Category Archives: Health Information Exchange

Is your HIT infrastructure ready for value-based healthcare?

By | Health Information Exchange, Population Health, Value-Based Care | No Comments

The CMS and Healthcare Transformation Task Force recently announced the rapid acceleration of value-based health care:

A group of the nation’s largest healthcare systems and payers, together with purchaser and patient stakeholders, have announced the creation of a new private-sector alliance dedicated to accelerating the shift to value-based business and clinical models in the U.S. healthcare system that are aligned with improving outcomes and lowering costs. Called the Healthcare Transformation Task Force,  the alliance includes six of the nation’s top 15 health systems and four of the top 25 health insurers. The Task Force has issued a challenge to providers and payers to put 75 percent of their business into value-based arrangements that emphasize better health, better care, and lower costs by 2020 1

According to new federal guidelines, the U.S. Department of Health and Human Services wants 50 percent of all ACO payments and 90 percent of all traditional Medicare payments tied to quality or value by 2018. 2

For healthcare providers, now is the time to assess their information systems infrastructure in relation to supporting value-based healthcare.

As a starting point, value-based healthcare will require core information systems functionality addressing four key areas: – data exchange interoperability, advanced population health analytics, community care coordination, and patient empowerment.

  1. Data Exchange Interoperability– the ability to support real time data exchange interoperability between multiple organizations and systems. Integrating information and workflows across EHRs, care teams, providers, community resources and health information exchanges (HIEs) with a reliable and robust master patient index system.
  2. Advanced population health analytics – the ability to support three levels of analytics: descriptive, predictive, and prescriptive for population health management and accountable care for improving population health outcomes.
  3. Community care coordination systems – the ability to support automated workflows and closed loop referrals with community partners engaged with your member/patient population. This includes the use of built-in rule engines that can trigger alerts and manage interventions, and can support the ability to systematically manage health pathways for members/patients – particularly those with multiple chronic illnesses.
  4. Patient empowerment systems – the ability to interact with members orpatients beyond simple portals, to include automated interfaces with phone apps and personal health monitoring devices. It also works to support members or patients in their self-care responsibilities, prescription drug adherence, lifestyle improvement and wellness programs.

Existing Electronic Medical Record (EMR) systems may be able to provide basic reporting on some of the value-based healthcare quality measures, but they may be inadequate at meeting the triple aim goals of improving care, enhancing patient health outcomes, and reducing per capita healthcare costs. Likewise, existing health information exchanges (HIEs) may be able to support direct messaging and transmit a continuity of care record for patients at the point of care, but may not be able to integrate or share care treatment plans, document patient interventions, support task workflows, capture non clinical social and demographic information.

In most cases, value-based healthcare delivery systems will require the adoption of new information systems and tools beyond current EMR and HIE systems.

Some healthcare providers may have purchased one, two, or even three of the four key component systems for value-based healthcare, and just need to fill the remaining gaps.  Others have yet to make any of these investments and will need to purchase all four components.

Until now, acquiring these four core value-based healthcare IT capabilities often required buying software applications from multiple vendors and then integrating those applications to work together. Today, some vendors are able to offer all four value-based healthcare IT capabilities, and eTransX is one of those vendors.

Purchasing a fully integrated value-based healthcare IT solution saves time, money, implementation efforts and shortens the learning curve. In addition, data flows more efficiently and smoothly between the four applications and security management is more manageable and secure.

eTransX welcomes the opportunity to show you a fully integrated value-based healthcare information systems infrastructure.   Contact us today for a presentation and demonstration.



1, 2/6/15

2 Setting Value-Based Payment Goals — HHS Efforts to Improve U.S. Health Care, HHS Secretary Sylvia M. Burwell, 1/26/15 New England Journal of Medicine

Why HIEs Struggle and How They Can Improve

By | Health Information Exchange | No Comments

There are many different models of Health Information Exchanges. Some successfully share data between systems, and may provide valuable services on top of just data warehousing and distribution. However, almost all still struggle to make participation in their programs worthwhile to a significant portion of their region.

The most widespread cause of HIE failure is the actual exchange of useful information. The EMRs, EHRs LISs, RISs, that make up a region’s medical information landscape very rarely conforms to a single method of data interchange. Recently, most HIE vendors have pursued the exchange of information via IHE Profiles. Of these, PIX – Patient Identifier Cross Referencing and XDS – Cross Enterprise Document Sharing are most common. These two profile sets do give a robust foundation for patient matching and document exchange, but they come with some major difficulties.

These standards require well-established metadata definitions and facility identifiers. The SOAP interchange that also comes with this standard and the security protocols associated require networking specialists to efficiently establish secure endpoints at each facility. This is not an issue for a well-prepared site who happens to have an EMR already configured to handle this protocol, but these sites are few and far between. Even those with a major EMR vendor continue to struggle to match up protocols and get IHE interfaces stood up efficiently. Even if this kind of communication is established, the end result is an exchange of documents with no one point of storage usable for any kind of reporting, data mining, or consolidation of patient records.

The answer is for HIE technologies to become more flexible in communication methods and data storage. Document sharing via IHE Profile can be an excellent method when available, but what about the facilities not interested in handling some new integration method? How do we get an entire region to buy in to connecting? First, use what each facility already has available for integration. Meaningful Use means that almost every site has HL7, and more recently, some form of CDA output.  Find which method each site can quickly and efficiently exchange data, use that method, then move on to the next site. It is far too easy to extend what should be a simple integration project with current technologies into a 12 month quagmire with extensive concept discussion, proposed development, environment upgrades, security configurations, etc. Second, store this data in a usable way. Display of documents in a portal is nice, but prepare for real value for the HIE participants. This means well organized and audited data, but also data parsed into usable data points.

The key is quick onboarding. The more sites that are sharing data, the more value a Heath Information Exchange can provide. Potential participants will see a smaller barrier to entry and more potential value if they see other sites easily connect. This will result in a snowball effect that will quickly end in exactly what a HIE is meant to be – a single point of contact for every facility in a region. Then, the purpose of the HIE may be realized.