4 Best Practices to Improve HIE Optimization

In order for healthcare to move toward preventative care and patient population management, clinical information should be free flowing across networks between hospitals and physicians. For this reason, healthcare organizations need health information exchanges. The interoperability that successful HIEs can offer will allow hospitals and healthcare providers to share clinical and financial data to deliver care more efficiently. Unfortunately, not all HIEs are implemented or optimized effectively to achieve interoperability and potential beneficial outcomes. For instance, studies on HIE outcomes have found mixed results.

"The industry talks a lot about HIEs as 'the holy grail' of reducing unnecessary testing because in theory an HIE should help to avoid duplicate testing. We need more empirical evidence showing this to be true. Studies are showing the results can go either way. HIEs are still an emerging technology in terms of penetrating the market place and what they can do," says Dave Caldwell, executive vice president of Certify Data Systems.

For this reason, Mr. Caldwell believes healthcare organizations are not optimizing HIEs effectively. "I would like to argue that most of what [healthcare organizations and providers] have been doing in the HIE space is not [optimizing] HIEs for their greatest potential," says Mr. Caldwell. Here are four best practices hospitals can utilize to better optimize HIE solutions.

1. Consider HIE format options. In order for hospitals and health systems to utilize HIEs effectively, executives may want to heavily weigh HIE choices. Mr. Caldwell recommends moving HIE participation away from centralized models because physicians' patient data is located on one server. Physicians view patient data as the life of their practice, and if other providers have complete access to their data through a centralized HIE, they could lose patients. For this reason, centralized HIEs may be at a disadvantage for physician participation. "Hospitals have to realize — and some do — that they are not getting value from centralized HIEs. If physicians do not participate and offer their patient's ambulatory data to the HIE's centralized repository, then the HIE is almost useless," says Mr. Caldwell.

However, whether an HIE should be centralized and de-centralized depends on how the healthcare network is set up, says Arun Ravi, senior consultant in the North American healthcare group at Frost & Sullivan. The ability of a public entity or the state to effectively manage and maintain a centralized HIE solution should be part of a hospital's decision to participate. "A de-centralized HIE may make more sense in a State with more hospitals and health systems to share the responsibility of HIE maintenance. However, a centralized HIE requires less maintenance, and in a State like Hawaii, where there are not as many health systems, a centralized HIE could be more successful. The flow of patients between providers and the amount of providers in the State should influence whether the HIE is centralized or de-centralized," says Mr. Ravi.

2. Focus on interoperability. Hospitals need to look for an HIE solution that focuses on interoperability across potentially disparate EHR systems. Interoperability is one of the key outcomes of HIEs, and maintaining focus on that outcome will keep the HIE optimization on track. According to Mr. Caldwell, cost-reduction and physician alignment is not achieved as easily with a third-party central web portal. The data does not need to sit in a central repository; it just needs to be accessible to providers so that a patient can be matched across all care locations. According to Mr. Caldwell, a system that uses edge servers and real-time queries to access data will achieve interoperability while allowing physicians to maintain control over their data.

"The idea is similar to how Google operates. No information accessible through Google is kept on one central server. Instead, when a search term is entered, all the relevant information is queried. This is how HIEs could work for healthcare. Hospitals and physicians would only be able to query patient data when the patient was presenting. They wouldn't have access to the data at all times, only when it would be necessary for care," says Mr. Caldwell.

3. More support from the CEO. When CEOs are not thoroughly invested in the HIE project it jeopardizes the success of the HIE. "The CIO should not be the only one thinking about the hospital's mission and strategy and how an HIE fits. If a hospital is going to spend significant dollars on an HIE, the CEO should be engaged in making the final decision. It is too big of a strategic initiative to risk and for this reason, CEOs need to be engaged at every stage of the process," says Mr. Caldwell. This does not mean the CEO needs to be involved in every day-to-day decision. "The CEO needs to have their finger on the pulse of the HIE project and its fit with the hospital's strategic direction," he says.

4. Engage physicians from an IT perspective. For HIEs to be successful, hospitals need to engage the physician communities they would like to share healthcare data with from an IT perspective. "Around 70 percent of physicians still practice in offices or centers with ten or less physicians. For this reason, they do not have 24/7 IT access because they cannot afford it. Whatever technology is deployed in a physician's office needs to be lightweight and easy to deploy from both the physician's and the hospital's perspective," says Mr. Caldwell. Hospitals need to consider the deployment of technology within their own facilities but also for the physicians in the community. Otherwise, the health exchange will not be community, regional or statewide. "For example, point-to-point interfacing is too unreliable, time consuming and labor intensive for physician offices and the hospital IT personnel when any changes are required," says Mr. Caldwell. If a physician office is still using an outdated technology — like point-to-point interfaces — it could hold up an HIEs success or a physician's participation in the HIE.

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