HIEs paving the way to more accountable care

Health information exchanges (HIEs) are foundational to the success of accountable care organizations (ACOs). Without HIEs, the shift from volume to value-based care will not be possible, speakers said at a National eHealth Collaborative webinar.

Bidirectional information exchange among the disparate payer, provider and community-based systems, ultimately, is “where we need to be,” said Karen Bell, MD, MMS, chair, Certification Committee, Certification Commission for Health Information Technology (CCHIT), who is leading a workgroup of more than 30 stakeholders to create an ACO/health IT framework. The workgroup is slated to make recommendations to the Health IT Policy Committee this December.

Other functions of exchange—such as crossviewing, single-system access, secure unidirectional “push” systems like Direct, data warehouses, LAND and SEE technology and portals —“are stopgaps,” she said. “They serve a short-term purpose. In the end, what we’re going for is a much more robust approach through bidirectional health information exchange.”

Bell asserted that information exchange is the most critical health IT element as it supports the processes and functions to meet key aims of an ACO—in particular care coordination. Other health IT requirements for an ACO include strong privacy/security capabilities, and health IT functions that support patient safety, data collection and integration from multiple clinical, financial, operational and patient-derived sources, she said.

The Pennsylvania-based Keystone HIE has proven beneficial to Geisinger Health System, said James Younkin, IT director, during the webinar. As an ACO with goals to reduce readmissions for patients with chronic heart failure and chronic obstructive pulmonary disease and improve patient and clinician satisfaction, it benefits from HIEs which facilitate analytic reporting, patient engagement, care coordination and patient record linkage.

Currently the exchange encompasses 20 hospitals and almost 100 practices, he said, with that number growing every month.

“It’s extremely valuable for not only ACOs, but all members of the care coordination effort,” he said, citing HIE services that include the ability to upload and scan documentation, receive alerts and notices and participate in Direct messaging. “When patients are discharged from a hospital, they can follow up with patients immediately to make sure meds are reconciled and that they have a post-care plan.”

Younkin also noted Geisinger’s creation of a tool that translates home healthcare’s minimum dataset (MDS)/Outcome and Assessment Information Set (OASIS) into a clinical summary that can be delivered to the HIE, thereably improving care coordination.

HIEs enable ACOs, echoed Mark Jacobs, MHA, CIO, Delaware Health Information Network. He cited interdependent relationships between ACOs and HIEs; for example, HIEs can exchange data on populations, which ACOs need to manage a patient population, and that they can provide value added services, helping ACOs decrease the impact of undesirable or complex clinical events.

Salim Kizaraly, chief corporate officer and principal consultant, Stella Technology, agreed that ACOs benefit from HIE features, which include care coordination, clinical messaging, data capture of quality measures, payer information, centralized information and services, public health reporting and patient engagement and retention.

“It brings together disparate stakeholders in managing the patient,” he said, citing a Colorado health network that uses HIE to capture real-time clinical data to enable more active care management by its payer.

“HIEs can really serve as a foundational platform to serve ACOs,” he said.