ONC12: Roundtable highlights HIE, interoperability efforts

Health information exchange (HIE) and interoperability are fundamental requirements for improving patient care, according to a panel of speakers who discussed the topic at the Dec. 12 annual meeting of the Office of the National Coordinator of Health IT (ONC). The speakers discussed their work and experiences during the session.

Meaningful Use (MU) Stage 1 contained good content standards, but there weren’t specific transport standards on how to get data to a patient or another provider, said John D. Halamka, MD, CIO of Harvard Medical School and Beth Israel Deaconess Medical Center in Boston. MU Stage 2 requires providers to exchange clinical summaries for 10 percent of transactions, and 5 percent of patients must do something with their online records. That incentive—providers won’t get paid unless they actually use their EHRs for these specific purposes—will drive patient engagement.

“We think of interoperability as not only for communication from provider to provider, platform to platform but also from provider to patient, provider to registry and potentially from provider to device to really coordinate that care,” said Justin Barnes, vice president of marketing, industry & government affairs, Greenway Medical Technologies. MU goes beyond a list of requirements. Providers need to determine what they want to achieve beyond each stage. What do you want your practice or your hospital to look like? How can you engage the community of health through interoperability? How can you make sure patients are engaged in their health and becoming more accountable which is “critically important in this process. We need to unleash data to make sure we have true data liquidity to create a more sustainable healthcare system.”

“Meaningful Use provides a focus,” said Doug Fridsma, MD, PhD, director of the ONC’s Office of Science and Technology. “Sometimes getting that focus and being able to identify very specific problems to solve helps focus energy and that’s an accelerant.”

ONC provides the convening space for these conversations, Fridsma said. Rather than one group identifying a problem, another group creating a solution and a third group do the implementation of the solution, “we can create a forum where we can feed off of each other to try to make sure we’re focused on the right problems.” The office also provides technology “to try to lower the barrier for people to collaborate and coordinate.” Our job is to serve as a platform for people to be successful in communities. These standards aren’t being developed by us. They’re being developed by people who are passionate about standards development, providers trying to solve real problems, vendors and others that are trying to provide solutions.

Every single hospital in Maryland is connected to the state’s HIE and feeds at least ADT data, said Josh Sharfstein, PhD, Maryland's secretary of health. “The HIE is a terrific asset in Maryland. For our hospital payment system, we have the only rate-setting payment system in the country, one of key issues is our readmission program.” A unique identifier allows for tracking of patients as they move from hospital to hospital so hospitals can get very specific information about patients. “That’s important to hospitals because that’s how they’re paid.”

Meanwhile, the HIE allows primary care providers to be notified in real time when their patients go to the hospital or emergency department. The information comes right out of the HIE through an ADT feed. “It’s one thing for a primary care provider to receive a fax about it later on but another to be notified right away so he or she can help manage the care.”

Maryland also is moving forward on development of maps to see particular acuity. “Even if you’re just looking at ER visits, it’s amazing what you can see on a map.” With the amount of clinical information now available and growing, “there is going to be an enormous opportunity between that and the public health side,” said Sharfstein.

Accountable care is driving the need for community-wide measures and community-wide data exchange, said Halamka. “We’re now seeing the rise of private HIEs to create registries and repositories in the interest of keeping people well and provide not too much care and not too little care. You can’t be an ACO unless you have an HIE strategy and care management strategy based on aggregating data across multiple sites of care.”

Data must be shared across competitive organizations, Halamka. “We can’t survive unless we ‘coopertition.’”

Within two years, patients are going to demand that information be shared between HIEs, Halamka predicted. “Infrastructures are being built. It’s becoming real. We, as patients, never want our wives or our children to experience paper-based transfers ever again.”

Most surveys about public health measures reflect the situation between six and 18 months earlier, said Sharfstein. “If we can use HIE to assess interventions, and assess the effectiveness of different strategies at different levels from the previous week or month it is a totally different experience about are we getting better and if not what can we do? It offers tremendous potential that will transform not just healthcare but public health also.”