Monday, June 20, 2011

The health information exchange spectrum - Point-to-point vs. statewide options explored

In this blog post, Charles does a great job of describing the advantages of true health information exchange connectivity vs. basic point-to-point integration in healthcare. The ability to access important patient information across the continuum of care creates numerous benefits including those mentioned in this post.

Moving beyond the basics with health information exchange - Healthcare business news, research, information and opinions | Modern Healthcare: "Statewide exchanges are on the other end of the spectrum and are able to aggregate a broader range of information and data, helping to provide answers to questions related to population health, statewide reporting and registry services, while reducing redundant testing, identifying drug abusers, spotting trends and potential bio-threats, among other capabilities. However, statewide exchanges take time to build, and there are often a multitude of legal hoops to go through. This model does not try to anticipate where care will occur or where the information will be needed or required."

Here is the full text from Charles' post:

Moving beyond the basics with health information exchange


By Charles Christian
Posted: June 20, 2011 - 11:00 am ET

I'm certain that most everyone reading this has heard about health information exchanges, and if you want to hit all the marks of the meaningful-use criteria, there is no question that you have to be able to at least accomplish a test or two using health information exchange capabilities and technologies. The real question is, exactly what size and type of exchange will be coming to your facility?

Should you opt for the simpler, straightforward approach of the Direct Project or hold out for a full-blown, industrial-strength health information exchange? That is a question that many of us are currently debating in the varied corners of our healthcare industry.

Please keep in mind that I've lived and worked in Indiana for more than 20 years and have had the opportunity to watch the birth of one of—if not the first—health information exchange in the country (although I'm certain that this point can be debated). Having said that, I may be a little biased in some of my thoughts. I've also had the privilege of working with a state-level group to accomplish much of the early groundwork on how to expand and connect several regional exchange offerings.

I’d like to take just a moment to briefly explore both ends of the health information exchange spectrum—The Direct Project and the full-featured health information exchange.

The Direct Project's initial focus has been on simplifying the process for providers to comply with Stage 1 meaningful-use requirements for health information exchange. The specifications are concerned with only point-to-point message transport using the Internet’s ubiquitous Simple Mail Transport Protocol, using secure Internet e-mail.

While this may be a good "on ramp" for the health information exchange highway and enable providers to meet the intent of the Stage 1 requirements, it's doubtful that this solution will satisfy the longer-term data and information requirements of coordinating a patient's care in the more complex environment of an accountable care organization. The Direct model assumes that the sender will know where the next stop for the information should be or where the next care encounter will occur.

Statewide exchanges are on the other end of the spectrum and are able to aggregate a broader range of information and data, helping to provide answers to questions related to population health, statewide reporting and registry services, while reducing redundant testing, identifying drug abusers, spotting trends and potential bio-threats, among other capabilities. However, statewide exchanges take time to build, and there are often a multitude of legal hoops to go through. This model does not try to anticipate where care will occur or where the information will be needed or required.

There also are other opinions related to how health information exchange should be implemented and how quickly it should occur. The PCAST report states that the healthcare industry is not moving fast enough to get on the health information exchange highway and that the ONC is not putting enough emphasis on health information exchange in stages 2 and 3 of its meaningful-use criteria.

What do the larger insurance companies know that we don't? It appears that they are counting on the use of health information exchange technologies to enhance their business models, because they are acquiring information-exchange technologies companies such as Axolotl and Medicity.

So the question might be, "How much health information exchange do we really need?" Do we just need to move the information from one care encounter to the next, or do we need to think outside the box a little and take a longer view of how care encounter data and information could be used? Could it be used for something more than to provide care for the patient—for example, to assist in the coordination of the patient’s care without having to know where the data needs to be next? I think my bias might be showing a little—OK, it's showing more than a smidgen.

Based on what I've experienced using the health information exchange technologies available in Indiana, I believe we've just begun to scratch the surface of how secure and appropriate data interchange can be used to improve our healthcare delivery system while at the same time providing an excellent tool for us to coordinate extremely high-quality care wherever and whenever the patient encounter occurs.
Charles Christian

CIO

Good Samaritan Hospital

Vincennes, Ind.

Vice chairman

Policy steering committee

College of Healthcare Information Management Executives

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