HIE Chronicles Part V: Aggregation awaits
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Rhode Island Quality Institute (RIQI) won't turn off the lights and power down as an organization when currentcare begins collecting clinical data. The Institute is already honing its game plan for enhancing Rhode Island’s statewide HIE.
RIQI, as a Beacon Community, plans to couple HIE services with an all-payors claims database to integrate payment information from all sources with patient information.
“This will reveal such things as what a procedure costs, who paid for the service and how many [readmissions] we really have in this state,” said Laura Adams, RIQI's president and CEO. “Currently, we can only track [readmissions] if patients are readmitted to the same hospital. If a patient is readmitted to a hospital different from the one in which they were originally hospitalized, the all-payor claims database will capture that admission.”
The ability to gain a rich understanding of the state’s patient population through metrics within the HIE and the accompanying data warehouse is a new prospect. In the future, currentcare will be able to match up clinical information with the all-payor claims database to figure out how well Rhode Island is doing at managing the health of individual patients and for the population as a whole. For example, the integrated database could track how many diabetics live in Rhode Island and how many have their blood pressure controlled.
“We have been one of the only industries in the U.S. that can inflict defects on our customers and bill those customers to fix them," Adams said. "It isn’t our intent, but it is what the payment system permits. We haven’t focused on the fact that patients simply don’t receive the coordinated care they need to keep them out of the hospital.”
Looking to the future, Adams sees the HIE spurring the redesign of the current reimbursement system to one based on quality, not on the number of tests, visits or procedures delivered. “This is not about preventing necessary hospitalizations," she said. "It’s about managing care so patients don’t need to be hospitalized or rehospitalized because, for example, their medications weren’t reconciled after discharge.”
Adams also sees the HIE becoming an efficient way of helping small practices so their data is integrated and up-to-date. “I see currentcare knitting together disconnected systems with the flow of information that follows the patient, so patients can trust that their clinical information is there at the moment it’s needed,” she said.
Over time, Adams envisions patients accessing their own information out of currentcare and uploading certain clinical data relating to such topics as medication and personal preferences to tell their own version of their medical story.
“I’m so excited,” concluded Adams. “We in Rhode Island have a unique and incredible opportunity to redesign our care delivery system using health IT as an enabler.”