Wednesday, May 19, 2010

Enhancing HIT Use

Health information linked to patients and tracked over time can provide insight into the relationship between interventions and the outcomes of care, according to Mark McClellan M.D., PhD, Director, of the Engelberg Center for Health Care Reform at the Brookings Institution. As moderator for a panel discussion on “Making Enhanced Use of Health Information” held on May 14th at Brookings, he stressed that today the major momentum is to use electronically collected data not only for clinical activities but also to use the data to help consumers and the general population.

Dr. McClellan summarized information from the Engelberg Center for Health Care Reform’s issue brief released May 2010, by discussing in detail how the enhanced use of health technology and learning from patient care data will influence quality, performance measurements, provide for better medical product safety surveillance, enable comparative effectiveness research, and provide for better public health surveillance.

However, as the issue brief points out, the Center for Medicare and Medicaid Innovation (CMI) due to be established by January 2011, along with the establishment of a shared savings program built around Accountable Care Organizations (ACO) by January 2012, will greatly need health information provided across multiple data sources. As stated in the brief, without having the health information needed for the project, it is difficult to see how CMI will be able to rapidly test promising payment and delivery models and be able to evaluate the results in time for ACOs to be established.

To further discuss some of the issues, panelists gathered to present information on current models that are currently making good use of health information or will find new ways to enhance the data in the near future. These examples show how information can be successfully gathered and how valuable the information can be for further use in the healthcare field.

For example, James Walker, MD., Chief Health Information Officer at the Geisinger Health System explained how his organization has developed a fully integrated inpatient and outpatient EHR. They also operate a networked PHR used by 146,000 patients, plus operate a health information exchange serving 2.5 million patients in 31 Pennsylvania counties.

According to Dr Walker, in order to improve the care process in our now fragmented health system, the healthcare community needs to work together, needs to understand the power and limitations of human intelligence, and focus specifically on task specific information to send to the care team and then on to patients.

Robert Steffel, President and Chief Executive Officer of HealthBridge, described HealthBridge as a not-for-profit multi-stakeholder community directed health information exchange. The exchange serves a population of 2.2 million in Southwestern Ohio, Northern Kentucky, and Southeastern Indiana to deliver information to hospitals, laboratories, and physicians. While the delivery of clinical data is essential, another important asset is to be able to use a systematic approach to deliver the most valued electronic information needed by public health officials at the community level.

David Patterson PhD, Chief of the Health and Demographics Section of the South Carolina Budget and Control Board’s Office of Research and Statistics, oversees the South Carolina Health Information Exchange (SCHIEx). He explained how the exchange provides clinical data including information on medications, diagnoses, procedures, and common problems. Much of the clinical data is obtained from paid South Carolina Medicaid claims as well as information available from participating providers EMR systems and continues to provide valuable ongoing data.

The Wisconsin Health Exchange supported by Microsoft is meeting the needs of 40 hospitals and 120 plus clinics, according to Michael Raymer, General Manager for Microsoft’s Health Solutions Group. The Exchange was able to provide the data needed and help researchers study the effects of the floods in 1993, and researchers were again able to look at the data available on the floods in 2008.

In the 1993 floods, 400,000 residents became ill because of contaminated water. However, after gathering information from data available from the floods in 2008, it was determined that this was no longer a problem during floods because after studying the information available electronically from the 2008 event, it was determined that today even during flooding, the water system can now handle the event and not become contaminated.

He explained how the exchange is the statewide repository of data available from hospitals, from ten years of paid state Medicaid claims, as well as from Health Plans to give providers clinical data on medications, diagnoses, procedures, and common problems. They have found that one of the biggest challenges to make usage of the exchange lies with rural doctors since there is still a lack of understanding by rural doctors to use the information.

John Steiner, MD, Senior Director of the Institute for Health Research at Kaiser Permanente in Colorado explained how Kaiser an integrated delivery system serving one-half million individuals has access to the data obtained from all of Kaiser’s research departments. This data provides valuable information to help determine how to improve care not only in Colorado but throughout the U.S.

To download the Issue Brief, go to