This is easier said than done. The ONC RFI on how to improve HIE noted that data exchange was particularly limited among three types of providers: Long-term care, rehabilitation and psychiatric hospitals. Rural healthcare providers, including hospitals and physician practices, also tend to be on the outside of HIE looking in.
Rural hospitals have small IT staffs, not to mention small operating margins, Kolkman says-and healthcare reform efforts to keep people out of hospitals has the adverse effect here of making those margins even smaller. Long-term care is often associated with acute care, which has a reputation for being low-tech, she adds. Finally, data exchange with behavioral health is stigmatized by HIPAA, which many misinterpret to mean that behavioral information such as a patient's medication regimen receives special privacy protection. (It does not.)
Collaboration, then, is key, Kolkman says. Find common ground among all HIE participants. This can be determined by asking what providers want, need and value, as well as what they are willing to pay. This also helps stakeholders identify their "trading partners," or the organizations with which they share a patient population and therefore should be sharing data with.
As with determining a data-sharing model, finding low-hanging fruit is different for each HIE entity. Kolkman recommends running the organization like a business but "providing services as though your life depends on it," namely by adding services only when demand can be proven and promoting those services only when there's a critical mass of data in the system. (The Indiana Health Information Exchange, for example, found that sending emergency room admission alerts and discharge summaries to primary care physicians helped PCPs reduce the number of subsequent ER visits, or readmissions, that their patients made.) If providers continue to look in the data repository but don't see anything, Kolkman says, eventually they'll just stop looking.
HIE 'Sea Change' On the Horizon
Though challenges abound, most experts remain upbeat about the future of HIE.
One reason is the government's commitment to the service, most recently reflected in the releases of an HIE toolkit for rural healthcare providers and three tactical data briefs that provide high-value HIE use cases.
Another cause for optimism is growing interest in the services themselves. Vermont, thanks to a state innovation model (SIM) grant, plans to add data analytics and warehousing, event notification and disease management to its HIE offerings. HIXNY, for its part, is aiming for portal-based, on-demand CCD exchange; when that happens, Ryba says the organization will be one of the first in the world to do it. "It took me a lot to get the HIE to where it is. I'm not regressing."
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