Sunday, November 28, 2010

Speakers Discuss HIEs

Health Information Exchanges (HIE) will continue to play a vital role in transforming the national, state, and local healthcare environment according to several panel experts on Capitol Hill to discuss HIE ongoing progress.

The discussion on November 18th took place with Neal Neuberger, Executive Director for the Institute for e-Health Policy and Joel White, Executive Director for the HIT Now Coalition hosting the Congressional Luncheon Seminar on behalf of the Capitol Hill “Steering Committee on Telehealth and Healthcare Informatics”.

Harry Greenspun, M.D., first Chief Medical Officer for Dell Health Services and moderator for the seminar, voiced the immediate need to exchange clinical information. The first panelist, Farzad Mostashan M.D., Deputy National Coordinator, Programs and Policy Office of the National Coordinator for HIT, agreed and said, “It’s a great time for health IT since incredible progress has been made in the past 18 months.”

Mostashan did caution that we must ask real questions and find out if people really want to exchange information and if they have a good reason to do so. In addition, we must make it easy to exchange information, lower the complexity of systems, and reduce costs for moving information. So much has been accomplished but there is still so much to do.

Mostashan pointed out that so far, the stimulus funding has enabled states to plan and establish regional extension centers, establish the BEACON community grant program, initiate research programs, help states plan and establish health information exchanges, plus establish health IT training programs at community colleges and universities. As he noted, it is vital to develop and build the business case whether it involves bundled payments, accountable care organizations, or other forms of coordinated care.

“Currently both DOD and the VA are sharing health data in today’s healthcare environment and are working to achieve a seamless transfer of information”, reports Stone Quillian, Deputy Program Executive Officer for Acquisition Programs for the Military Health System. For example, the Bidirectional Health Information Exchange allows for two-way views of health data in real-time and exchanges data between all DOD and VA medical facilities.

In addition, the Federal health Information Exchange provides the monthly transfer of health data on more than 5 million service members such as lab results, pharmacy standard ambulatory data consultation reports, and deployment-related health assessments.

Quillian emphasized that DOD and the VA are working to assist with mental health issues. Today, the VA Polytrauma Centers in Tampa, Richmond, Minneapolis, and Palo Alto exchange radiology images and scanned medical records for severely wounded service members from Walter Reed AMC, Bethesda NNMC, and Brooke AMC. The electronic movement of data transfers data one-way but this only occurs when the decision is made to transfer the patient to the VA. Currently, DOD providers are able to access VA’s data through AHLTA and VA providers can access DOD data through VistA, CPRS, or VistAWeb.

He went on to explain that a pilot demonstration project involving image sharing is underway with radiology images being shared between a limited number of DOD and VA facilities with users located in specified geographic regions. In the future, the DOD’s Health Artifact and Image Management Solution (HAIMS) will provide access to scanned documents, digital radiographs, clinical photographs, videos, and cardiographic EKGs, and echocardiographs. Plans are for HAIMS to be deployed to additional limited user testing sites in FY 2011.

DOD’s goal is to be able to share data with anyone that has a valid purpose for the information and to increase access to DOD’s inpatient documentation for up to 90 percent of the total DOD inpatient beds by September 2011.

DOD and the VA are working to create a Virtual Lifetime Electronic Record (VLER) to enable viewable and seamless access to electronic records for service members and veterans through a single portal. Collaborative efforts on the project are ongoing with DOD, the VA, Office of the National Coordinator, plus private parties.

Chief Technology Officer for Ingenix, Art Glasgow wants to see the health information technology landscape achieve much greater connectivity and to fully develop on a national and or regional scale. The goal is to reduce complexity and create a coherent workable network with a sustainable partnership model.

As Glasgow looks to the future, HIEs need to be ready to exchange information with providers, hospitals, integrated delivery networks, and pharmacies. He envisions that in the future, clinical information delivery will be primarily workflow driven, will reduce gaps in care, be able to treat population health, provide various treatment options, effectively manage care and diseases, provide for drug surveillance, assist with claims submissions and eligibility requirements, and provide data on comparative effective research.

For an idea of how an effective EHR works, Glosgow mentioned the Quality Health Network covering Western Colorado. This system was the first hybrid-federated EHR in the U.S and exchanges clinical data with two hospitals at Mesa County and the Rocky Mountain Health Plan. He reports that the benefits were found to be astounding and the system is heavily used by more than 1.5 million with 800 people per month viewing the EHR page.

Verizon is taking several unique actions to help in the electronic transfer of data. Peter Tippett, M.D. PhD, Vice President for Technology and Innovation, explained how the company is issuing identity credentials to 2.3 million physicians, physician-assistants, and nurse practitioners at no charge so they can comply with the HITECH Act.

The legislation calls for the use of strong identity credentials when accessing and sharing patient information electronically beginning mid 2011. Currently, there is no universal means of issuing multi-factored credentials to healthcare professionals to access any healthcare system, database, or application.

Now healthcare professionals with credentials will be able to receive digital health information via the Verizon Medical Data Exchange complete with access to a secure private inbox available from a new web-based healthcare provider portal.

Secondly, the Verizon Medical Data Exchange has previously enabled limited sharing of dictated notes. The company is now expanding their Medical Data Exchange to enable a wider range of healthcare providers from large health systems, rural hospitals, to small physician practices to receive the notes and share additional digital records.

Maryland’s “Chesapeake Regional Information System for our Patients” (CRISP) the state’s designated statewide HIE and regional extension center went live in September. David Horrocks, President and CEO of CRISP, said “It took one and one-half years and cost the state ten million but the goals were achieved with the Governors support, the hospital leadership in the state, and the support of all the Maryland communities.

Since the system was rolled out, several hospitals have come on line to include Holy Cross Hospital, Suburban Hospital, and Montgomery General Hospital however; a number of hospitals are coming online before the end of the year. These hospitals will include many of the state’s federally qualified health clinics serving Medicaid, uninsured, and other underserved patients.

According to J. David Liss, Vice President Government Relations for The New York Presbyterian (NYP) Hospital which is affiliated with Columbia and Cornell Medical Schools, the NYP Health System is one of the nation’s largest not-for-profit hospital systems. The system oversees 32 acute care and specialty hospitals, 5 long term care centers, and 24 ambulatory clinics, plus the system manages 5.5 million inpatient and ambulatory encounters each year.

He detailed the specific difficulties in operating in the Washington Heights and the Inwood (WH/I) areas of New York. The area has a population of 270,000 with s 30 percent of the residents living below the poverty level as compared to 21 percent city wide. Over 50 percent of the residents are born outside of the U.S, mainly in the Dominican Republic, Ecuador, and Mexico.

The area served has a prevalence of diabetes with 11 percent as compared with 9 percent for New York City. Chronic disease is rampant with pediatric asthma and mental illnesses the leading causes for hospitalizations and the leading cause of death is cardiovascular disease.

Liss explained that several funding initiatives are helping such as the AHRQ PROSPECT grant support to help characterize patients to determine the sickest patients and to predict which patients will become sicker. In addition, the state’s HEAL NY 17 $120 million program will play an important role so that community-based HITs will produce a more streamlined approach for sharing patient information and help patients with both diabetes and depression.

For more information, contact Neal Neuberger, Executive Director of the Institute for e-Health Policy at (703) 508 -8182 or email