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HIE: Do too many rights make a wrong?

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Much of our current work focuses on engaging state and local public health departments regarding planning for meaningful use.  In the last two weeks alone, we’ve had excellent conversations with five state health departments.  A recurring theme: What to do about the state HIE?

–KJH

Long term, there is no question that the right thing is to have a single source for electronic health information.  Public health would be well-served by this one “healthcare data pipeline” that carried syndromic data, infectious disease reports, lab results, immunization reports and registry data.

That’s the vision of a functional state HIE. And it is the right one.

State HIEs are looking for ways to do the right thing.  Short term, they have milestones to demonstrate their overall value—to the government, providers, and payers.

The HIEs are also concerned about establishing a long-term sustainable revenue model.  That’s the right thing to do as well.

Eligible hospitals and eligible professionals will be seeking credit for meaningful use via syndromic surveillance data exchange—definitely the right thing to do.

For State Epidemiologists, the list of rights is much longer. They need to add hospitals and professionals to their existing syndromic surveillance system (if they have one) and support the state HIE.

Here’s where it gets complicated. Because all of those rights could easily turn into a wrong.

The relationship between the state health department and the HIE is not likely to provide the core revenue model for sustaining the HIE going forward.  At best, it is a value add to the health department and an incremental revenue stream for the HIE.

But the HIE can demonstrate benefit from public supported funds by working with public health. In return, public health can quite sensibly provide a list of milestones for the HIE to accomplish.

A demonstration project can fit the bill for both parties.  Public health can continue to meet the needs of eligible hospitals and professionals while engaging the HIE.

What would that project look like?

It would involve cooperative demonstration of the HIE ability to securely connect healthcare providers to the system and monitor for real-time data flow and quality.  This type of task is different in nature than many other data exchange requirements that lack a real-time data requirement.  Billing and charges for health information exchange can be off by days or a week.  Patient medication history may not include prescriptions written in the last 24 to 48 hours.  But for syndromic surveillance, these are key requirements for compliance.

A demonstration project would show that the health department and the HIE can work together, in a limited scope, to provision data connections while managing them effectively.

Starting with a limited demonstration project lessens the risk of impacting the overall syndromic surveillance project. And it gives the HIE an opportunity to demonstrate its capabilities without undertaking a substantial new effort.

It’s a positive scenario for both public health and the HIE. And it’s definitely the right thing to do.

Public Health Professionals’ Meaningful Use Conference Call: Join In

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In the discussions we’ve had with our EpiCenter users, one topic is on everyone’s minds—the challenges of implementing Meaningful Use and Syndromic Surveillance. Some clients have moved further along in the process than others, but the common thread we’re hearing is that a collective effort of insight, ideas, and assistance would be of great benefit.

–KJH

To help our clients deal with these challenges, HMS is coordinating a conference call to bring together Public Health Professionals from across the country. We’ll frame each call with a topic, then ask for input—anything from questions to proposed solutions—to help all involved move through the issues and find a workable solution.

A number of our clients have told us that an impediment to implementation has been coordination with state Medicaid programs. And it’s no wonder. These state programs have faced a daunting task to get up and running in a hurry. The Public Health Professionals who have successfully coordinated with state Medicaid programs are finding that they’re now fielding many questions from hospitals and eligible professionals about Meaningful Use and Syndromic Surveillance.

It’s time to open up a discussion about what’s working and what is not. By sharing information and ideas, we can help to simplify the process of Meaningful Use and Syndromic Surveillance implementation.

All that we need is your assistance. We’re getting ready for the inaugural Public Health Professionals’ Meaningful Use conference call in May.  If you are not a current EpiCenter user and are interested in participating, please contact Lauren Bradford for more information.

 

Feedback on the Draft Guidelines for Inpatient and Ambulatory Clinical Care Data

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Andy Walsh, PhD, HMS Director of Public Health Solutions  The inclusion of syndromic surveillance reporting in the Meaningful Use requirements has created an unprecedented opportunity for the field. By crafting guidelines for how to define that reporting, the syndromic surveillance community can have a significant impact on the way that public health agencies and healthcare […]

HIE—The Challenges and Promise

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Health Information Exchange (HIE) provides the opportunity for Public Health professionals to access a wider range of data—from Syndromic Surveillance to notifiable conditions, immunization, and health registries.

Upcoming Webinar Provides Insight into Health Information Exchange

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Health Monitoring Systems is committed to providing Public Health professionals with resources that give insight into Meaningful Use, Health Information Exchange, and Syndromic Surveillance challenges.

On Tuesday, May 29, the Health Information and Technology Practice Group and the Public Sector Health Lawyers Task Force will hold a webinar to explore Stage 2 Meaningful Use criteria regarding electronic reporting. The webinar, “Public Health Reporting Through a Health Information Exchange,” will cover techniques for streamlining or automating mandatory reporting for infectious disease surveillance and other public health reporting requirements. Panels will explore models for electronic reporting and address security safeguards.

Learn more and register for the webinar at The American Health Lawyers Association website.

We encourage you to continue an open dialogue about Meaningful use and Health Information Exchange by commenting on our blogs.

 

A Hospital Administrator's View of Syndromic Surveillance

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Penn Krause, HMS’ Vice President of Business Development, has previously served as a CEO, COO, and Division Vice President in non-profit and investor-owned healthcare systems. During his tenure as COO of the Pittsburgh Mercy Health System, the system was named one of Hospitals and Health Networks “Most Wired.”

In a recent HealthData Management article, Joseph Goedert writes, “sales of electronic health records (EHR) systems hit $17.9 billion in 2011, a 14.2 percent increase over the previous year, according to an annual study from Kalorama Information, a New York-based research firm.”

As the adoption of EHRs accelerates, more hospitals are working to understand the financial and technical requirements of Syndromic Surveillance Implementation.

Technical Issues

EHR implementation can be a challenge for even the most skilled IT department. Syndromic Surveillance is just one part of the bigger EHR picture. The biggest areas of concern involve:

• Time. Installing or upgrading an EHR system is time-consuming.  To achieve Meaningful Use certification, most hospitals will need to upgrade or install new systems.
• Scope of work.  Meaningful Use implementation is much more complex than most IT projects, which are often geared toward coding.
• Changes for ICD-10 and HIPAA. EHR implementation overlaps with these changes.

Cost and Timing

Additionally, the up front cost of an EHR is a concern. While compliance ensures receipt of Medicare and Medicaid incentives, getting an EHR system up and running is costly—both in terms of time and money.

• The cost of implementation and the degree of coordination with other projects requires a strong leadership commitment. There is agreement that the EHR strategy should be included in the overall strategic plan and vision of the hospital.
• A budget for EHR can be in the tens of millions of dollars—with a ROI of several million.
• Because of the complexity of project implementation, and its effects across a health system, hospital leadership understands that EHR implementation cannot be rushed. Instead it is part of a multi-year plan.

Long Term Planning

Stage 2 Meaningful Use implementation becomes mandatory in 2014, so long term planning is critical to address the challenges involved.

• There will be changes to the core care delivery processes, affecting physicians, hospital personnel, and the IT staff.
• Project management is being utilized to oversee the redesign of multiple processes while monitoring potential disruptions.
• Hospitals are looking back at Stage 1 as they move forward. During Meaningful Use Stage 1, hospitals discovered that EHR vendors’ work capacity was constrained by the high demand generated by the incentive programs. This comes at a time when both hospitals and vendors face significant shortages of trained staff.

Addressing these complex issues now will help hospitals to plan well for Syndromic Surveillance implementation.  This will help to ease the transition to stage 2.

Delivering on the Promise of HIEs

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Health Information Exchange (HIE) is a key component in the move toward meaningful use of electronic health records. Because working with an HIE is relatively new to many in Public Health, there are a number of questions surrounding it. One of the biggest involves how the state’s HIE will support public health needs for the collection and monitoring of healthcare data. This data can include syndromic surveillance data, notifiable condition data, immunization, health registries, or other unique projects.

That is a tough question. To answer it, we need to fill in the landscape a little bit.

Going back to 2006, Health Monitoring Systems (HMS) completed a study of existing functional health information exchanges. At the time, they were referred to as RHIOs – Regional Health Information Organizations. We undertook the study with the expectation that EpiCenter, our Syndromic Surveillance system, would need to work—from day one—in concert with the evolving RHIOs.

To our great surprise, we found that only two RHIOs nationally were viable and functional. Our research wasn’t exhaustive but it involved an active search for functional, self-sustaining RHIOs.

–KJH

So What Happened?

The big question then (and now) is why HIEs/RHIOs haven’t thrived. The benefits of exchanging healthcare data seem obvious. In our research, Dr. Andrew Walsh was able to demonstrate time savings, improved care, and financial savings associated with HIE use.

Despite these proven benefits, undefined costs remain—notably, who pays for the HIE?

The American Recovery and Reinvestment Act (ARRA) provided funding for HIE creation. Along with the standards supported through ONC, two substantial barriers have been lowered.

The jury is still out on whether the result will be a long-term, financially viable health information exchange.

Public Health Dilema

Public health has a need for data, and that need is constantly growing—from monitoring current health conditions to event response and measuring the effectiveness of public policy.

The promise of HIE was that it would lower the burden on public health for data collection while improving the range of data available. It has yet to deliver.

On a positive note, the promise of HIE has forced public health to collaborate and support the HIEs. But short-term issues still remain.

Recommendation


HMS fully supports the overall vision of HIE. We are anxiously awaiting the opportunity to provide our clients with access to a wider range of data. But the possibilities for improving the delivery of healthcare through IT cannot be fully realized until HIE is ubiquitous throughout the country.

Until then, we strongly recommend that public health engage the state HIE in a pragmatic way:

• Realize that the two primary goals of the HIE are to achieve long-term financial viability and demonstrate short-term benefit. These two goals may be in conflict over time, as available funding is reduced for the HIE.
• Create well-defined, tightly scoped demonstration projects that evaluate the feasibility of using the HIE for data access
• Develop technical and administrative relationships with the HIE to ensure that the public health IT roadmap and the HIE roadmap are compatible
• Keep HIE success off of the critical path for urgent data collection projects—until all of the kinks are worked out technically, politically, and financially.

For syndromic surveillance, we recommend engaging the state HIE in a demonstration project that includes data collection from a small number of facilities. The project could provide redundant data through the HIE while taking advantage of the greater breadth of surveillance data available through the HIE. A demonstration project benefits both public health and the HIE, while revealing potential problems for more critical, longer term, and complicated engagements.

Most importantly, it supports the long-term vision and need for effective health information exchange and starts the engagement out on a positive note.

The Challenges of Meeting Meaningful Use Requirements: What We’re Hearing from Public Health

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In a previous HMS blog entry, Vice President of Business Development Penn Krause provided insights on the article Public Health Struggling to meet Meaningful Use Challenges.  As our friends in Public Health know, this isn’t new news. Last July, Barbara White (@frombarbara) tweeted the struggles of local public health officials (see Tech Target)

While it’s true that Public Health departments are wrestling with hard decisions on how to move forward—quickly—I don’t believe that should be defined as struggling.

We are in a unique position at HMS; we are working with a number of hospitals and health departments across the country, hearing their stories of what is working and what isn’t. Let’s consider some basic questions we hear from public health departments all across the country—these issues have arisen in just the past month:

  • How do I fund this? Will the funds be available on an ongoing basis?
  • Who is responsible for coordinating with Medicare and Medicaid to support self-attestation?
  • The state hospital association wants to preview and approve the data requirements before we submit them to the hospitals, is that the right approach?
  • My eligible professionals desperately want to connect, but they are lacking in funding and technical expertise. One hospital system won’t connect unless we’re able to work with all of their allied EPs concurrently.
  • There is a lot of pressure to work with the state HIE but it isn’t even operable yet.  Syndromic, lab, and immunization data aren’t even on their radar.  The implementation plan would require us to write a query mechanism to pull, not just get the data.  What am I supposed to do?
  • What technical resources will I need? I am not familiar with HL7 and data collection. I don’t have the background to understand and implement the ISDS recommendations for syndromic surveillance.
  • What is a test message? I have a hospital that sent one message, but it was garbled and our system failed. Does this count as a success?

These inquiries prove that Public Health’s challenges are very real, and continually evolving. Most issues revolve around collaboration efforts with other branches of government, organizations, associations, and vendors—anyone who has worked in that environment knows it isn’t a struggle; it is an endurance event.

We’ll be following up with additional blog posts on recommendations and best practices based on what we’ve seen. If you have the chance, post comments with your thoughts, or drop us a line at blog@hmsinc.com.

–kjh