Webinar: ONC HIE efforts gearing up
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Fridsma charted the process of the national HIE strategy during a July 18 webinar entitled “Exploring the National Roadmap for Health Information Exchange,” sponsored by the National e-Health Collaborative.
The ONC’s HIE strategy focuses on three elements necessary to achieve functioning, interoperable healthcare information systems:
1. Enable stakeholders to come up with simple shared solutions for common HIE challenges;
2. Curate a portfolio, standards services and policies to accelerate IE; and
3. Enforce compliance with validated information exchange standards
Exchange success
Members of the Nationwide Health Information Network Exchange, a group of federal and state agencies and health information organizations, have piloted Nationwide Health Information Network standards, services and policies, he said. For example, the Social Security Administration has used the Exchange to expedite its disability determination program.
The SSA processes more than three million initial disability applications and more than 15 million requests for medical evidence annually, from approximately 500,000 sources of information. If information is not readily accessible, the disability determination process can require additional exams, x-rays or scanning, copying and shipping paper records.
In a pilot program, the SSA partnered with MedVirginia HIE to exchange information about disability applicants. The SSA has seen an 18 percent reduction in case processing time overall. Information gathered electronically was sufficient to make decisions in 15 percent of cases. In 3 percent of cases, the agency was able to decide disability claims in 48 hours, and could identify cases that could be fast-tracked, enabling disability determinations to be made within days, said Fridsma.
“That may not seem like significant impact. But 92 days [the SSA’s average processing time] is three months,” which can have a serious affect on applicants’ finances. “If you can get this decided, it has significant benefit to the applicants that are working through [the process],” he said.
Other Exchange participants include the SSA, Department of Veterans Affairs, Department of Defense (DoD), Centers for Disease Control and Prevention (CDC) and organizations including Kaiser Permanente, HealthBridge and Regenstrief Institute, among others.
Exchange powers the exchange of summary patient records between the DoD and the Department of Veterans Affairs, supporting the Virtual Lifetime Electronic Record (VLER). The next pilot project for the VLER is slated to start in September. "By September 2012, we hope to have a significant portion of veterans covered within the Nationwide Health Information Network,” said Fridsma.
In all, 13 organizations are in production with Exchange, 41 are in the process of joining and ONC hopes to have 35 organizations online by the end of the year, he said.
Getting more organizations online will require improved operational efficiencies, which are in the works as well. “For technical evaluation, each participant must have the appropriate security and privacy safeguards in place. In the past, it has taken us weeks to sort out details, but when people are well-prepared and have access to good specifications, it can take us less than an hour to run through all auto testing,” said Fridsma..
Direct progress
Direct was established to take communication of health information beyond printers, faxes and unsecured email. “About 18 months ago, we were working on meaningful use criteria and some work going on with the [ONC Health IT Standards Committee] to figure out how we should use the Nationwide Health Information Network to support meaningful use,” continued Fridsma.
“Exchange had a use case [but] there were a lot of information exchanges described there that weren’t related to the use case [for Exchange].” The Direct specification enables people to push information to others who need that information in anticipation of care. “Direct extends a simple, secure, standards-based transport mechanism that allows participants to exchange information with known recipients over the internet,” he said.
Part of the Direct specification calls for attachments of documents that include XDR as a way to exchange information with Direct and Exchange.
Direct participants include EHR and personal health record (PHR) vendors, heath systems and federal agencies. In addition, as of March, 20 states have committee to incorporate Direct specifications into their HIE initiatives, he said.
Standards & Interoperability Framework
The S&I Framework, which started less than year ago, identifies specific health interoperability initiatives to guide design and development of a fully integrated, connected health information system, said Fridsma.
The goals are to move toward more computational implementation specifications via scalable processes; developing tools to increase the efficiency of IS development and maintenance; implementation specifications that are explicit and subject to less interpretation; and certification that is linked to standards and implementation processes.
This is necessary because “meaningful use is still a moving target,” and a lot of early policy suggestions have implied the need to exchange information rather than expressing it, added Fridsma.