HIMSS14: Patient matching, consent authorization mar HIEs

ORLANDO--“Interoperability is always on our mind but never completely within our grasp,” said James R. Younkin, director of IT for Geisinger Health System at the Healthcare Information and Management Systems Society's pre-conference Interoperability Symposium.

In 2007, Geisinger launched its regional health information exchange (HIE), Keystone HIE, which encompasses 38 organizations.

Three years later, it expanded its HIE when launching the Keystone Beacon Community, which entailed four hospitals, five nursing homes, five home health agencies and clinicians from five counties in central Pennsylvania joining the system’s advanced medical home program. Goals of the Beacon included reducing readmissions for patients with chronic heart failure and chronic obstructive pulmonary disease, and improving patient and client satisfaction.

The HIE provides much value, Younkin said. It offers a full line of services, including publishing and viewing records, notifications and Direct messaging. Also, a patient can view their health data through the HIE’s portal, as opposed to utilizing multiple portals at individual practices and hospitals to find their data.

“Instead of patients logging onto one portal at a hospital, or another for a physician practice, they access data all aggregated under one single roof,” he said.

Additional benefits include easier physician access to data and the fact that patient access counts toward meeting Meaningful Use requirements.

However, challenges hindered the flow of data, including problems with consent management, authentication of patients and differing rules among states regarding protected health information.

HIEs can be difficult because of states’ jurisdiction over consent and protected information. Younkin said no solution has come forward to harmonize consent processes, saying that he would support a centralized place where a patient can register and consent to have their data available in every state. “I don’t know how we can get to that point. There is a lot of work to do there.”

Exchange also suffered as providers would submit patient data to the HIE in a discrete data format, which would come in as a document, and not integrate into the system. “It’s an area we have to see improvement in to really show value to clinicians who don’t want to go to the portal to view information. They want it within the workflow.”

Interoperability is more than just exchange of data, said Walter Suarez, MD, PhD, executive director opf health IT strategy and policy for Kaiser Permanente. KP runs an exchange platform serving seven regions and contains a single connection point for external organizations.

“As we move into health information exchange, we are not just talking exchange between systems, but other elements that are required like identity management, secure authentication, access control and other elements that allow systems to interoperate,” said Suarez. He noted challenges at the legal and policy level, and the policies and legal frameworks that vary between states.

Like Younkin, Suarez said the key gaps in HIE effectiveness include patient identity matching, consent engagement and the overlapping regulatory frameworks.

However, “technology is beginning to help manage the differences," he said. "I think technology will help policy makers see options they didn’t see before.”