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Another Path to HIE Interoperability for Physician Groups


Since the enactment of the HITECH Act of 2009 and Affordable Care Act of 2010, the lion’s share of Health IT initiatives – whether by hospital or primary/secondary practice – have rightly revolved around implementation and adoption of EMR/EHR systems.  Revenue Cycle and Practice Management systems followed closely behind in priority and visibility.  More recently, initiatives around Patient Experience (self-service, CRM) and Patient Engagement (personalization, mobility) have dominated IT focus.  However, despite the obvious benefits and a far degree of regulatory incentive, interoperability never seemed to be on the main stage.  Participation in Health Information Exchanges (HIEs) have progressed slowly with standardization and data quality as key challenges.  The organization of HIEs (statewide, regional, private, etc.) has not been consistent and vendors have not focused heavily on interoperability.  It appears, though, that impetus for change may be arriving.

In CMS’ most recent announcement of April 24th, 2018, covering “Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System” rule changes, a prominent theme was interoperability.  The original incentive program, “Meaningful Use” (previously renamed to “Advancing Care Information”), meant to drive adoption of EHR systems is changing its name once again.  Going forward, CMS will use the name “Promoting Interoperability” to reflect the emphasis on electronic sharing of data.  It is proposing new measures for the Merit-Based Incentive Payment System (MIPS) that include:

  • e-Prescribing
  • Health Information Exchange
  • Provider-to-Provider Exchange
  • Public Health and Clinical Data Exchange

The direction seems clear.  Using MIPS as one potential carrot, CMS is turning up the volume on message that interoperability – essentially, loosely-coupled integration of Electronic Health Records – other types of providers in the future.

Of course, it’s not all carrot.  The message also seems to have a stick component.  In its call for stakeholder commentary, CMS suggests that it may revise its Conditions of Participation (CoP) regulations to “further advance electronic exchange of information that supports safe, effective transitions of care between hospitals and community providers.”  While this does necessarily portend any imminent rule changes, it is clearly sends a signal of where CMS intends to go and what priority it places on interoperability.

Today, more than 95% of hospitals participate in the MIPS program according to the ONC.  Yet, as of 2014 (the most recent year available for national statistics), HIE participation stood at just 30%.  While various surveys show increases in specific regions and states, it’s clear that adoption is far from universal.  With changes in the MIPS program taking place as soon as 2019, non-participating hospitals should turn their IT focus to interoperability very soon.  They will look to make foundational investments in a technology architecture that support secure integration and interoperability in the same manner as they did with EHR adoption when MIPS first came about.

For physician and specialist practices, as adoption of HIE grows, the value of access to patient data grows.  In localities where major hospital HIE participation is high, the value is already there.  If not already connected, these physician groups should seriously consider making the investment interoperability now.  In particular, organizations participating in alternative payment models (Account Care Organizations, Medical Homes, etc.) or attempting to implement a narrow-network / subscription-based model should look to interoperability, especially HIEs, as a natural and requisite element of patient visibility.  Charged with managing the overall health outcomes for their patients, data like HL7 Admit-Discharge-Transfer notifications should be fundamental.

Of course, interoperability isn’t always easy to achieve.  Despite the well-established and accepted HL7 standards and government funding to operate most exchanges, there is still considerable effort required for organizations to join HIEs.  EMR/EHR systems often lack native support ingesting external health records.  Implementation can be costly and complicated.

Another option exists.  With the proliferation of CRM in Healthcare, platforms like Salesforce Health Cloud are providing practices with new means of getting a 360 degree view of their patients.  These CRM platforms, in contrast with EMR/EHR systems, tend to be open, flexible, and integration ready.  Because most are cloud-based, security and privacy controls are built right into platform.  Salesforce Shield, for examples, enables all the necessary capabilities to ensure full HIPAA compliance.  Connecting these platforms to HIEs provides an alternative means to access the valuable data without having to make costly investments in modifying EMR/EHR systems.  The integration-friendly architecture of modern CRMs means comparatively low implementation costs.  Once connected, Practices can enable automated workflows and other key, patient-centered capabilities as HIE data is received – opening a new set of possibilities for patient services and quickly gaining full visibility of their patients’ health, even outside their practice.

To learn more about this approach, contact MST Solutions from this site.

MST Solutions partners with Healthcare providers today to deliver integrated, interoperable CRM solutions that drive improved patient experience, deeper patient engagement, comprehensive visibility, and workflow automation.