Working on trust, reaping results

Various organizations are working on an ongoing basis to improve the privacy and security of patient information flowing across the healthcare system. Even as those efforts continue, information exchange is driving improvements in patient outcomes and lowered costs.

“It’s imperative that there is a chain of trust throughout the exchange of healthcare information. We are only as strong as the weakest link,” said Paul Uhrig, chief administrative and legal officer, chief privacy officer of Surescripts, speaking during a National eHealth Collaborative (NeHC) webinar on HIE governance activities.

The theme of trust as a critical foundation of HIEs emerged in the discussion with healthcare organizations and officials from the Office of the National Coordinator for Health IT (ONC).

Since April, NeHC and ONC have worked with 30 HIE governing entities to discuss, prioritize and catalog challenging aspects of HIE governance and identify common solutions.  

For Surescripts, Uhrig said HIEs must have the ability to answer the following questions: Who can connect to, and transact with, the network? What are the requirements and conditions to connect (e.g. security)? What standards are used to exchange information? What message types can be transmitted? What are the conditions of continued participation?

Uhrig stressed that swift enforcement action must follow any breach of a rule of participation. “This can’t be stressed enough. It’s not enough to establish the chains of trust, you have to monitor compliance.” When a breach of a rule is identified, the party responsible must follow a remediation plan or lose their certification as an HIE participant.

One in three Rhode Islanders are participating in the state’s HIE—CurrentCare—which makes it a good testing site for new processes, said Jonathan Leviss, MD, chief medical officer of the Rhode Island Quality Institute (RIQI), speaking at the AMDIS Fall Symposium.

Leviss discussed the organization’s experience in improving care coordination through the HIE. The state’s practices and accountable care organizations have a vested interest in knowing when their patients are admitted, discharged or seen in the emergency department of a hospital. “If providers know when their patients are admitted and discharged, they know what to do. By connecting the pieces, maybe we can reduce readmissions.”

They helped the practices recognize that they were missing 10 to 50 percent of admissions. The process has led to increased patient satisfaction and RIQI found that the primary care providers receiving these alerts have a 10 percent lower 30-day readmission rate. “That drop translates to avoiding 68 readmissions a month and $860,000 saved.” If CurrentCare and the hospital alert system expands to the rest of the state’s population, the same 10 percent drop in readmissions would save $7 million.