Health Care Informatics
Writing Assignment Content
- Nursing Leadership Informing Community Health Information Exchange Strategy
You are in the chief nursing officer role and have been asked by your healthcare system to represent the hospital on the board of a new not-for-profit entity established by your community to build and manage the HIE within your region. Your region has been awarded a federal grant of $250,000 to build the HIE to serve the community. At the first board meeting of diverse stakeholders, including payers, providers, hospitals, public health, and healthcare consumers, the group must advise the chief executive on what type of exchange the group believes is needed. The chief executive indicates that a basic exchange using the Direct Project protocols for the size of the community is likely to exceed the federal grant dollars, and as such, the group needs to align on a value proposition of what the community needs. This is hoped to result in the community being willing to pay for the additional costs.
The community has a population of more than 250,000, with a significant indigent population that tends to use the ED as an access to care for routine healthcare needs. Hospital staff also suspect that they have drug seekers going from one ED to the next seeking additional medications, yet do not have the information to confirm this suspicion or to track patients from one institution to another.
The community has two major healthcare systems that are heatedly competitive and unlikely to be willing to share data in a central data repository. Providers in the community compromise one large-practice consortium and multiple independent providers. The large group of providers is demanding that some sort of exchange be established to support their referral base. As a result, there is heated debate as to whether the community aligns with a business and infrastructure strategy.Based on information within Chapter 11, consider the following questions:
1. Based on the needs of the community noted in the case study, what is your recommendation as to the best infrastructure and technical exchange model that the community should promote?
2. What are some of the barriers consistent with other communities’ failures that might be issues for your community and how do you overcome those issues?
Please note the grading rubric. The submission should be maximum 2 pages not counting the cover page and references.
CHAPTER 11
Electronic Health Records and Health Information Exchanges Providing Value and Results for Patients, Providers, and Healthcare Systems
INTRODUCTION
National Academy of Medicine envisioned:
A safe, effective, patient-centered, timely, efficient, and equitable healthcare.
eHealth Exchange was envisioned under the Health Information Technology for Economic and Clinical Health (HITECH) Act.
To connect the nation through health information exchanges (HIEs) at regional, state and federal level.
Health information exchange is fundamental to multiple acts like HITECH Act.
To establish meaningful use (MU), Medicare Access and CHIP Reauthorization Act (MACRA) provisions, 21st Century Cures Act.
Technical and financial issues hamper the realization of the envisioned healthcare system.
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HISTORY OF HIEs COMPARED WITH CURRENT HIEs
Historically significant community-based initiatives for healthcare data exchange includes:
Community Health Management Information Systems (CHMIS): payer-driven model to assess eligibility and address high healthcare costs.
Community Health Information Networks (CHINs): commercially driven endeavors to reduce costs for providers.
Regional Health Information Organizations (RHIOs): neutral, third-party organizations involved in regional exchange of data.
Health information exchanges (HIEs) are community-based initiatives funded under HITECH Act.
To lay the architecture of exchange.
eHealth exchange (eHEX) is a group of federal agencies and non-federal organizations.
Aim is to maintain infrastructure to support health information exchange.
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TRUSTED EXCHANGE FRAMEWORK and COMMON AGREEMENT (TEFCA)
Trusted Exchange Framework and Common Agreement (TEFCA) is a set of common agreements among HIEs.
Includes standards to establish a nationwide HIE.
Expected to go live this year.
Recognized Coordinating Entity (RCE) is the governance body responsible to:
Draft the Common Agreement and requirements for joining TEFCA system.
To join TEFCA, Qualified Health Information Networks (QHINs) must:
Fulfill the minimum terms and conditions.
Sign the Connected Agreement.
Other national initiatives working to increase interoperability are:
Sequoia Project
Carequality
CommonWell Health Alliance
Strategic Health Information Exchange Collaborative (SHIEC)
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ARCHITECTURAL AND DATA-EXCHANGE MODELS FOR HIE
HIE can vary. It depends on whether the data is managed in a:
Centralized repository
Decentralized manner or
A combined approach
Two models supporting technical exchange of data:
Direct-messaging
Query-based transactions
Direct-Messaging Project runs through DirectTrust, a collaborative non-profit association.
Supports secure, interoperable health information exchange via Direct-message protocols.
Query-based exchange allows the providers to find information when delivering unplanned care.
The Patient Unified Lookup System for Emergencies (PULSE) enables query-based exchange for natural and other disasters.
PULSE has helped providers during California wildfires and Hurricane Harvey.
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STANDARDS AND INTEROPERABILITY FRAMEWORK
National exchange of data is a major challenge.
The Standards and Interoperability (S&I) Framework promotes interoperability.
S&I Framework addresses development of specific areas involved in health information exchange.
United States Core Data for interoperability (USCDI) contains standards applicable on application programming interfaces (APIs).
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BUSINESS MODELS
HIEs vary across the nation in terms of architecture and business model purposes.
Value-based services that HIEs provide:
Referral management
EMR publishing and transfer
Provider of clinical messaging and notifications
Demographic and clinical data exchange
Data feed and interfacing
Analytics and reporting
State agency connectivity
Alerts
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HIE AND 21ST CENTURY CURES ACT
21st Century Cures Act:
Has reformed the Federal Drug Agency.
Supports Precision Medicine Initiative.
The statutory definition of Interoperability as defined by the Act:
Enables secure exchange of electronic health information
Allows complete access for authorized use under applicable State and Federal law
Does not constitute information blocking
The Interoperability and Patient Access Final Rule:
Clarifies what does and does not constitute information blocking under the Cures Act.
Prohibits developers from restricting how the customer is using the service.
Office of the National Coordinator (ONC) Rule includes eight circumstances.
Failing to share information is not considered information blocking.
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MASTER PATIENT INDEX AND RECORD LINKAGE
Master Patient Index (MPI) and a record-locator helps identify unique patients across institutions.
MPI applications provide passive or active functionality to identify individuals.
Primary methods for linking records with HIEs:
Deterministic
Rule-based
Probabilistic
Linking records in a central data repository model can:
Allow tracking and trending of outcome measures in a care setting.
Examine chains of readmissions.
To determine factors that might be targets for improvement.
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VALUE OF HIE COUPLED WITH EHRs
Studies have shown allowing physicians to access patient data from EHRs results in:
Fewer repeat procedures
Reduces medication errors
Fewer diagnostic tests
Follow-up visits decrease
Cost savings increase
Success of nationwide health information exchange depends on:
The privacy and accuracy of the information being exchanged.
The Data Use and Reciprocal Support Agreement (DURSA) serves as the main legal framework.
For eHEX participants
To ensure privacy protections are followed.
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SUMMARY
Health Information Exchange can help achieve goals for the eHEX and the TEFCA system.
For safe, effective, patient-centered, timely, efficient, and equitable healthcare.
TEFCA, expected to go live this year.
Aims to establish a nationwide HIE by setting common standards for national information exchange.
The HIEs can vary in architecture and business model.
Based on the needs of the region or state.
Linking the records of patients using MPI helps:
Track and trend outcomes.
To determine targets of improvement within healthcare delivery system.
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