How HIEs Help Hit Healthcare Compliance, Cost Savings Goals

Compliance With the CMS Interoperability and Patient Access Final Rule

The CMS Interoperability and Patient Access final rule requires payer and provider organizations to demonstrate that their EHR system can send admission, discharge, and transfer (ADT) to all applicable post-acute care providers through the ADT messaging standard. This includes primary care practitioners and groups, and other practitioners and groups identified by the patient as primarily responsible for her care.

Paul Wilder, executive director of CommonWell Health Alliance, noted in a recent EHRIntelligence interview that compliance with the ADT messaging standard may come with challenges, as contact information for post-acute care providers is not common within EHR systems.

“Providers might have an entry somewhere of the patient’s primary care provider, but they’re actually not sure exactly how to get the message to them, or if the PCP wants it,” he told EHRIntelligence in an interview.

Wilder explained that intermediary connections to frameworks like CommonWell and regional HIEs often support ADT notifications, but a lot of networks are designed for pulling data first and later moving toward pushing data. In fact, CommonWell originally only had data pulling capabilities, he added.

Now, CommonWell can send ADTs from any facility to every other facility that has that patient in its database. Wilder noted that this capability is relatively new. He estimated that two to three dozen facilities out of 24,000 have signed onto ADT messaging through the health alliance, highlighting the beginning of an adoption curve.

Care organizations that are not connected to intermediary connections need to set up the push notification functionality for EHR data exchange on an individual basis, which is a transformational effort, he added.

“ADT alerts require pushing data which is different than pulling data,” Wilder explained. “When I'm looking for data, I actually don't need to know the other parties at all. When I'm pushing something, I need to know exactly where to send it.”

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

“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 a January 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.

Preparation for the Trusted Exchange Framework and Common Agreement (TEFCA)

According to a study published in Health Affairs, most state and local health information exchanges (HIEs) are supporting a vast number of services and are developing connections to each other and national networks in preparation for the Trusted Exchange Framework and Common Agreement (TEFCA).

Drafted by the ONC to fulfill the aims of the 21st Century Cures Act, TEFCA is a set of policies and standards to support the development of the Common Agreement. Ultimately, this should help support nationwide electronic patient data exchange across HINs.

HIEs are helping circumvent financial issues tied to patient data exchange, ultimately fulfilling the goals of TEFCA. Additionally, HIEs that can offer increased services will be in a stronger position to compete with national networks under TEFCA, the study authors wrote.

In 2019, the study authors conducted an HIE survey across the country to dissect the current state of HIEs and examine TEFCA-based responses.

Survey respondents revealed 89 active local and statewide HIEs, 17 fewer than a similar survey from 2014 identified. The 2019 survey also revealed 45 states, including Washington DC, leveraged at least one HIE, and 32 percent of health service areas in the country had more than one HIE.

Fifty-seven percent of HIEs connected to other HIEs in the same state and 53 percent to other states. Sixty-seven percent leverage eHealth Exchange, 46 percent connect to DirectTrust, and 38 percent leverage SHIEC Patient Centered Data Home (PCDH).

Ninety percent of HIEs exchanged medications, 87 percent exchanged problems, 84 percent exchanged laboratory results, and 83 percent exchanged immunizations.

Looking forward, 56 percent of HIEs planned to participate in TEFCA, while 41 percent were unsure at the time.

Health IT Cost Savings Through HIE Consortiums

Alaska’s statewide HIE, healtheConnect Alaska, recently joined a health IT consortium that connects them with stateside HIEs to save costs and promote innovation.

The HIE joined CRISP Shared Services, a collaborative of the Maryland statewide HIE and the HIE in Washington DC.

“Geographically on the surface, it doesn't look like it makes sense,” Laura Young, executive director of healtheConnect Alaska, said in a May interview with EHRIntelligence.

However, while Alaska is not likely to share patients with HIEs located in the continental US, healtheConnect Alaska shares similar values and technology with CRISP Shared Services, Young explained.

“The CRISP Shared Services group has some similar technologies, so it meant that we didn't have to do a complete migration to a whole other technology platform,” she continued. “We can maintain a lot of the things that we've already built. For us, it was really about how we could be the least disruptive in terms of any changes that we made.”

CRISP Shared Services presents data in a master patient index that has multiple lives in it for each state’s HIE, allowing for the organizations to share technology costs.

Young also explained that healtheConnect will benefit from the consortium from an innovation standpoint.

“Health information exchanges have been going on over 10 years now and we're all finding that we have some common problems to solve,” said Young. “The idea behind it is to come together to share technology ideas, resources, and best practices around health information exchange.”

As the digital health transformation continues, HIEs could provide the roadmap to widespread interoperability.