HIE market still a little like the 'Wild West'

CAMBRIDGE, MA – Healthcare organizations have been very focused over the last two to four years on rolling out their electronic health record strategy, which has been driven largely by the meaningful use incentives. Today, however, Integrated delivery networks (IDNs) are starting to recognize that their EHRs alone will not solve every problem – especially care coordination issues between IDNs.

“We’ve seen much more of a focus with the IDN this year on what do we do next, what is the platform that enables us to leverage the EMR that we’ve invested in and build a more connected healthcare system,” said Paul Grabscheid, vice president of strategic planning for Cambridge, Mass.-based InterSystems. “We see much more interest than ever before among healthcare providers doing more to connect with their patients through patient portals and community-building capabilities.”

[See also: HIE as a verb: ONC wants to move quickly on data exchange]

IDNs want to get the most complete, most useful and usable information about patients from different systems to their clinicians when they need it to identify, for example, a population that’s important to them or identify patients who are in that population in order to systematically deliver better quality care, according to Grabscheid.

This business and clinical requirement has made health information exchange (HIE) attractive to IDNs and large providers because the value of HIE is its ability to intelligently aggregate patient data from multiple sources and present a comprehensive view of the patient’s medical status and history.

It comes as no surprise then that the larger market for HIEs is with IDNs and larger providers.

[See also: HIE on the upswing]

“It’s a younger market that is not so well crystallized yet,” Grabscheid observed.

As he sees it, despite the growth in this segment of the market, what’s lacking is a common understanding which software is needed to solve those problems and how best to solve those problems.

“There’s a lot of opportunity for education in the market and a lot of experimentation,” Grabscheid said. “It’s still a little bit of the Wild West.”

Grabscheid pointed out that simply exchanging pieces of data does not leverage the full value HIEs can deliver. He highlighted three IDNs that are looking to take advantage of InterSystem’s HealthShare’s HIE platform. A data model takes all the information accessible through HealthShare and makes it available for analysis via the analytics core technology. Key performance indicators or metrics can then be measured, and those results can be translated into charts and reports and onto dashboards to help clinicians and other users make sense of the data.

One IDN, which comprises 10 hospitals and 20 service sites, and also serves as a payer, is looking to connect its internal and external systems, which include Cerner and Epic EHRs, as well as create comprehensive patient records for provider and patient portals. One of the goals of the IDN is to reduce readmissions for its congestive heart failure patients through the use of analytics. Finally, the IDN wants to link to the regional HIE in its area.

A six-hospital IDN with a large primary/specialty care network is leveraging the HIE platform to streamline multi-payer administrative transactions; enable comprehensive record sharing between acute and primary care providers; alert clinicians of events to ensure safer, more effective care transitions; increase the effectiveness of primary care, specialist, and acute-site referrals; and automate public health reporting to local, state and federal authorities.

A large urban health system, comprising hospitals, clinics, skilled nursing facilities and home health, and serving more than one million patients, has a plan to connect its multiple EMRs, financial systems and more than 500 applications in order to present a consolidated patient record across the enterprise. Once that is accomplished, the IDN will connect to the seven regional health information organizations (RHIOs) in the area.
 
All three are leveraging the HIE platform for multiple initiatives that involve connectivity, interoperability, analytics, and quality measuring and reporting, which will deliver business and clinical benefits that surpass the EMR’s capabilities.

“They’re trying to figure out what they can see right now,” Grabscheid said, of the three IDNs. “But the one thing they know for sure is there’s more change coming,” he added, referring to the upcoming presidential election. “The most important thing in healthcare right now is staying nimble so that as the rules change you can react,” he said. “Trying to guess what is happening and start doing that is too tough. The key is to keep flexible.”

Backers Of Cost-Free Coverage For Birth Control Fault Legal Challenges

Andrew Shaw/iStockphoto.com

You know all those lawsuits now pending around the country charging that the Obama administration's rule requiring most health insurance plans to offer no-cost contraception is a violation of religious freedom?

Well, a whole bunch of supporters of the rule are chiming in now to say that argument has no legal merit.

The dozen new suits, representing some 43 Catholic dioceses, universities and charities "have made a splash by virtue of their number, but when you take a moment to actually look at them, there's nothing to see," Sarah Lipton-Lubet, policy counsel for the American Civil Liberties Union, wrote in a blog post. "The rule is constitutional, it violates no federal law, and it's incredibly important for women."

 

Lipton-Lubet is talking about the rules issued in January (and amended in February to address the religious backlash) that require prescription contraception and sterilization services to be available without additional copays as part of most health insurance packages.

While those filing the lawsuits charge that offering the coverage (or even being forced to facilitate it) in violation of their religious belief runs afoul of the First Amendment's guarantee of freedom of religion, Lipton-Lubet points out that the Supreme Court has already weighed in on the question.

"The Free Exercise Clause does not require any exemptions from a neutral law of general applicability. As the Supreme Court held two decades ago, in an opinion authored by Justice Antonin Scalia, to do otherwise would be to create a system "in which each conscience is a law unto itself." Translation? If it applies equally and doesn't target any faith, it's not a First Amendment violation."

(Backers of the church challenges, however, point to a more recent case, a unanimous ruling this past January, where the justices said religious organizations should have broader hiring and firing power than other businesses.)

But even setting the Supreme Court aside, pointed out Ian Milhiser of the Center for American Progress, more than half the states already require contraceptive coverage. And the issue has already been litigated at that level by the Catholic church � and the challengers lost.

In 1999, in California, Milhiser wrote, "five of the court's six Republican justices held that, even if the law were examined under the strictest level of constitutional scrutiny, California's contraceptive access law is constitutional."

And even if the issues hadn't been litigated before, the current cases are premature, says Nancy Northup of the Center for Reproductive Rights. That's because the work on the regulations remains ongoing.

"This is the most cynical kind of political theater and nothing more," she said in a statement. "Rather than working constructively with the Administration and allowing the rulemaking process to reach a resolution, these groups have chosen to grab headlines with a political stunt that will only burden the courts with untimely claims."

But even though most religious-based organizations will have an additional year � until August 1, 2013 � to come into compliance with the new requirements, some are already taking action.

The 2,800 student Franciscan University of Steubenville in Ohio, for example, announced earlier this month that it would stop offering health insurance coverage for students this fall rather than comply with the mandate.