As provider organizations across the U.S. continue to move forward with health information exchange (HIE), no one would deny that the successful exchange of health information comes with an array of challenges. Perhaps the biggest HIE implementation challenge is to create a model that is more than the exchange of information. It’s about leveraging that infrastructure to use insight and data to support clinical decision-making, improve care coordination, and make processes more efficient.
To this end, in Pensacola, Fla., Baptist Health Care is progressing with health information exchange in the state on a local level (the local HIE in Pensacola includes Baptist and Sacred Heart Health System) via the Harris Corporation, an international communications and information technology company based in Melbourne, Fla. Being in the town of Pensacola, rather than a big city such as Chicago, presents its own challenges and opportunities when it comes to data exchange, says Steven Sarros, vice president and CIO, Baptist Health Care.
Sarros will be part of a group panel discussion, "Optimizing Clinical Care through Data Exchange and Interoperable Systems" on Feb. 11 at the Institute for Health Technology Transformation’s (iHT2) Health IT Summit in Miami. Among the panel’s objectives will be to identify ways HIE is enabling meaningful use and clinical decision support, discuss strategies for sustainable HIE models, as well as the importance of governance, clinician workflow, and physician engagement within an HIE. Click here to register for the Miami Health IT Summit to see Stephan and plenty of others. (iHT2 is a sister organization to Healthcare Informaticsunder the corporate umbrella of the Vendome Group). Sarros also recently spoke with HCI Associate Editor Rajiv Leventhal to preview the panel as well as discuss health information exchange in Pensacola, and nationwide. Below are excerpts of that interview.
How is Baptist progressing with health information exchange?
We have had mixed results, mind you, but the biggest accomplishment has been made over the last year, using information exchange for our patient portal. We have put together our physician system in NextGen and our inpatient system in McKesson Horizon into the NextGen patient portal so patients see the data all in one place. Medical group doctors see it too, so they can correspond [appropriately]. Overall there has been relatively low usage, but at the same time, it’s something to point to, and will drive some success. In terms of managing the patient side, I think we are being progressive.
Regarding the physician side, we have been using the local HIE for quite a while. We have 80-100 doctors using it every month, with 600 or so patients getting better care because they’re on it. And this allows us to put all of our inpatient and ED data on the HIE alongside of our key competitor, Sacred Heart [Health System]. Physicians can see the record, so it’s all out there in the local HIE. And then we have the Allscripts product for data sharing and sending to our referrals, who also have access to the HIE, which has the Veterans Administration (VA) and Department of Defense (DoD) on it as well. There is a big military presence in Pensacola, and we are seeing more military patients online for both of them.
Does the competition factor with Sacred Heart Health System ever get in the way of the goal to share more data?
No, at the mission level, we want to improve care for all people and communities that we serve—that’s the last line of our mission. We didn’t want to make patient information a competitive roadblock; we established that with Sacred Heart. The HIE is essentially sustaining itself on subscriptions from Baptist and Sacred Heart. It’s a lean HIE, there’s not a lot of overhead with a solid infrastructure.
Is this HIE model sustainable long term?
I think it’s sustainable in the context that it’s low cost. I see the market is changing and hopefully they’ll keep up with it. Payers aren’t interested in this market historically, but now with CVS making a play nationwide, they are more relevant than just tourists needing to get a Band-Aid. So it’s sustainable if they are innovative and can adapt to the value proposition.
Big picture, where do we stand today when it comes to interoperability in healthcare?
My take is that we have done some pretty big things right here. The Horizon-to-NextGen interface with our patient portal is a good example where we have ability with CCDA or C32-type records to bring them in and parse them. We have flexibility in terms of whether we want to be discrete or PDF. Higher-end functions, such as APIs need to be written, but now, we’re able to accomplish some pretty big things with the standards today. It can only get easier, but the basics are there. You still have to parse through what doctors want in the record—other than medications, allergies, the last history of physicals, they don’t want all of it. It can be too much, and each doctor wants it a little different. But they will have to get more used to standard data sets versus having them technically.
But even as HIEs continue to grow, healthcare leaders within and outside HIE organizations see stumbling block after stumbling block facing the sector in the next few years. What, if anything, can address this?
Well, we have had some big wins but also some misses. You have to keep in mind the cost implication. When you’re talking about interfaces and integration, you need to put in place a sophisticated application management program. It’s not a “set it and forget it” type thing. Every time someone touches the system, you need to know that it’s working, and you need a team of people to make sure of that. It’s sustainability, maintenance, and management. It also comes down to what doctors really want, as some wants lab results instantaneously, and some want to wait for the complete report, for instance. Usability and user preference, and maintenance and sustainability are the issues now.
Also, IT used to be 2 percent of the budget for health systems, but now we’re seeing 3.5-4 percent, so we’re competing for operating dollars. ROI is the goal, and hopefully we can point to that, but I don’t know if anyone is able to say right now that they spent X money on this IT infrastructure, look at this ROI. There are so many process changes that get in the way of the causality of the savings. But we are competing for a larger percentage of our total operating cost.
Most people can agree that it is far too early to deem HIEs as a failure. But do you think that it has become too difficult?
It’s community by community, not a one size fits all answer. In our community, HIE has had moderate success. We haven’t knocked it out of the park, and haven’t changed how we improve care necessarily, but it has improved care for specific patients. It’s market by market, you can’t paint this picture with a broad brush.
What will it take to really see improved care?
To improve care, you need a critical mass of users. We’re improving the lives of 400-600 patients a month, who are getting better care because doctors are getting more information. But we are still selling the physicians on using it. There is a transition there, and it’s an evolution, not a transformation. Go back and look at hand washing with physicians—it took almost two generations for all physicians to start washing their hands. Peoples expectations in the “e-world” and tech world are too high. It takes a while to figure out how it best fits their day and make that connection. The other thing is the patient portal, because once patients are online, doctors will have to be online. But we are maybe a generation away from that too.
Another issue is, what is success? When you look at number of patients who are chronically ill, that’s 10-12 percent of the population. If you only have an IRA at your company, how often do you go out and look at your stock portfolio? Maybe once a year because you’re not interested, not near retirement and you don’t have a problem. The majority of patients don’t need to get on, as only about 8-10 percent of patients are consistently going into the doctor’s office and consistently having problem. Otherwise, you’re going once a year. Patients need the on-ramp, but doctors won’t center their day around the EMR until there’s a critical mass. It’s about the denominator of who’s using it and who needs to be re-calibrated so we can redefine what success is.
In Pensacola, there is some trepidation amongst the doctors to embrace technology. They want to meet with patients, talk to them, and see them. If you drove down to Pensacola, people cross the street because cars stop for them. In Grand Rapids, you might get hit if you step on the street. So there is a huge cultural difference, and that affects physician engagement. Now that shouldn’t stop the portal from going, but it will make it more about transactions rather than the people part of it. We might be a generation away from doctors here really embracing more electronic.
To learn more about optimizing data exchange, please check out the Health IT Summit in Miami, Feb. 10-11, 2014 sponsored by the Institute for Health Technology Transformation.