Gaining a Better Understanding of the Role of HIEs in Health Care

^{By Julie Gould} 

Chad Peterson, vice president of public sector solutions, and Sean Donoghue, senior vice president, both at Orion Health, discuss the next generation of HIEs and highlight why HIEs are beneficial in integrated health care systems.

Please tell us a little bit about yourself.

Chad Peterson:   I'm the Vice President of Public Sector Solutions for Orion Health. I have been in that role for six months.

Prior to this, I was an Orion Health customer for many years. I was an Orion Health customer in two different venues, first with the North Dakota Health Information Network, and then also with an HIE in Minnesota.

I have a lot of experience working with Orion Health, and it's a lot of fun to be on the inside working with them as well and helping other HIEs around the country.

Sean Donoghue:  I'm a Senior Vice President, and responsible for strategy and operations for Orion Health in North America.

I've been with the company since 2012, and I've held various roles throughout those years, including working with Chad when he was a customer, and now I have the privilege of working with Chad as an Orion employee.

Can you briefly highlight the history of health information exchanges, or HIEs?

Chad:  A health information exchange as we know it now really started in the 2009/2010 time frame. Before that, back in the 1990s, there were a few variations of it. Some of them still exist today, but it really started in the early '90s with Community Health Management Information Systems, which was sort of a centralized database approach. It was kind of a combination between patients and payers. It didn't get a lot of traction, and I don't know if there's any that are still around.

That led to, later in the '90s, Community Health Information Networks, or CHINs, and there still are some CHINs in existence. In fact, we just saw a group of states put out an RFP for a CHIN solution recently, and so they're still active.

They work in conjunction with health information exchanges. They're more of a decentralized approach. Again, we went from centralized to decentralized.

Then RHIOs came along in the 2000s. There's still quite a few RHIOs, or Regional Health Information Organizations, that are in existence. There's quite a few of them in New York, for example.

That all led to the health information exchange approach that we saw, really with the HITECH Act and the ARRA funding that came along to the different states to promote exchange. That's kind of where we are today, but as you know, we're getting ready for more change with what that model looks like.

Why have HIEs become an essential part of health care?

Chad:  I think HIEs help complete the picture, that complete picture of a patient, so the provider has access to the essential information they need to treat their patients most effectively, which is what the bottom line of all these various initiatives have been.

As we look at the larger hospital systems, for example, that maybe have quite a bit of data on patients, they might not have some of the other data from some of the other key stakeholders like long-term care, private practices, physical therapy units, folks like that.

Bringing in that picture and giving providers that insight as well helps the overall treatment of patients. That's why I think it's a real essential part of health care, and it's growing.

Can you dive into what the next generation of HIEs will look like? Do you expect to see an increase of them in health care, or use of them?

Chad:   We think with TEFCA, and other initiatives that are going on in the country, that we're going to see HIEs being more and more active working across what their traditional boundaries have been, whether those are geographic boundaries or state boundaries.

There's a lot more consolidation that's going on from some of the existing HIEs. Some of that is for sustainability reasons, and some of it is just so they can provide more information to help with patient care.

The next generation of HIEs really needs to fit into this new ecosystem, this network-of-networks ecosystem and perhaps provide some of the shared services that are necessary to span these boundaries.

For example, it might be a master patient index, or record locator-type services, master patient directories, or provider directories. Those are the types of things that are essential to make this multi-state or interstate exchange happen.

The Patient Centered Data Home Initiative that the Strategic Health Information Exchange Collaborative has is a great example of that. That's an event notification system based on ADT messages and it spans across states. In order for that to work, you need to have a good infrastructure in place. That's where we see HIEs being an important part of that going forward.

While there's this consolidation that's going on, part of these national initiatives, we also think that smaller groups are going to become more active at adding health information exchange-type services to their groups. Maybe it's a small network of providers. It might be an ACO or two.

They need to have the functionality of an HIE. In that sense, we think there's going to be an increase in the number of HIEs.

Why are HIEs beneficial in integrated health care systems?

Chad:  My take on that is that, again, HIEs help complete that picture of that total patient insight that you need to have, especially when you think of the larger systems, maybe a large EMR system, for example. With the functionality built into that EMR system, they're able to access other pieces of data from similar EMRs.

What they miss out on is, we'll call it, the 30% of the data that maybe is existing in other types of patient records, whether it's assisted living, long-term care, those types of services. Public health units is a great example.

Even social services-type providers, when you think of behavioral health, other things that complement that social determinant of health picture. That type of information needs to be provided by somebody. We think that HIEs are that conduit that can help the folks that are using integrated health systems to get to that other piece of data from within the community.

On top of that, I think that HIEs are uniquely positioned then to give that population-level insight and to the patients within the ecosystem.

Something to throw out here as a great example of how HIEs can be beneficial, especially for smaller providers in this example is that with the national eHealth Exchange, which is one of those national network initiatives that's going on.

HIEs can be that pipeline that allows the small providers to take part of being an eHealth Exchange participant, which gives them access to things that are part of the CommonWell network and the Carequality network without having to go through the onboarding piece of that.

Simply by being part of that health information exchange, you are able to be a participant of that. Not only are you able to access documents from those integrated delivery networks, but those IDNs are also able to get to the pieces of essential information from you, whether you're using your EMR at your long-term care facility or what have you.

It's an essential piece of helping to fulfill the gaps in that integrated health care system.

Can you briefly discuss how HIEs accommodate payer participation, which often leads to increased integration of claims as well as clinical data?

Chad:  We think certainly the value-based payment system. There's a unique spot for HIEs to help payers get some additional information that they need. It might be to help care coordinators, for example, from the payer side of things, get additional clinical data much sooner than, perhaps, the traditional methods they've used in the past of getting that information.

We think a great benefit of that, obviously, is that there's much more effective follow-up and care that happens as a result of that.

Combining that claims and clinical data allows the right people -- in this case, it's on the payer side -- to get that additional insight by using predictive analytics. They can determine who the most at-risk patients are. Who do they need to spend more time with?

If you're using it at a clinical level, you can find out who you need to spend time with today. If you're looking at it from a broader perspective, certainly what do you need to do to be changing behaviors or helping in certain geographic areas with certain health care needs.

That payer and clinical integration is huge for us. We think, again, Orion Health is uniquely positioned in this space to be able to bridge both worlds and bring it all together.

Sean:   I will elaborate on how Orion Health accommodates payer participation. We see that in a number of different ways.

Payers are oftentimes joining the public HIEs in order to gain access to the clinical data so they can see claims and clinical data together.

Health plans are also launching their own proprietary platforms using the same HIE technology in order to connect to their provider partners and provide a platform for their provider partners to have visibility to the claims data as well.

In addition to joining the public HIEs, they're often using the same technology to launch their own proprietary platform.

Chad:  We think that will eventually tie in to that network of networks that we talk about the future HIEs looking like and combining the best of all worlds so that you don't have to belong to multiple HIEs down the road.