The Healthcare Intelligence Hub E-Newsletter
Data / Empowering High Performance
Utah Reaches New Heights of Health Information Exchange
Whitney L.J. HowellSeptember 23, 2011
Preparation for a statewide, electronic exchange of patient data sprouted wings nearly 20 years ago in Utah, when healthcare industry leaders joined together to improve patient care through information sharing. Today, the state is a leader in the creation of health information exchanges (HIEs).
While electronic health records (EHRs) aren't new to Utah, the latest endeavor to link patient records across the state via a HIE is only a little over a year old. Known as cHIE - clinical health information exchange, Utah's statewide, vendor-neutral, patient-data repository is still under construction. The process hasn't been wholly simple, even with buy-in from healthcare leaders and state officials.
"The easiest part has been the technical component behind cHIE," says Teresa Rivera, COO of Utah's Health Information Network (UHIN), a non-profit coalition of insurers, providers and government officials. "But, now we need to integrate all the pieces. All the data contributed by providers must be organized and mapped correctly."
UHIN launched cHIE and is dedicated to controlling healthcare costs and improving the quality of care through electronic data exchange. So far, UHIN has been very successful. Not only does the Ogden-Clearfield area in northern Utah have the lowest healthcare spending in the country ($2,623 per capita), according to Thomson Reuters, but the state also has a higher EHR adoption rate than much of the nation. More than 60 percent of providers already contribute to the more than 30 EHRs housing Utah patient data.
Currently, the state's four main hospital systems and one of three major labs are already filling cHIE's data coffers, says Rivera. The ultimate goal is to enroll the remaining two labs, as well as all rural hospitals within the next year. The deeper the data well, the easier it will be for patients to receive the highest level of care even when they can't see their regular physician. cHIE will give providers access to medical histories and medication lists for all patients who opt-in.
Enrolling Participants
Rather
than debuting cHIE and putting the onus on patients to tell their healthcare provider they'd prefer
not to participate (often called the opt-out process), UHIN made patient consent the lynchpin of
the program's success.
To date, nearly 7,000 patients have opted-in to adding their health data to cHIE. The state has 2.7 million residents, so the task ahead is large, says Rivera. Reaching 100-percent participation isn't feasible; education will be the tool used for getting as many patients enrolled as possible.
"We're informing the population about the benefits of cHIE, and explaining why it's important to tell their provider if they do or don't want to participate," she says. "We're at health fairs, we've had media events, we've placed information in school offices and even the Department of Motor Vehicles. Most people, however, learn about cHIE from their provider."
Consequently, it's the provider's job to assure patient data submitted to cHIE is encrypted and secure. If patient choose not to participate, none of their information will be included in the system.
Overall, providers have been happy to take the extra time to make sure patients understand what cHIE is, and explain how submitting their health records could benefit them in the future, says Rivera. Having greater access to patient information, including the details needed to potentially make critical care decisions or avoid errors, far outweighs the added responsibility.
Although UHIN encourages all providers and facilities to submit patient information, there are instances where certain details of a patients' history can be omitted. For example, providers aren't required to submit some emotionally charged details, such as past or current substance abuse or HIV status.
Some groups also have leeway to forego submitting records without losing access to the information.
"There are cases where an organization won't contribute but will still use cHIE information," says Rivera. "Planned Parenthood might not contribute data, but it's valuable for them to have access to the health records. When treating patients, they must have access to a patient's medical history. Otherwise, they can't offer the best care possible."
Impact
When physicians have ready access to patient information, the patient almost always benefits from improved quality of care. cHIE also positively impacts the providers who treat patients. Using the system allows doctors to prescribe, order or deliver reports, or refer a patient electronically. The system also provides access to all hospital reports, lab results and clinician documents.
According to Julie Day, M.D., Medical Director for Quality at the University of Utah Health Plans, having access to a state-wide HIE, such as cHIE, could bolster the services offered by a large provider.
"For a major system like ours, it would be very helpful to be able to pull a patient's clinical background, history of chronic conditions, or medications, if they came into our emergency department and weren't already one of our patients," says Day, who is also part of the internal medicine team at University of Utah Health Care. "You can save time and cost that way by not having to potentially repeat every test you might need," she adds.
The university is committed to providing patient data to cHIE, and is currently working to integrate its existing EHR system with cHIE technology, says Day.
However, patients and physicians aren't the only beneficiaries of the services cHIE provides. Payers can also access portions of this mound of patient data to guide them through setting policies around various clinical conditions. For example, Rivera says, payers use the data to decide for which treatments patients must receive pre-authorization.
"Not only does having access to cHIE give payers the ability to make informed decisions based on real clinical data," Rivera says, "but it allows them to receive the information in a far safer manner than fax or snail mail."
The Challenge
Putting patient information at provider and payer fingertips might place Utah ahead of the curve in EHR adoption. And, making sure the systems work is important for meeting criteria associated with Meaningful use under healthcare reform guidelines. But the attention given to climbing onto that bandwagon has made it harder - at least in the short term - for cHIE to reach its goals, says Rivera."
Meaningful use and accountable care organizations have been a plus and a minus for us as we've been pushing cHIE forward," she says. "Providers understand the importance of meaningful use and the incentive payments attached to it, so it's sometimes been difficult to focus their attention on what we're trying to put into place."
This is where HIE technology vendor Axolotl (now OptumInsight) can step in and keep the ball rolling. The company, which has been involved in cHIE's development since the early stages, is in the ideal position to keep physicians engaged and to continue offering enhanced services, according to Glenn Keet, Axolotl's president.
Not only did the company play an integral role in developing and shaping cHIE's guiding policies, including privacy and consent principles, but company representatives were also instrumental in implementing the HIE infrastructure. As cHIE grows, Keet says the company will continue to provide services needed for advanced analytics and interoperability.
"Axolotl envisions itself providing continued value services," says Keet. "As an example, with UHIN being one of the participants of a Beacon community, Axolotl has an opportunity to help UHIN with innovative analytics reporting, providing unprecedented access and analysis of clinical information for improved chronic disease management."
Putting cHIE To Work
Last year, the Office of the National Coordinator for Health Information Technology labeled Utah a Beacon community, giving the state funding to support existing EHR and HIE efforts. Called IC3, "Improving Care Through Connectivity and Collaboration," Utah healthcare providers will use cHIE to actively improve diabetes care in the state.
The funding supports implementing HIE technology at HealthInsight, a community clinic offering coordinated, convenient care for diabetic patients, says Rivera. These patients receive primary, eye and kidney services under one roof. Having an operational HIE helps physicians track the treatments and services provided.
According to Chris Wood, M.D., Medical Director of Information Systems at 23-hospital Intermountain Healthcare, using Beacon funding to bring community physicians into the fold will benefit patients, as well as all providers."
With the Beacon grant, we'll be able to take information about the services we've provided to diabetic patients at Intermountain and make it available to the primary care physicians who see them more routinely," says Wood. "That way, all the providers can see what's been done for the patient and to determine what needs to be done next to provide the best care."
Tweet
Follow @PorterResearch
