How HIEs Can Prepare Clients for the ONC Interoperability Rule

Implementing ADT Notifications

The CMS rule will require all providers to send a notification to a patient’s provider after the patient is admitted, discharged, or transferred from another healthcare facility. HIEs can help enable this by embedding their own ADT notifications structure within the HIE service.

Manifest MedEx (MX), a nonprofit HIE network in California, currently helps facilitate patient data between 120 hospitals, 700 ambulatory care sites, seven health plans, 13 EMS providers, and six EMS agencies.

The California-based HIE currently offers real-time ADT notifications to its connected healthcare organizations and up to seven years of searchable patient medical history to improve clinical decision making, patient care delivery, and hospital savings.

“The great thing about an infrastructure like MX is we do the heavy lifting of going to the ambulatory providers, getting their patient panels, and setting up the panel,” Claudia Williams, Manifest MedEx CEO, said in an interview with EHRIntelligence.

“All the provider needs to do is share an ADT and we make it so the client does not have to figure it all out on their own. Then, sort of magically, when the provider shares the ADT, it gets routed to the right places. I think the rule was very clear in saying, providers don't have to satisfy every mechanism.”

If a provider is connected to an HIE, then it is likely connected to ambulatory providers, which Williams said should allow the provider to comply with the rules.

“I think that's really encouraging for those that are participating in those health information exchange networks,” Williams said.

Patient Data Exchange

The ONC interoperability rule primarily focuses on making patient data exchange more fluid for patients, payers, providers, and virtually the entire healthcare network.

To comply with the interoperability rule, communication between HIEs, vendors, and consultants is vital.

“The interoperability rule is one of the agenda items that we are always aware of and talking about,” Randy Thompson, chief health analytics officer at Billings Clinic, said in an interview with EHRIntelligence. “We have some consultants who are making sure that we're compliant with the interoperability rules. That's an extremely important area that we want to be compliant with. Our vendor is HITRUST certified, so cyber security is obviously a big concern, as well.”

The ONC rule will require information to be more standardized, integrating terminology standards on the information’s meaning.

“We're going to focus on far less standard Consolidated-Clinical Document Architecture (CCDA) and more standard United Stated Core Data for Interoperability (USCDI),” Michael Gagnon, executive director for HealtHIE Nevada, explained to EHRIntelligence. “This is not only much more constrained, but it also includes labs that must be coded to LOINC and things like that.”

The rule also requires APIs to open up access to patient data and forces providers to share this access, which ultimately relieves HIEs from this burden.

“One of the burdens we've always had in Nevada is that providers needed to pay their EHR vendors a sizeable fee to effectively push their data to somebody else,” Gagnon explained. “They get more value out of the data coming to them and they get less value out of their data going to someone else.”

“Although they want to be good citizens, it's expensive to be a good citizen, and they're less incentivized to be one,” Gagnon continued. “The business practices part of the information blocking rule will be just as important as the technology parts of the information blocking role.”

HIEs are in a good position to facilitate patient data exchange because it serves as a business associate, covered under HIPAA, removing the patient privacy risk.

“You come to us [the HIE], and we ensure that the data gets exposed to a particular app, but under conditions where it's still protected as a business associate,” Gagnon said. “I would create agreements with those organizations to make sure that patient data doesn't become freely available to everybody. It becomes used for the purpose it was intended for the patient's needs.”

HIEs contain patient data from diverse sources. An HIE can help aggregate or consolidate data instead of having providers open numerous APIs or connections to vendor applications.

“We've struggled with having patient portals because a patient sees multiple providers then has multiple portals,” Gagnon continued. “It just becomes very inconvenient and very just fragmented for them, but the HIE could solve that problem.”

“I'm not saying I'm jumping into the portal market for patients yet, but I've always jumped into the market of being the aggregator of the information and pulling it together into a particular singular dataset for all of my participants. That role will just be expanded and enhanced with the new rules.”

With the upcoming compliance dates right around the corner, HIEs, providers, and health IT professionals will be working together to make the transition as smooth as possible.