What HIE needs to mature: Regional critical mass

In the course of meeting Stage 1 Meaningful Use criteria, Beaufort Memorial Hospital in Beaufort, S.C., will have the basic infrastructure in place for health information exchange, which by design will enable meeting the more complex HIE requirements expected for Stages 2 and 3.

To have patient data available and shareable makes a lot of sense - and a lot of patients would agree with that, said Ed Ricks, vice president of information systems and CIO of the 197-bed hospital. "A lot of clinicians absolutely believe that the more good information they have - it has to be information they rely on and trust - when they're trying to make clinical decisions the better decisions they can make," he said. But for now, Ricks said, he’s still looking for a business case for HIE.

Ricks is not alone. Many in the industry expect studies to come out in the coming years that quantify both clinical and business value. The Wisconsin HIE and Vanderbilt University Medical Center are two notable examples in 2011. But the HIE market is not mature and what's required to reach that point in the journey is a critical mass of participating healthcare providers in the region and volumes upon volumes of data.

There are other issues that Beaufort Memorial Hospital must contend with, which are not unique to the hospital. It is just starting implementation with the South Carolina Health Information Exchange, despite the fact that getting participation from other hospitals in the state has been difficult. Beaufort Memorial Hospital is 20 miles from the Georgia border, with two large hospitals south of it in Georgia, which are part of the local healthcare market Beaufort belongs to, geographically speaking. "More likely our patients migrate to those hospitals than in-state hospitals," he said, pointing out one of the challenges of statewide HIEs. As a retirement and vacation destination for snowbirds, who live part of the year up north, Ricks notes that it's more meaningful to communicate and exchange patient information with physicians in those northern communities, as well. That said, Ricks points out that the two Georgia hospitals aren't participating in HIE efforts.

The federal funding for statewide HIEs is covering expenses for SCHIE for approximately 24 months, enough time for stakeholders to assess the value of HIE for the community, according to Ricks. "What's valuable in our community is that we can integrate all of our physician offices and hospital data together. Then that population of people - 95 percent of their care is in the community - wherever they present, someone has the full picture," he said. "That's the grand scheme." In addition, Ricks said, "We hope it will help us meet Stage 3. That's why we've got the structure going for us, that's why we're participating."

Beaufort Memorial Hospital is anticipating what's coming down the pike by building a better discrete data structure, which will enable the hospital to be more nimble and interface and integrate the data more quickly, Ricks said. "There's clearly going to be more quality measure reporting, which has to be done with discrete data from the EMR," he explained. "So we're just trying to structure all of our documentation to be less narrative - more discrete data - so we'll be able to capture it as we need." Building the infrastructure to store and manage more data and to have the ability to extract the data more rapidly will also allow the hospital to participate more easily and quickly when standards are finalized.

With respect to standards, Ricks believes the industry actually needs more government. "I think we need to be told exactly what we need to do, what data elements are critical and how everyone can transmit the same things in the same format," he said. It will likely take five or so years to get to that point, according to Ricks. "The early adopters are going to be doing things that are a waste of effort at some point, but we still want to participate," he said. To date, Beaufort has built the interface that extracts data and is testing the transmission of the continuity of care document format, which is a Stage 1 requirement.

In the process of capturing data as completely as it can, the hospital is mindful of ensuring that physicians' workflow is not impeded. "Engaging the physician is critical," Ricks emphasized. "One of the goals is to make sure that a full implementation of your EMR is not just an IT project, it's actually a business project, and everyone in the organization understands that they have a role in both building and using the system."

A national health information network is up to seven years away, Ricks predicts. "People are thinking in that way and getting on the right path," he said. "Part of that is impetus from the Meaningful Use money and part of it was that organizations were already trying to work towards doing the right thing for their patient population."

This article was originally posted at http://ping.fm/qObk5