standards of exchange and governs regulatory facets of health reform. The NHIN collaboration includes sectors like the Center for Disease Control (CDC), social security administration, Beacon communities and state HIE’s (ONC). 11 A cubicle of National Coordinator for Health Information Exchange (ONC) has honored $16 million in additional grants to encourage innovation at the state level. Innovation at the state level will ultimately lead to better patient care through discounts in replicated tests, links to care programs for chronic patients leading to continuity and finally timely public health alerts through agencies like the CDC based on this information. 12 The health Information technology for Economic and Clinical Health (HITECH) Act is funded by dollars from the American Reinvestment and Recovery Act of 2009. HITECH’s goals are to invest dollars in community, regional and state health information transactions to build effective networks which are connected across the country. Beacon communities and the Statewide Health Information Exchange Cooperative Agreement were initiated through HITECH and ARRA. To date 56 states have received grant awards through these programs totaling 548 million dollars.
History of Health Information Partnership TN (HIPTN)
In Tennessee the health Information Exchange has been slower to advance than places like Maine and Indianapolis located in part on the diversity in our state. The delta has a vastly different patient population and health network than that of middle Tennessee, which differs from eastern Tennessee’s Appalachian region. In May of 2009 the first steps were taken to build a statewide HIE consisting of a non-profit named COOL TN. A board was established at this time with an operations local authority or council formed in November. COOL TN’s first initiatives involved connecting the work through Carespark in northeast Tennessee’s s tri-cities region to the Midsouth ehealth Alliance in Memphis. State officials estimated an expense of over 200 million dollars from 2010-2015. The venture involves stakeholders from medical, technical, legal and business backgrounds. The governor this season, Phil Bredesen, provided 15 million to match federal funds in addition to giving an Executive Order establishing a cubicle of eHealth initiatives with oversight by the Office of Administration and Finance and sixteen board members. By 03 2010 four workgroups were established to pay attention to areas like technology, clinical, privacy and security and sustainability.
By May of 2010 data sharing agreements were in place and a production preliminary for the statewide HIE was initiated in August 2011 along with a Ask Proposal (RFP) which was posted out to you to over forty vendors. In Come early july 2010 a 5th workgroup, the consumer advisory group, was added and in September 2010 Tennessee was alerted that they were one of the first states to have their plans approved following a release of Program Information Notice (PIN). Over fifty stakeholders came together to gauge the seller demonstrations and a contract was signed with the chosen vendor Axolotl on September 30th, 2010. At that time a production goal of Come early july 15th, 2011 was decided and in Economy is shown 2011 Keith Cox was hired as COOL TN’s CEO. Keith brings twenty six years of stint in healthcare IT to the collaborative. His previous interests include Microsof company, Bellsouth and several entrepreneurial efforts. COOL TN’s mission is to improve access to health information via a statewide collaborative process and provide the structure for security in that exchange. The vision for COOL TN is to be thought to be a situation and national leader who support measurable improvements in clinical quality and efficiency to patients, providers and payors with secure HIE. Robert S. Gordon, the board chair for HIPTN states the vision well, “We share the view that while technology is a critical tool, the primary focus is not technology itself, but improving health”. COOL TN is a not for profit, 501(c)3, that is solely reliant on state funding. It is a combination of centralized and decentralized buildings. The key vendors are Axolotl, which acts as the patio umbrella network, ICA for Memphis and Nashville, with CGI as the vendor in northeast Tennessee. 15 Future COOL TN goals will include a gateway to the National Health Institute planned for late 2011 and a clinician listing in early 2012. Carespark, one of the original regional health exchange networks voted to cease operations on Come early july 11, 2011 based on lack of financial support for it’s new structure. The data sharing agreements included 38 health organizations, nine communities and two hundred and fifty volunteers. 16 Carespark’s closure details the need to build a network that’s not solely reliant on public grants to invest in it’s efforts, which we will discuss in the final section of this paper.
Current Status of Healthcare Information Exchange and HIPTN
Ten grants were honored in 2011 by the HIE challenge grant supplement. These included initiatives in eight states and serve as communities we can look to for guidance as COOL TN evolves. As previously mentioned one of the most honored communities lies less than five hours away in Indianapolis, IN. Based on the similarities in our health communities, patient populations and demographics, Indianapolis would provide an excellent mentor for Nashville and the hospital systems who serve patients in TN. The Indianapolis Health Information Exchange has been recognized across the country for it’s Docs for Docs program and the manner in which collaboration has had place since it’s pregnancy in 2004. Kathleen Sebelius, Assistant of HHS said, “The Central Indianapolis Beacon Community has a level of collaboration and the ability to organize quality efforts in an effective manner from its history to build long standing relationships. We are thrilled to be working with a residential area that is far ahead in the use of health information to bring positive change to patient care. inch Beacon communities that could act as guides for our community add the Health and Hospital Corporation of Marion Local and the Indianapolis Health Centers based on their recent awards of $100, 000 each by HHS.
A nearby type of excellence in practice EMR conversion is Old Harding Pediatric Associates (OHPA) which has two clinics and 18 medical professionals who handle the patient population of 12, 000 and over 72, 000 patient encounters a year. OHPA’s conversion to electronic records in early 2000 occurred as a result of the search for excellence in patient care and the desire to use technology in a manner that benefitted their patient population. OHPA established a cross functional work team to improve their practices in the areas of facilities, personnel, communication, technology and external influences. Significant was chosen as the EMR vendor based on functionality and the similarity to a standard patient chart with tabs for files. The software was customized to the pediatric environment complete with patient growth graphs. Windows was used as the os based on provider familiarity. Within four days OHPA had 100% complying and use of their EMR system.
The future of COOL TN and HIE in Tennessee
Tennessee has received close to twelve million dollars in grant money from the State Health Information Exchange Cooperative Agreement Program. 20 Regional Health Information Organizations (RHIO) need to be full scalable to allow private hospitals to grow their systems without compromising integrity as they grow. 21and the systems located in Nashville will play an intrinsic role in this nationwide climbing with companies like HCA, CHS, Iasis, Lifepoint and Vanguard. The HIE will act as a data repository for all patients information that can be accessed from anywhere possesses a full history of the patients medical record, tests, physician network and medicine list. To entice providers to enroll in the statewide HIE tangible value to their practice has to be shown with better safer care. In a 2011 HIMSS editor’s report Richard Lang states that instead of a top-notch down approach “A more practical idea may be for states to support local community HIE development first. Once established, these local networks can feed regional HIE’s and then hook up to a central HIE/data repository central source. States should use a area of the stimulus funds to support local HIE development. “22 Mr. Lang also believes the primary care physician has to be the inspiration for your system since they are the main point of contact for the patient.
One part of the challenge often overlooked is the patient investment in a functional EHR. In order to bring together all the waste the HIE challenge patients will need to play a more active role in their healthcare. Many patients don’t know what medicines they take every day or whether or not they have a living will. Several versions of patient EHR’s like Memitech’s 911medical id card exist, but very few patients know or carry them. 12 One way to combat this lack of awareness is with a healthcare facility as a catch-all and discharge each patient with a fully loaded UNIVERSAL SERIAL BUS card via case administrators. This plan also might trigger better complying with post in patient treatments to reduce readmissions.
The execution of connecting qualified organizations began earlier this year. To completely support organizations to move toward training course a cubicle of National Coordinator for HIE (ONC) has designated regional education centers (TN rec) who assist providers with educational initiatives in areas like HIT, ICD9 to ICD10 training and EMR changeover. Qsource, a non-profit health consulting firm, has been chosen to supervise TNrec. To ensure sustainability it is crucial that Tennessee build a network of private funding so that what happened with Carespark won’t happen to COOL TN. The eHealth Initiatives 2011Survey Report states that of the 196 HIE initiatives, 115 act independently of federal funding and of those independent HIE’s, break even through in business revenue. Some of these transactions were in existence well before the American Recovery and Reinvestment Act just last year. Startup funding from grants is only meant to get the car going as we say, the sustainable fuel, as observed in the case of Carespark, has to come from value that can be monetized. KLAS research reports that 54% of public HIE’s were concerned about future sustainability while only 35% of private HIE’s shared this concern.
Hospital Ramifications of COOL TN (A Call to Action)
From a Financial perspective, taking our hospital into the future with EMR and a built-in statewide network has unique ramifications. At any given time the cost to find a vendor, establish EMR in and outpatient will be a costly task. The changeover will not be easy or limited and will involve constant development as COOL TN integrates with other state HIE’s. To get a realistic idea of the benefits and costs associated with health information integration. we can look to HealthInfoNet in Portland, ME, a statewide HIE that expects to save 37 million dollars in avoided services and 15 million in productivity reduction. Specific areas of savings include paper or fax costs $5 versus $0. 25 in an electronic format, virtual health record savings of $50 per affiliate, $26 saved per ED visit and $17. 41 per patient/year due to a tautology tests which amounts to $52 million for a population of 3 million patients. In Grand Junction Colorado Quality Health Network lowered their per capita Medicare health insurance spending to 24% below the national average, gaining recognition by Us president Obama just last year. The Father christmas Jones Health Information Exchange (SCHIE) with 600 doctors and two private hospitals achieved sustainability in the first year of operation and uses a ongoing fee for the organizations who interact with them. In terms of government dollars available, meaningful use rewards exist to encourage private hospitals to meet twenty of twenty-five objectives in the first phase (2011-2012) and implementing and implement an approved EHR vendor. ARRA specified three ways for EHR to be useful to obtain Medicare health insurance refund. These include e-prescribing, health information exchange and submission of clinical quality measures. The objectives for phase two in 2013 will expand on this baseline. Execution of EHR and Hospital HIE costs are usually charged by bed or by the number of medical professionals. Fees can range from $1500 for a smaller hospital up to $12, 000 per month for a larger hospital.
Maybe the most compelling argument to developing a functional Health Information Exchange is patient and community safety. The Healthbridge lowering of disease break out prognosis of 3-5 days is a perfect example of this safety benefit. Imagine the ramifications in the case of a wild virus like avian or swine flu. The goal is to avoid a repeat of the 1918 influenza break out and ultimately save the lives in our most in danger. Ralph Krohn of Healthsense makes the case for a socially responsible HIE that serves those who are chronically ill, uninsured and abandoned. As the taxpayers ultimately bear the societal burden for our place’s healthcare coverage, the need to reduce redundancies, increase efficiency and provide healthcare worthy of the united states is imperative. Right now our healthcare is in the Critical Care Unit it’s time to become stable it through in business excellence beginning with our hospital. Let’s rebuild the System of Babel and enhance communication to provide our patients the healthcare they deserve!