Information exchange chugging along

Beth Walsh, Editor, CMIO

Although many health information exchanges (HIEs) are in a state of flux as they continue to fine-tune logistics and mechanisms to create the most efficient and effective resources, studies continue to prove that electronic systems and the ability of clinicians to exchange and access patient information is improving outcomes and saving money.

For example, a recently completed three-year pilot program intended to inform the model design of a patient-centered medical model yielded positive results, according to Blue Cross & Blue Shield of Rhode Island. The pilot involved 79 primary care providers who received partial funding for EHR implementation, monthly stipends and financial incentives for demonstrating improved quality.

Patients receiving care from participating providers enjoyed healthcare costs that averaged between 17 and 33 percent less than patients receiving care from non-participating providers. The pilot also netted improved healthcare quality, with a 44 percent median rate of improvement in family and children’s health, 35 percent in women’s care and 24 percent in internal medicine, the payor reported.

On the e-prescribing front, a study found that prescriptions handwritten by 78 providers’ offices over the course of approximately one year contained more than two errors per prescription written. Researchers believe that error rate could be significantly lowered through the use of e-prescribing systems, which automatically resolve instances of illegibility; a rate that could be further improved through the use of systems with clinical decision support (CDS).

“The use of an e-prescribing system has the potential to reduce error rates markedly,” the authors wrote in the Dec. 5 issue of the Journal of the American Medical Informatics Association.

Quality measures are a crucial component of HIEs but building quality measurement sets that are compatible with a wide range of EHRs and other health IT products has proven difficult for both vendors and healthcare provider organizations. Vendors, providers and government organizations have an ongoing game of tug-of-war in play as they determine the best ways to build those quality sets.

National Quality Forum (NQF) invited Siemens Healthcare's CMIO of the health services unit, Marc Overhage, MD, to discuss electronic measure (e-measure) implementation during a Dec. 8 webinar. Standardized formats for e-measure sets, particularly the Quality Data Model (QDM) developed by NQF, may help vendors incorporate measure sets into their health IT products, but Overhage indicated it will take time to determine whether vendors can use them successfully.

“Everyone is quite excited about the evolution of the QDM,” he said. “It’s clear that it should reduce the implementation burden by removing the ambiguity and the need for translation that exists today.” But, he said the lack of experience in the vendor community should require a learning curve.

Although the QDM should make it easier for engineers to build measure sets into EHR systems, Overhage said that some vendors are concerned that the model will place restraints on their ability to build the systems that they conceptualized. “The development and evolution of the QDM has the potential to greatly improve the speed and agility with which measures can be created and integrated into vendor systems,” Overhage said.

“The biggest challenge is related to prioritizing data and thinking about consistency of data across measures,” he concluded. “As we bring more measure sets into practice, we’re going to have to look more diligently across systems to find common ways to fix problems.”

HIEs will continue to gain traction over the next, as more and more attention is paid to the need for both providers and patients to access relevant information. From CMIO to you and yours, have a happy holidays.

Beth Walsh
CMIO Editor
bwalsh@trimedmedia.com