MU Stage 2 to force interoperability
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“In Stage 1, HIE was fairly watered down. Going from something ambiguous and poorly defined to a tighter definition, hospitals and providers are looking to change the HIE use case to supporting the transition of care,” he said.
According to Giancola, providers originally put off HIE work in part because vendors haven’t historically supported HIE as robustly as they could. “Many products had weak support especially in regards to exchange across systems. More importantly, there are big process changes that providers and hospitals are going to make in order to send during transitions of care to where the next venue of care will be.”
The current NPRM will ramp up efforts in this arena as within the legislation lies a sleeping game changer. While not only 10 percent of transitions of care have to be supported by electronic exchange, Giancola applauded the fact that the calculation of numerator and denominator requires that information exchanged to satisfy the measure has to be exchanged with organizations outside the hospital and/or provider and use disparate systems.
“You can’t satisfy the measure by sending clinical information from the hospital to the ambulatory group with everyone using one system,” Giancola clarified. “This forces everyone to get serious about interoperability.”
The burgeoning health IT environment has helped narrow the scope of HIE. “I’ve known one of the biggest challenges is to get financially conscious organizations to see the value of participating in an HIE,” he said. “Many still have the idea if they share clinical information, they will lose those patients.” With meaningful use Stage 2 narrowing to support transition of care, he believes the new Stage 2 requirements draw a clear line to monetize the value of HIE.
In addition, the birth of the accountable care organization model and reimbursement cuts are furthering HIE’s cause. Giancola said patients are increasingly expecting their information to move from one place to another. He cited CSC’s work with the New England Health Exchange Network (NEHEN) as one where administration simplification through HIE is not viewed as a matter of competition between providers and payors. Providers are creating pooled resources of clinical information, bypassing a middle man charging for transaction fees. “You’re removing the implied penalty of participating in an exchange where every time you make an exchange, you pay for it. Because it’s peer-to-peer, information flows freely.”
From a sustainability perspective, Giancola said organizations need to discuss sustainability from the very beginning to ensure that funds will still be incoming once grant funding runs its course. A large part involves getting private sector buy-in, he noted. “The first step is to do a market analysis. Understand what the providers in your market are like. What’s their volume? Who stands to gain the most from the exchange of clinical information? Who is discharging the most people? Get them to the table and build your model.”
Looking forward to Stage 3, if it follows suit with the transition from Stage 1 to Stage 2, he believes it will increase the HIE minimum requirement from 10 percent to a higher threshold, but also the information being passed around. “For example, only hospitals right now are being required to send around information like syndromic surveillance or reportable lab results. Potentially in Stage 3, eligible providers will do that as well. I see more of the same for trying to get the information moving but widening the scope.”