HIEs – Start with the end result in mind

Health Information Exchanges or HIE is a major topic in healthcare discussions across the country.  As we move to greater use of computers to collect information on patients and treatment protocols, HIEs are the next step to utilizing that data to derive better outcomes.  For as long as I can remember, hospitals have gone to great lengths to coordinate their care across multidisciplinary teams to optimize care for their patients.  Combining efforts of many hospital departments, clinicians, and physicians to share patient information and coordinate care plans that improve outcomes has been the goal.  With HIEs, the healthcare industry faces the challenge of sharing information electronically beyond the hospital walls with multiple care entities.  These entities utilize their own legacy systems presenting IT issues in determining a communication standard regarding how this information can be shared and what should be shared.  To begin this process and get a positive result, we need to review why HIEs were proposed in the first place.

The creation of HIEs is supposed to bring higher quality care, lower cost, and better clinical outcomes.  So, with this in mind, focusing on those outcomes should be the starting point, beginning with a chronic disease process such as Diabetes or Congestive Heart Failure where an intensive effort in resources could produce a dramatic improvement in outcomes and cost.  Where are the patients treated?  Hospitals, physician offices, nursing homes all have a role in the health of patients in these disease processes.  Who else?  Visiting nurses, retail pharmacies, urgent care centers also come in contact with these patient groups.  How do we get them linked and what do we share?   I am not an IT expert but do appreciate the challenge of moving information in and out of different software platforms so that shared data is available to the end-user.  For the purpose of this blog, I am going to focus more on the data utilized by the end clinical user.  With Diabetes and Congestive Heart Failure there are widely accepted clinical protocols relating to these patient groups.  Coordinated care has been clinically proven to improve the long term outcomes for patients who have these disease processes.  Coordinating that care and sharing the patient medical record has benefits, but what is shared?  Who is ultimately responsible for interventions when shared data suggests an issue with a patient?  If you are not directly involved with a patient’s care i.e. pharmacy, but have shared access – what is your role?  Establishing a new care model to fully utilize the shared information will be necessary to take full advantage of an HIE’s capabilities.

HIEs are going to change how providers follow and treat their patient populations.  HIEs and patient information that will be available will change how care is coordinated and that will lead to new and broader care models.  HIEs will certainly reach beyond care providers.  Payors, governmental agencies, maybe even industries like pharmaceutical and medical device companies, will be involved.  As with any new healthcare model that has been explored in the past, HIEs will vary across the country to meet the needs and restrictions of the local markets.  Having goals of higher quality and better outcomes will result in HIE models that make sense and are worth the effort.