Moving electronic health data between points-of-care helps coordinate patient care

Ray Scott, Arkansas Health Information Technology Coordinator, uses himself as the prime example of how the State Health Alliance for Records Exchange (SHARE) can help improve the quality of healthcare in the state with a Health Information Exchange that allows different healthcare providers in the state to exchange patient Electronic Health Records (EHR).

Scott gives the example of his personal experience. He sees a cardiologist at St. Vincent Health System, an endocrinologist at University of Arkansas for Medical Sciences, and an ophthalmologist at Baptist. In most cases when someone has multiple providers likely to have different EHR systems, few providers at each place are exchanging information about each visit.

“SHARE is building a mechanism where an individual’s health information can be accessible to their providers at those various points of care,” Scott said. “Few people get their entire healthcare from one organization or facility. The process of moving records from one point of care to the next is greatly enhanced if they are connected to and using SHARE.”

SHARE, basically, helps different EHR systems at each healthcare provider or facility to communicate so that there can be an information exchange that is helpful to patients getting the best healthcare, and to the healthcare system in reducing costs by preventing duplication of testing and facilitating a team approach to healthcare.

In the past and still too often today, much of the information sharing has been by fax machine. Scott says that is far less efficient than being able to read health information electronically in real time at the point of care.

SHARE is not a data warehouse.

“It is not about aggregating and storing huge amounts of data, but having the mechanism to move that information where it is needed when appropriate for HIPAA-permitted purposes,” Scott said. “The value of SHARE is not in having the data, but literally in sharing the data between different points of care. The technology we are deploying has to be able to interface with any certified EHR. We must be brand agnostic.”

One of the challenges is that while there are national certification requirements for EHR products, how those companies meet those standards may vary widely. The bad joke in the industry is there are standards that are not standard. It would be like having an AT&T cell phone that would work only with other AT&T cell phones.

“Unfortunately, EHR communication between different vendors is simply not possible in the current environment without a lot of human intervention,” Scott said. “That is why the HIE is a necessity if physicians are going to exchange common patient data, especially if they are using different EHR systems. Connecting to SHARE can be the mechanism where information flows from your system to an unaffiliated system using a different product. Our goal is to build interfaces with all Arkansas hospitals and practices. Every time we connect to another provider or facility, the value of SHARE increases for all providers and facilities.”

Scott said records from other healthcare providers and hospital systems must be shared in a form that is meaningful to the end user. It must be in an appropriate format that is easy to read and search through, or it will be of limited value to providers.

Following the adoption of the HITECH (Health Information Technology for Economic and Clinical Health) Act in 2009, the federal government provided millions of dollars in incentives for physicians, clinics and hospitals to adopt EHR systems. The next phase is to move to producing proof that the electronic health information is being used to better coordinate care, eliminate duplicate tests, and avoid unnecessary costs.

SHARE hears from providers concerned about the cost of EHRs, and the fact that some of their systems don’t live up to what was promised.

“We have folks who have had great experiences transferring to an EHR, and others who have had difficult experiences with that,” Scott said.

There are at least 600 nationally certified EHR products, with at least 50 to 75 being used in Arkansas.

“There are challenges on our side with the time, effort and cost it takes to build interfaces with all these products,” Scott said.

For clinics joining SHARE, the fee is between $50 and $75 depending on the number of primary clinical users accessing the system. EHR vendors also charge practices and facilities for interfacing their software with SHARE

“Companies that are willing have entered into statewide licensing agreements that have brought the price to providers and facilities down for some products,” Scott said. “For example, we have one company with 108 practices in the state using their product, and as a result of our negotiated agreement, their price dropped by an average of $10,000 per practice per year.”

There are several persuasive reasons for clinics and hospitals not waiting to join SHARE, Scott said. Medicare and Medicaid have EHR incentive programs because the government wants to make sure that records are used in a meaningful way. SHARE can help providers meet these incentives for Meaningful Use by facilitating the Transitions of Care summaries being exchanged between unaffiliated providers. This is the first year the state Medicaid program has implemented the Patient-Centered Medical Home (PCMH) model that sets expectation and requirements for how practices are going to manage Medicaid patients, which includes coordination of specialty care, medication compliances, and making sure necessary tests are done. If a practice qualifies and enrolls in the PCMH initiative, one requirement is to join SHARE to receive in patient discharge and transfer information. These “event notifications” will alert the practice of emergency department and hospital admissions, enhancing coordination of care for follow-up visits and reducing the cost of care.

“If a patient goes to a hospital and someone else admitted them, what Medicaid has found out is often the primary care provider that has primary responsibility for that patient may not get timely notification that the patient was admitted or discharged from the hospital,” Scott said. “You can’t manage what you don’t know about. It is not about blaming anybody. It is simply fixing the way the system should work in managing chronic conditions. The folks responsible for care need access to information about their patients.”

Currently more than 270 healthcare facilities in Arkansas are connected to SHARE, and there are more than 850,000 discrete patient records in the system. “We think at the rate things are going now it may hit a million before the end of the year,” Scott said.

For more information visit www.sharearkansas.com or http://ohit.arkansas.gov/