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GEN i - The Integration Generation in Healthcare

01.31.2012

What is Integrating the Healthcare Enterprise (IHE)?

by Rob Brull

IHE is a group of health care industry representatives that work to improve the way health care systems share information electronically. The group was formed in 1998 as a cooperative venture by the Healthcare Information and Management Systems Society (HIMSS) and the Radiologic Society of North America (RSNA) with the goal to promote interoperability among imaging and health care information systems. Today, IHE membership includes more than 200 global health care professional associations and health care vendors.

IHE encourages the use of established interoperability standards such as HL7 and DICOM. Systems developed in accordance with IHE communicate with one another better, are easier to implement and help health care providers use information more effectively and, ultimately, provide better patient care.

What can IHE do for Health IT Professionals?
Creating interfaces between systems is a key challenge faced by many health care IT departments. Understanding the differing implementation of standards in various vendor systems and creating a way to share information between those vendors is challenging.

IHE offers a common framework for vendors and IT departments to understand and address clinical integration needs. IHE Profiles, described below, are not just data standards, they describe workflows, which makes them more practical for use by healthcare IT professionals and more applicable to their day-to-day activities.

Because IHE’s membership includes a wide array of end users, it focuses on solving relevant integration issues. These solutions provide vendors with many benefits including:

  • Shorter, less costly implementations.
  • Cross-system dataflow out of the box.
  • Smoother, complete workflows.

IHE Profiles
IHE strives to solve specific integration problems faced by its membership in the real world through Integration Profiles. These profiles define the systems involved (i.e., actors), the specific standards used, and the details needed to implement the solution. Each profile offers developers clear communication standards that have been reviewed and tested by industry partners.

Commonly Used Health IT IHE Profiles for Interoperability

XDM – Cross-enterprise Document Media Interchange
What it’s used for: According to IHE, XDM transfers documents and metadata using CDs, USB memory or email attachments. This profile supports environments with minimal capabilities in terms of using Web Services and generating detailed metadata. This standard is utilized by the Direct Project.

Example: Using secure e-mail, a physician e-mails the patient’s CCD to the patient’s Microsoft Healthvault e-mail account for uploading to the patient’s online PHR.

XDR – Cross-enterprise Document Reliable Interchange
What it’s used for: The exchange of health documents between health enterprises using a web-based, point-to-point push network communication, permitting direct interchange between EHRs, PHRs and other systems without the need for a document repository.

Example: A nurse at Hospital A enters a patient’s information in the local EHR, and then sends the CCD directly to Hospital B’s system.

XDS.b – Cross-enterprise Document Sharing
What it’s used for: The sharing of documents between any health care enterprise, ranging from a private physician office to a clinic to an acute care in-patient facility, through a common registry.  Medical documents can be stored, registered, found and accessed.

Example:

  1. Hospital A has a document to store. Hospital A creates a description and metadata for the document and submits it to the HIE Repository.
  2. The HIE Repository accepts the document with metadata. It stores the document and forwards the metadata to the HIE Registry.
  3. The HIE Registry receives a query from Hospital B and identifies the document as a match based on the metadata.
  4. Hospital B retrieves the document from the HIE Repository.

XDS-I.b – Cross-enterprise Document Sharing for Imaging
What it’s used for: The sharing of images, diagnostic reports and related information through a commonregistry.

Example: A radiologist accesses the local HIE, in a similar manner as for XDS.b, to find a MR report conducted and uploaded to the HIE at Hospital A.

PDQ – Patient Demographics Query
What it’s used for: Requesting patient ID’s from a central patient information server based on patient demographic information.  Used when a system has only demographic data for patient identification.

Example: Hospital A admits Patient Y, who has not been at the hospital before. Hospital A submits a request to the local HIE, based on demographic information such as name, birthdate, sex, etc., to obtain the appropriate HIE patient ID for Patient Y.

PIX – Patient Identifier Cross Referencing
What it’s used for: Cross-referencing multiple local patient ID’s between hospitals, sites, health information exchange networks, etc. Used when local patient ID’s have been registered with a PIX manager.

Example: Hospital A transmits Patient D’s ID information to the HIE for cross referencing. Hospital A receives Patient D’s local ID for Hospital B which they can use to request information from Hospital B, based on need.

 

IHE Integration Profiles provide standards that address specific needs, eliminating ambiguities and ensuring a higher level of practical interoperability. Because it encourages use of established healthcare standards such as HL7 and DICOM, IHE is in a unique position to accelerate the process for implementing standards-based interoperability among electronic health records systems.

For more information visit: www.himss.org/ASP/topics_ihe.asp.
 

Tags: Health Information Exchange, Healthcare Interoperability, Health IT Matters

01.04.2012

Health Information Exchange: What’s the Motivation?

by Chad Johnson

HIE Series. Part 1 of 6.

Now that the majority of innovative healthcare organizations have invested the capital, the time and the effort to install electronic medical records, many are looking to fully leverage the technology by connecting to a health information exchange, or HIE.

According to eHealth Initiative’s "2011 Report on Health Information Exchange: FAQs," there were 255 HIEs in 2011, an increase of 9% from 2010. A majority (70%) of existing HIEs are private, yet just 24 total claim to be sustainable.

See: Forward-Looking Organizations are Connecting to HIEs to Improve Care

There are several reasons why HIEs are a logical “next step” for health providers who have implemented EMR systems, including qualifying for Meaningful Use or serving as a precursor – or “test case” – for connecting to a future Accountable Care Organization. Whatever the motivation, both examples can mean significant revenue for the organization:

  • The earlier a health care organization qualifies for Meaningful Use Stage 1 requirements, the more financial benefit the provider or health organization will receive as part of the Medicare Electronic Health Records (EHR) incentive program. For Medicare-eligible hospital systems, qualifying for Meaningful Use in 2011 means receiving millions of government dollars earlier than if they qualify at a later date. (Visit this CMS Meaningful Use page and scroll down to the “Medicare-Eligible Hospitals” section for detailed reimbursement information.)
  • Care providers who are members of an ACO, as defined in the Affordable Care Act, can potentially earn significant Medicare rewards for the realized cost savings from bundled payments and meeting pre-defined quality of care benchmarks. While EMRs are not required of all ACO providers, they are required to perform an analysis of the ACO’s overall patient care metrics against the 32 benchmarks set by the U.S. Department of Health and Human Services.

HIEs also have the potential to provide cost savings to connected organizations in the forms of increased productivity, avoidance of duplicate medical procedures, and the resulting shared savings as a result of payment by episode of care.    

While revenue or a positive return on investment is always the key motivator for organizations to make costly business moves such as installing EMRs or paying to connect to HIEs, the good news for patients – which includes everyone – is that both Meaningful Use requirements and ACOs share a common end result – improving the quality of patient care.

The argument whether or not HIEs or ACOs are the proper way to improve the patient experience are best left for political blogs. The reality for health IT professionals is that HIEs are forming in every state, yet there is uncertainty about the different forms of HIEs and what challenges health organizations likely will face when trying to exchange data within a HIE.

I hope to help address these topics in future articles in this six-part HIE blog series. Themes of future posts will include:

  • HIE Architecture Types
  • Concerns with HIEs
  • Building Blocks of HIEs
  • Communication Methods
  • Patient Portals

Additional Resources

  1. Round Table on HIE Connectivity: Real Experiences with Health Information Exchanges
  2. EHR/HIE Interoperability Workgroup Releases Technical Specifications
  3. Meaningful Use, EHR Certification, & Healthcare Integration

Tags: Health Information Exchange, Healthcare Interoperability, Infrastructure, Workflow, Meaningful Use & HITECH

12.07.2011

What Does the Meaningful Use Stage 2 Timeline Extension Mean For Providers?

by Rob Brull

On November 30, 2011, the U.S. Department of Health and Human Services (HHS) announced that eligible providers that start participating in the Meaningful Use Stage 1 incentive programs in 2011 can delay meeting the new standards for Meaningful Use Stage 2 to 2014, rather than the original deadline of 2013. This shift in requirements was marketed as a method “to encourage faster adoption” by HHS Secretary Kathleen Sebelius.

Sebelius said, “When doctors and hospitals use health IT, patients get better care and we save money. We’re making great progress, but we can’t wait to do more.”

Logically, it seems counterintuitive that a delay in a deadline would encourage faster adoption rates by providers. But, here is how the incentive is supposed to work:

  • Prior to the delay, if a provider completed Stage 1 Meaningful Use in 2011, then they would have to complete Stage 2 Meaningful Use by 2013.
  • If a provider completed Stage 1 Meaningful Use in 2012, then they would have to complete Stage 2 Meaningful Use by 2014.
  • Thus, in order to lock in the 2014 deadline, it is suspected that many providers who were capable of attesting to Meaningful Use Stage 1 in 2011 were instead purposely waiting until 2012 to attest.

HHS officials said they are confident the timeline extension will encourage providers to accelerate their adoption of EHRs. There is now a major advantage to attesting to Stage 1 in 2011: Providers who first attest in 2011 can get three payment years for meeting Stage 1 requirements. Providers first attesting in 2012 will only get two payment years under Stage 1.

This announcement has no impact on eligible hospitals that had not already attested in 2011, only eligible providers who have not yet attested. Eligible hospitals are on a fiscal calendar that ends in September and thus will not have the opportunity to attest in 2011. Eligible providers have up to 60 days after the end of the calendar year to submit required data.

HHS indicated that the announcement is based on input from the healthcare community that the current schedule for Stage 2 compliance in 2013 was unrealistic. This sentiment was largely due to the fact that the Stage 2 rules would not be released until June 2012. Once the rules were released, the EHR vendors would first need to design, release and certify compliant software. After which the provider would have been responsible for upgrading and collecting the required data before the end of year 2013.

HHS claims to be working towards a realistic balance between achieving desired results of EHR implementation with the practical realities that providers are facing in implementing EHR systems. However, there are trade-offs to consider in this approach:

  • On the positive side, more providers will likely implement EHRs sooner than they would have otherwise. Although only slightly sooner, since this announcement was made towards the end of the year.
  • On the negative side, there are likely many providers and hospitals that would have stepped up to the challenge of a 2013 deadline for Stage 2. But with the delay, most will likely take their time and implement Stage 2 in 2014.

Since Stage 2 gets the industry much closer to greater interoperability and quality of care, it is disappointing to see that hospitals and providers will not be challenged to at least try to reach the Stage 2 metrics sooner. But on the brighter side, maybe this will allow the industry to achieve the Stage 2 metrics together in a more consistent and controlled manner.

 

 

 

 

Tags: Meaningful Use & HITECH

11.16.2011

EHR/HIE Interoperability Workgroup Releases Technical Specifications

by Rob Brull

The EHR/HIE Interoperability Workgroup released its initial technical specifications Nov. 8, 2011. The specifications aim to standardize connections between healthcare providers, health information exchanges (HIEs) and other entities involved in communicating patient health information. The specifications can be downloaded from the group’s website: www.interopwg.org.

This workgroup started as an initiative in the state of New York, with the founding member being the New York eHealth Collaborative (NYeC). There are now seven federally designated counterparts, including the states of California, Colorado, Maryland, Massachusetts, New Jersey, New York, and Oregon. The group is looking for widespread adoption as the specifications gain momentum.
 
The group has gained the support of both the Director of the Office of Standards & Interoperability at the ONC, Dr. Doug Fridsma, and the Co-Chair of the HIT Standards Committee, Dr. John Halamka:
 
"I am encouraged by and excited about this type of collaboration, which has the potential to advance real-world pilots, implementation and feedback on standards for health information exchange. The results of this kind of initiative can help us advance health IT nationwide." --Dr. Doug Fridsma
 
"I applaud the work that the EHR/HIE Interoperability Workgroup is doing to move states from implementation guides to production. I expect that the flexibility and agility of the EHR/HIE Interoperability Workgroup will serve as an ideal laboratory for standards that are rapidly evolving." --Dr. John Halamka
 
In developing the standards, the workgroup used as a baseline existing HL7 standards, profiles from IHE International, and HIE implementation experience as inputs for the initial version of the specification. For this first set of specifications, the focus is on two use cases along with additional constraints around the specification of a Continuity of Care Document (CCD). 
 
  • Statewide Send and Receive Patient Record Exchange Use Case. Includes guidance on how encrypted health information can be transmitted over the Internet.
  • Statewide Patient Data Inquiry Service Use Case. Provides details regarding the clinician's ability to query an HIE for relevant patient health information.
  • Specifications related to the CCD document. Provide additional constraint to the HITSP specifications for a CCD. 
The additional constraints for the CCD are aligned with the overall goals of HL7 Version 3, which include:
  • Reduced optionality.
  • Increased consistency of documents.
  • Reuse maximization.
The EHR/HIE Interoperability Workgroup next steps includes evaluating potential reference implementations of the specifications across states and with different vendors; and working on future capabilities, according to their website.
 
Dowload the free white paper, “Continuity of Care Document (CCD): Changing The Landscape of Healthcare Information Exchange.” to learn more about CCDs and how they're changing how health care – and what health data – is exchanged in HIEs and in the handful of functional Accountable Care Organizations (ACOs), 

Tags: Health Information Exchange, Healthcare Interoperability, Leadership, Workflow, Health IT Matters

10.21.2011

Final ACO Rule Issued to Mostly Sighs of Relief & Support

by Jon Mertz

In a press announcement yesterday (October 20, 2011), the Department of Health and Human Services (HHS) issued the final rules for Accountable Care Organizations (ACOs), created by the Affordable Care Act. HHS Secretary Kathleen Sebelius stated:

“Today we have taken another step to improve health care for people with Medicare. We are excited to give doctors, hospitals and other providers the flexibility and support they need to work together and focus on making sure patients get the care they need.”
In the release, two initiatives were launched that help the formation of ACOs. The release outlined these two initiatives as:
  • The Medicare Shared Savings Program will provide incentives for participating health care providers who agree to work together and become accountable for coordinating care for patients. Providers who band together through this model and who meet certain quality standards based upon, among other measures, patient outcomes and care coordination among the provider team, may share in savings they achieve for the Medicare program. The higher the quality of care providers deliver, the more shared savings the providers may keep.
  • The Advance Payment model will provide additional support to physician-owned and rural providers participating in the Medicare Shared Savings Program who also would benefit from additional start-up resources to build the necessary infrastructure, such as new staff or information technology systems. The advanced payments would be recovered from any future shared savings achieved by the Accountable Care Organization.
The American Hospital Association (AHA) was quick to support the adjusted final rules, stating:
“In response to the concerns of the AHA and its hospital members, CMS made significant changes to the financial model, provided more flexibility in the assignment of beneficiaries and took a second look at the quality framework. We believe today’s menu of ACO options allows America’s hospitals to create new models of accountable care organizations on which the transformation of health care delivery is so dependent.”
In a Healthcare IT News article – “Final rule eases ACO regulations, lifts EHR requirements” – the following changes were outlined:
  • In the proposed rule ACO requirements were to be aligned with EHR requirements, by stipulating that “50 percent of primary care physicians must be defined as meaningful users by start of second performance year.” The final rule has eased this burden by making it “no longer a condition of participation,” and instead has “retained EHR as a quality measure but weighted higher than any other measure for quality-scoring purposes.”
  • The final rule requires 33 measures in four domains, instead of 65 measures in five domains required by the proposed rule.
  • The final rule makes the one-sided model truly one-sided. It still offers two tracks for “ACOS at different levels of readiness, with one providing higher sharing rates for ACOS willing to also share in losses.”
  • The final rule expands participation to Rural Health Clinics and Federally Qualified Health Centers and organizations where specialists provide primary care.
  • The final rule provides a more a flexible starting date in 2012.
Although providers seem to be satisfied with the new regulations, employers and insurers were less than pleased. The American Benefits Council, which represents employers, stated:
“The final rule includes a clear recognition that not all ACOs will benefit consumers and reinforces that existing antitrust rules will be vigorously enforced. But words alone will not be sufficient to ensure that consumers and purchasers are protected from unjustified price increases, lower quality care or restricted access to health care providers and services." (Council President James Klein)
The next phase of new regulations and changes to our US healthcare system are moving forward, and it essential to keep current in order to adjust workflow and health IT initiatives to meet the new operating guidelines.
 
Additional resources to read:

Tags: Meaningful Use & HITECH