Leveraging the Health Information Exchange

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A way forward on population health

Population health, accountable care and assumption of risk continue to be at the forefront of overall health in Indiana and across the country. To succeed, hospitals and physicians will have to know much more about what’s going on with patients than they do now. And that takes timely, comprehensive information to identify and analyze health problems.

The Indiana Hospital Association has made population health management a priority in the coming year and beyond, due in partnership with two health information exchange (HIE) networks that are well-positioned to facilitate widespread use of data to guide the monitoring and care coordination that will be central to the mission.

Bryan Mills, IHA chair and the president and CEO of Community Health Network, Indianapolis, says the onus of mobilizing the state’s providers for this effort is on the association as a convening agent. The motivation goes beyond the usual concerns about how to organize for the alternative payment models that Medicare and private payers are beginning to require.

Mills says he wanted to make a difference as chair. “And for me personally, I have always been surprised and embarrassed by the overall rankings of our state in health indices, especially when I know the fabulous health care organizations that we have, and all the other fabulous organizations, whether they be insurers or Big Pharma or device manufacturers—if you look at it, there are all kinds of wonderful organizations here. But when it’s all said and done, our data is what it is.”

IHA can’t accomplish the health improvement goals on its own, so Mills has proffered the challenge to other health care stakeholders and received “a resounding yes” from all he has talked to, including the Indiana State Medical Association, Chamber of Commerce, state government and the Indiana University School of Public Health. He says it’s been heartening “that everybody can put ‘who’s good’ and ‘who’s bad’ aside and let’s come together and let’s show what we can do collectively when we lock arms and try to improve the healthiness of the state.”

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Mills is also the chair of the Indiana Health Information Exchange (IHIE), which has a 12-year track record of acting as dispatcher of the very information that population management relies on to track, coordinate and manage people most likely to have health issues. Similar success in accumulating such information and readying it for population health purposes can be found in northern Indiana at the Michiana Health Information Network (MHIN), the health information network owned and operated by two area health systems and a regional laboratory.

IHIE has a mature process of tracking the ins and outs of patient admissions and emergency department visits, using daily feeds from hospital admission/discharge/transfer systems to make this information available to clinicians who need to know, says Chuck Christian, vice president of technology and engagement. Emerging accountability for people’s health status elevates this service to a key element of overall population management, not just for doctors treating episodes of care but also nurses and others charged with managing and coordinating the care of a panel of individuals, he says.

MHIN has developed a highly integrated network of information collection and sharing among its participating facilities, with a data lineup that includes ADT transactions, operative and ED reports, discharge summaries, lab test results and radiology readings, says CEO Kelly Hahaj.

Nearly two years ago, the network formed a not-for-profit subsidiary to transform its stored and incoming data into population health services. One aim is to supply regular reports of when patients use any participating health care entity in the area, and the reasons for it, says Hahaj. The attraction for providers planning for population health management is “to understand what happens to a person and where they’re going for care in real time based on the data feeds that we have.”

An impetus for the subsidiary was to make the region’s set of data on patient activity and clinical status much more timely and relevant than other sets from sources, such as the Indiana State Department of Health, that are based mainly on claims data, says Al Gutierrez, the subsidiary’s chair and the CEO of Saint Joseph Health System – Mishawaka Medical Center. Claims data works for retrospective review but not the close management that will be essential to making medical moves as soon as situations arise, he says.

That close management amounts to drawing a bead on a small but costly and medically needy segment of the population, usually under the care of several doctors, not all of them in the same practice or health system. The actions of each of these physicians is likely unknown by the others and left uncoordinated.

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“The most important person on the field in this new model is going to be the care coordinator,” says Gutierrez. The ability of an HIE to quickly fire an alert when a patient on a registry of difficult cases is hospitalized, visits an ED or sees a specialist helps support sophisticated care coordination.

Community Health Network has formed a separate company to organize this coordination and close management from the ground up, centering around primary care and deploying nurses, social workers and others to take ongoing responsibility for certain patients who need it. Douglas Stratton, CEO of the startup company, called Primaria, says a couple of small pilot projects underway will provide evidence over the next year that having more of the work done by these non-physician managers and coordinators will pay dividends in improved care of an overall population.

The use of care management and a dedicated clinic for ongoing medical attention has already shown results at Reid Health in Richmond. An important element is the ability to identify patients with a risky health condition, in this case congestive heart failure, and keep track of their every move, says Craig Kinyon, president and CEO.

The health system tracks data comparing patients managed by the clinic and those not managed.

If managed, the readmission rate is less than one percent. If not managed by the clinic, the readmission rate is 17 percent, says Kinyon.

“That’s real proof that this does work–identification of patients, access to information and then turning that access to information into intervention and connection.”

Already a participating IHIE health system but on the Ohio border, Reid began exchanging data with Cincinnati-based HealthBridge early in 2016 to extend its information intake into three adjacent Ohio counties in its service area. The linkage adds to the picture that Reid can put together on a wider group of patients, better informing a staff of care coordinators in operation more than four years. Employed by the hospital corporation, the coordinators are assigned to work with area physicians, Kinyon explains.

“Information becomes the base requirement for specific actions, or, you could say, more efficient actions,” he says. “The more I know about somebody, the more efficient I will be about what I do next. If you’re a blank canvas, I need to paint on that canvas; if you give me a partially painted canvas, I can fill in the rest.”