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Value Based Care: Medical Practices' Partnership with Health Information Exchanges

Health Information Exchanges are valuable partners for medical practices who want to have the fullest picture of the care a patient is receiving in the community.  They stand ready to assist and advise providers in the healthcare communities they serve.
Occasionally we read articles or hear people say, “Health Information Exchanges (HIE’s) are dead!” However, we here at Zen Healthcare IT know that is simply not true. And that is good news for the medical practice community.  Especially for those physicians and practices taking on “risk” to care for certain patient populations.
While it is true that not all communities are served by HIE’s (yet), where there is a regional or state HIE in your healthcare community, you are likely to see them expanding their services.  To accomplish this, they may merge or consolidate with another successful HIE in the state or region.  But either way, community HIE’s today are laser focused on making sure they offer the services that medical practices need when entering into value based contracting arrangements or when they just want a complete picture of patient care.
Here are three important ways HIE’s are supporting value based care in their communities:

  • Notification/Alerts of ED and/or Inpatient visits. Medical Practices managing patient populations need to know what is happening outside the context of an office visit.  Because the HIE’s receive data feeds from local hospitals, they can notify the medical practice when an event such as an ED encounter or inpatient admission has occurred for specified groups of patients.  Notification/Alerts can be delivered in various ways including Direct Secure messaging, a common transport method used today.
  • Results / Reports Distribution. With value based care, it is even more important for medical practices to have timely access to radiology, lab and other diagnostic testing results.  HIE’s often act as the hub to aggregate and/or distribute results across the healthcare community.  Independent Diagnostic testing specialty groups should actively engage with their local, regional or state HIE’s on this topic.  Otherwise, hospital based diagnostic services might suddenly have a competitive edge, since hospitals are frequently the “first in” to an HIE initiative.
  • Facilitating Transitions of Care. Whether it is providing visibility to EMS care when transporting a patient to the hospital, communicating hospital discharge information back to a primary care physician, or supporting primary care to specialty care hand-offs, HIE’s are increasingly moving beyond routing simple ADT type messages (primarily focused on demographic and basic encounter data) and routing more comprehensive Clinical Summary Documents (CCDA’s) across the community based on pre-defined business logic.

Imagine a business rule, for example, that says “every time a Medicaid patient is discharged from the hospital, update their provider(s) of record with a Clinical Summary Document.”  The business logic / routing capabilities of most HIE’s had expanded dramatically within the past year.
If your practice hasn’t engaged with your regional or state HIE yet, it’s time to consider making that a priority.  Not sure how to start?  Here are some suggestions from the Zen team:

  • What are your HIE options? Some communities are served by multiple HIE’s.  It’s important to do some research to understand which HIE offers your practice the greatest value. HIE’s will have different sustainability models and value-added services.  In addition to interacting with local and state resources to understand your options, there is also the national trade association of HIE’s called SHIEC – the Strategic Health Information Exchange Collaborative.

The members of SHIEC are some of the best examples of successful HIE’s across the country.  Visit their website to find a map of all their HIE members.  SHIEC members are a great resource and wealth of experience and we highly recommend reaching out to any of their members for assistance. http://strategichie.com/

  • If you have picked your preferred HIE, how do you get started with connecting? Next steps depend on your practice’s level of experience in dealing with setting up interfaces to outside healthcare organizations.  If you have in-house technical expertise with experience dealing with outside interfaces, then connecting to your HIE should not be hard.  However, if your organization doesn’t have that experience, you should proceed with caution.  Most practices tend to rely heavily on their EHR vendor for setting up and supporting interfaces.

However, this isn’t always the most cost effective approach.  It is important to understand your EHR’s policies and pricing related to interfacing. What are the initial upfront costs?   Are there ongoing fees (per interface or per transaction)?  Are there existing interfaces already working that can be leveraged to facilitate the HIE connection?  Is there funding available to help pay for the HIE connectivity? If this part seems overwhelming, strongly consider hiring a consulting project manager with HIE / interoperability experience to assist.
While there is some cost upfront for this approach, it may reduce overall costs, since you won’t be heading down the wrong path inadvertently.  Ask your preferred HIE partner which consultants they recommend. Most HIE’s have outside interoperability experts they work with routinely, and they’ll know who you can trust.

  • Clinical Workflow – what’s the best approach for incorporating HIE data into provider’s daily workflow? Workflow is directly tied to how the HIE data will benefit a provider and/or provider group.  In a primary care office, notifications and alerts may be the primary way a provider interacts with HIE data. The focus on workflow decisions should be how to best incorporate those incoming alerts into current workflows, while making sure important alerts don’t get lost in the noise of a busy practice’s internal communications.

For specialty practices, there is value in receiving Clinical Summary Documents from a primary care physician when a referral is made.  Or accessing the HIE Provider Portal directly as part of an initial patient workup.  Your preferred HIE partner will be able to share with you what has worked for other similar practices in your area. They are as invested in your successful use of the HIE as you are!


Insights provided by Marilee Benson, President of Zen Healthcare IT, Inc.  Marilee and her team are experts at architecting clinical data flows between medical practices, health information exchanges, healthcare technology vendors, and hospital/health system organizations. Their technology tools and practical expertise help these organizations overcome data exchange, consent models, and policy challenges to operationalize health information exchange and better patient care. Learn more about Zen Healthcare IT and their work with the largest HIE organizations by visiting http://www.consultzen.com/.

Last Updated on May 8, 2017

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