Community News

Health Information Exchange: Lessons From Libraries

Health information exchange: Congress has encouraged it, the business case is strong and the public assumes it is happening behind the scenes. But on the ground, medical staff fight this war with fax machines and frantic calls to medical record departments.

But what if a lab test only had to be done once, and then everyone had access to the results? What if real-time referrals included pertinent notes and results, transmitted directly as structured data into the specialist's electronic health record system?

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Top Ten Tech Trends: "Survivor: Edition HIE"--Can Statewide HIEs Achieve Sustainability?

The answer is a qualified ‘yes’—but, say those in the know, it will take business realism and a strong dose of ingenuity

Can health information exchanges (HIEs) survive the present moment? The question might seem overly simplistic, but the reality, as knowledgeable observers note, is that broad-based, and particularly statewide, HIEs are indeed failing or faltering across the country. Indeed, many public and semi-public statewide HIEs are struggling these days, in the wake of the dwindling of federal and state grants to support them. What are industry observers seeing? Largely this: that many of the statewide and regional HIEs created with wonderfully high-minded intent, but without a hardheaded business focus on long-term sustainability, are finding it difficult to make ends meet as the grant money begins to wither.

 

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Matters of Life and Data

SDBJ

 

Matters of Life and Data

MEDICINE: Providers Look For Secure, Effective Ways To Share Medical RecordsBy Brittany MeilingFriday, January 30, 2015

Dan Chavez, executive director of San Diego Health Connect, is overseeing the effort to coordinate the exchange of patient health information among the region’s hospitals and community clinics.

Dan Chavez, executive director of San Diego Health Connect, is overseeing the effort to coordinate the exchange of patient health information among the region’s hospitals and community clinics. Photo by Stephen Whalen.

Imagine a health care system with a central hub that collects all of a patient’s information: lab reports, allergies, prescriptions, doctor’s notes, sensitivities, and all the diet, exercise and lifestyle data collected by wearable and medical devices.

Unfortunately, health care lags far behind other industries when it comes to collecting and, more importantly

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sharing data, a practice that would allow health care providers to make smarter decisions and lead to better patient experiences.

Right now, when a patient visits a primary care physician and fills out a clipboard full of paperwork, the patient’s health information is stored at the doctor’s clinic. Even if that patient visits a specialist the next day within the same provider, there’s a good chance the specialist will not have access to notes and paperwork from the primary care doctor. This becomes especially frustrating when a patient sees many specialists and doctors, and health care data among all the clinicians is disparate, disjointed and incomplete.

Disconnected health data can, and does, lead to tragic outcomes. Tens of thousands of deaths occur every year as a result of wrong or incomplete medical records, according to the American Medical Informatics Association.

But an effort is underway in San Diego County to remove the barriers that hinder the sharing of patient information.

The first step is creating the pathways for medical records and other health information to be safely shared between providers.

Patient Identifier

Today, the only way to legally identify a patient within a health record system is by their name. Unfortunately, many people go through marriages and name changes, or have multiple versions of their name.

“How do I know that Dan Chavez is Daniel Chavez is Danny Chavez who has had four addresses and three different entries in the California DMV?” said Dan Chavez, executive director of San Diego Health Connect, a not-for-profit that coordinates the exchange of health information. “It’s fundamental to have a complete medical record, especially if I have a chronic disease. Many medical mistakes are a result not of bad medicine, but improper patient identification. Giving the wrong drug to an asthmatic, for example, can be very dangerous.”

Although all Americans have a unique Social Security number that could help health care providers avoid the problem of misidentification, it is illegal for them to set up a records system using a unique identifier to sort and aggregate data.

The original Health Insurance Portability and Accountability Act (HIPAA) legislation from 1996 called on officials to develop a system of unique patient IDs to help with the compilation and exchange of health records.

Proponents of the unique patient ID idea agreed that research, continuity of care, record keeping, follow-up, preventive care, prompt payment, and detection of fraud and abuse would be improved. However, opponents felt that privacy would be jeopardized. The fear, which was not unfounded, was that a single health identifier, whether or not based on Social Security numbers, would allow easier access to individuals’ health information — and the potential to exploit such information for commercial advantage, personal gain, or malicious harm.

Federal appropriations legislation passed in 1998 denied funding to implement a patient ID program claiming a system of patient identifiers could pose privacy risks.

Though the Obama administration officially remains opposed to a national patient ID, some in the health information technology industry believe the vision of a nationwide network of electronic health records (EHRs) is unrealistic without a standard means of locating and authenticating records.

Disparate Systems

Another challenge within the industry is disparate operating systems at hospitals and clinics that use various coding languages that cannot speak to one another. Just as an Apple Macintosh has trouble transferring information to a Windows PC, hospital and clinic EHRs use proprietary systems that cannot always speak to each other. The ability to exchange information from one system to another is called interoperability — a buzzword in health IT today.

Major EHR companies such as Epic and Cerner Corp. have built-in interoperability so that health care providers can choose to network internal systems together. Connecting health records internally and between separate health care providers could increase the quality of care within a region, Chavez said.

It seems the federal government agrees. In 2009, the Office of the National Coordinator for Health Information Technology encouraged the growth of regional Health Information Exchanges (HIEs) in which local or statewide hubs could connect disparate EHR systems to help exchange patient information. Proving that the federal government will make really long names in order to create a catchy acronym, the Health Information Technology for Economic and Clinical Health (HITECH) Act was formed to push adoption of electronic health records. Part of the HITECH act mandated the adoption of EHRs in order for health care providers to receive Medicare payments.

The latter part of the vision was to connect all digital records in a network of patient data. As a result of this long-term vision, grants were legislated into the HITECH components of the American Reinvestment and Recovery Act in 2009, pumping $250 million into the creation of patient information exchange hubs to help connect health systems disparate EHR systems.

The Solution

San Diego received a huge chunk of this federal money when UC San Diego Health System received $15 million dollars to create one of 17 nationwide HIEs in 2010.

Incubated at UCSD for a few years, the San Diego HIE eventually graduated into a separate, public nonprofit in September 2013 called San Diego Health Connect.

The hub has helped health care organizations overcome the barriers of information exchange by creating an index of patient records and issuing regional patient identifiers to help avoid misidentification. The HIE also manages the communication between disparate health systems by acting as a central hub for the data to flow.

Shortly after the San Diego HIE relaunched under its new name, it laid claim to long-term viability by recruiting nearly every hospital system in the county, along with dozens of clinics and medical facilities.

Chavez said the involvement of nearly every hospital system in the region shows that the local industry recognizes the value of a community data exchange; even though each hospital system operates a private HIE for its member institutions.

“(Information from the HIE) helps us to understand what is going on with our patients, and assures we are aware of new medications, allergies and issues that can affect our patients,” said Capt. Lisa Gleason, the director of information technology at the Naval Medical Center San Diego.

Ed Babakanian, chief information officer at UC San Diego Health Systems, said it’s about offering the best care to the patient.

“To provide the best possible care, we believe that we need to interoperate with other care providers that may have had a hand in keeping you healthy over your lifetime,” Babakanian said. “So we need to include the children’s hospital and places where our patients may have other records. We want to ensure continuity of care. We want to make that information available in a secure environment.”

Chavez said San Diego Health Connect strictly adheres to the federal HIPAA standards, which govern the release of medical records.

Membership for San Diego Health Connect costs anywhere from $500 a year for solo practices to $200,000 a year for large hospital systems.

Exchanging medical records is the first step in achieving meaningful use of health information. Once data sharing is standardized between health systems, it will be possible for organizations to use the extraordinary amount of data the latest technology is collecting to raise the bar on American health care.

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CMS intends to modify requirements for Meaningful Use

Today, we at the Centers for Medicare & Medicaid Services (CMS) are pleased to announce our intentto engage in rulemaking to update the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs beginning in 2015. These intended changes would help to reduce the reporting burden on providers, while supporting the long term goals of the program.

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ONC issues draft nationwide health IT Interoperability Roadmap; Implementation resources also released as first deliverable

The U.S. Department of Health and Human Services' Office of the National Coordinator for Health Information Technology (ONC) today released Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap Draft Version 1.0. The draft Roadmap is a proposal to deliver better care and result in healthier people through the safe and secure exchange and use of electronic health information. 

 

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In San Diego, a Robust Exploration of HIE and Consumer Engagement

A very robust, expansive discussion of health information exchange and patient/consumer engagement helped kick off the Health IT Summit in San Diego, being held this week at the Omni San Diego Hotel, and sponsored by the Institute for Health Technology Transformation (iHT2), a sister organization to Healthcare Informatics. Broad questions around standards development, HIE process optimization, and true patient/consumer engagement, dominated the discussion on Tuesday morning’s first panel discussion, entitled “Next-Generation Data Exchange Driving PHM.” 

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HIE for EMS Summit November 18-19

The California Emergency Medical Services Authority (Cal EMSA) will be hosting its 2nd Annual HIE for EMS Summit November 18-19.  All CAHIE Members are invited to attend this important event, which will feature speakers from the ONC, state and local agencies, and CAHIE leadership and HIO representatives.  The integration of EMS in HIE is critical to the success of day-to-day healthcare delivery, as well as during a disaster.  There is special focus on California to lead the way, so don’t miss this opportunity. 

 

November 19

11:35 a.m. - 12:10 p.m. San Diego HIE – EMS Integration 2.0

Dan Chavez, San Diego Health Connect

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Medical Marketplace - SDBJ

Medical Marketplace

HEALTH: The EMR Mandate Opens Door For Industry InnovationsBy BRITTANY MEILINGFriday, October 24, 2014

Rick LeMoine is chief medical information officer for Sharp Healthcare, which employs 520 people in information systems, 70 of whom work in the new field of clinical informatics.

Rick LeMoine is chief medical information officer for Sharp Healthcare, which employs 520 people in information systems, 70 of whom work in the new field of clinical informatics. Photo by Stephen Whalen.

A federal mandate requiring hospitals to installelectronic medical record systems has not only streamlined the collection of patient information, it has opened up new markets for innovation in San Diego County and created a new field in health care.

Rick LeMoine, chief medical information officer for Sharp HealthCare, said hospital EMR systems have increased the demand for highly skilled staff with expertise in computer information systems. As a result, schools are now offering training in what is being called clinical informatics.

The mass of health data also has proved a goldmine for entrepreneurs.

“The moment you become digital, it opens up huge other industries,” said Jonathan Mack, program coordinator for University of San Diego’s Hahn School of Nursing and Health Science’s graduate program.

But the nationwide launch of the EMR system has had its kinks.

New Challenges, New Opportunities

The health care industry has been slow to install EMR systems for a number of reasons, say experts. Chief among them are concerns about patient confidentiality, the costs to install the systems and resistance from staff.

However, the federal Centers for Medicare and Medicaid Services launched an initiative in 2011 called “Meaningful Use” as part of health care reform that incentivizes hospitals to install EMR systems by awarding money to organizations that meet certain requirements. In short, the mandate demands providers show that they are meaningfully using their EMR systems to improve patient care.

Once the EMR system is installed and operating, the hospital must demonstrate that it is meeting federal standards for meaningful use each year to receive an incentive and avoid penalties.

Meaningful use has galvanized hospitals to go completely paperless, creating new jobs, new challenges and new business opportunities.

New Jobs

Sharp HealthCare entered the game much earlier than most hospitals, installing its first EMR system in 1984 and going paperless in 1985. The hospital system upgraded to a Cerner Corp. EMR in 2008. Cerner is one of the top two EMR providers in the country; the other is Epic Systems. Hospital EMR systems provided by companies like Epic and Cerner allow quite a lot of customization depending on the hospital’s operations, and require in-house maintenance not provided by EMR companies.

“There’s a lot of day-to-day things with a complex system like an EMR,” Lemoine said. “There’s always reports to be run for people, fine-tuning of some of the parameters, changes people would like to see.”

Of Sharp’s 16,000 employees, 520 now work in information systems. About 70 of those jobs are in the new field of clinical informatics.

This new demand at Sharp is typical of the growing career opportunities available in health care informatics, Mack said.

“The skill level for managing the old systems was quite low, you didn’t need a coder or a programmer,” Mack said. “Now, all of a sudden, you have these complex electronicmedical records and you have no staff that can manage them.”

A clinical informaticist combines knowledge of health care, hospitals and patient flow with information systems and computer science.

“These EMRs have to be integrated into the workflow,” Mack said. “That means you have to have a clinical informaticist that knows how to look at workflow and then build the screens.”

Learning to Share

Once hospitals have installed EMR systems, they face another challenge: sharing that information with each other.

San Diego Health Connect is providing a solution and nearly every hospital in the county is on board. SDHC is a nonprofit association launched from the 2010 San Diego Beacon Grant awarded from the Office of the National Coordinator The grant created a central hub that allows the electronic exchange of patient information, such as test results, imaging data, allergy information, medications and medical care summaries.

“(By using San Diego Health Connect,) if someone goes to the emergency room at UCSD and cannot communicate, the emergency department physician can instantly look at that patient’s records from Scripps, Sharp or any other San Diego-based doctor,” said Dan Chavez, executive director of SDHC. “The ED physician may then find out that the person is currently being treated for a chronic disease. This information might be critical for the ED physician to know, but unless patient records are shared between medical systems, that information may be overlooked during a precarious juncture in the delivery of care.”

Chavez said sharing medical records also prevents patients from paying for tests they’ve already completed at another health care institution. And he said San Diego Health Connect strictly adheres to the federal Health Insurance Portability and Accountability Act of 1996, also known as HIPAA, which governs the release of medical records.

A central hub for patient information opens opportunities outside of hospital systems, as well.

“With an electronic medical record for every patient, we have created a whole new industry,” Mack said. “Not just for EMRs, but for subsystems.”

These subsystems include companies developing medical devices, mobile health technology and wearable fitness gear that measures personal health metrics.

The beauty of a patient record “central hub,” Mack said, is that companies developing tools for health care can connect to one source instead of many, saving time and money. Companies can maintain or expand their reach without establishing new contracts and building new interfaces with each individual hospital system.

“The health information exchange is a unique place for startups to develop apps,” Mack said. “The gizmos that collect clinical data at home really don’t need to go to the hospital anymore; they can go to the information exchange instead.”

To date, the health information exchange in San Diego includes Kaiser Permanente, the Naval Medical Center, Rady Children’s Hospital San Diego, University of California, San Diego and Veteran’s Affairs. The exchange also has seven local hospital systems in testing, including Sharp Healthcare, Tri-City Medical Center, Palomar Health, Scripps Health, and 12 local clinics.

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Adding HIE Info to EHR Data Raises Medication Accuracy to 91%

EHRs fare significantly better with the help of community health information exchange (HIE) resources when it comes to medication list accuracy, finds a new study in the American Journal of Managed Care (AMJC).  While the EHRs at two sample hospitals captured an average of 80% of medications accurately, the addition of commercial database information and data from a community-based HIE was able to improve that number by 11 percent.  The additional accuracy can be a crucial advantage during transitions of care, which are highly vulnerable to negative patient safety events

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Essential Elements of Health Information Exchange

As healthcare organizations continue to transition from gathering data through EHR systems toward building knowledge based on that data, the ability to exchange patient information, consistently, privately and securely becomes ever more paramount to improving quality of care. 

In this first-of-its-kind class in Southern California, some of the region’s most experienced HIE leaders will present the essential elements of an HIE, including, but not limited to:

  • >The benefits and national push for HIEs

  • >Major technical components

  • >Modes of exchange, such as the NwHIN and their related requirements

  • >Implementing an HIE, including vendors, products and implementation

  • >Business models and governance

  • >Capstone project for students to apply the concepts learned

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