Improving Health Care Quality and Efficiency through Health Information Exchange

Health information exchange is expected to help physicians, hospitals, health plans and administrators operate more efficiently by enabling real-time, 24/7 access to and exchange of critical financial and clinical data. Ingenix recently launched a portfolio of integrated health information exchange solutions that will make real-time data accessible to all health care system participants using open networks and products.

Ingenix experts Ana English and Kepa Zubeldia recently discussed the challenges and benefits of interoperable health information exchange networks with Bill Braithwaite, health information policy consultant and author of the Administrative Simplification Subtitle of the Health Insurance Portability and Accountability Act (HIPAA).

What are the biggest problems with health information exchange?

Bill Braithwaite, M.D, PhD, Health Information Policy Consultant: The real issue boils down to the lack of a set of standards for interoperable exchange of health information. This involves standards for messaging, including the format structure, terminology and codes that are used in those things; standards for secure conveyance of those messages, including encrypted transport authentication; standards for the network services like patient locators; and certification servers for the public key infrastructure that would support secure communications.

You can’t be interoperable until both of the terms that people use to describe certain concepts can be related to some common terminology that’s maintained on a national basis. Also, businesses that exchange information have different kinds of workflow, so the way information gets into the system and gets used by the system can be different.

If I had to pick the top barriers to HIE, interoperability would be the top one, but certainly incentives to get IT properly incorporated into health care practice are missing. And we also have a sort of societal and cultural approach to health care that prevents the investigation of systemic failures and prevents us from building systems that detect and prevent errors, because as soon as we have a system that detects an error, somebody wants to use it to sue somebody, put them out of business or make some money off it. And that prevents us from improving the system.

Bill Braithwaite: In the U.S., there are dozens of organizations that develop standards, but there’s nobody that says that anybody has to use them, so everybody uses the one that is least expensive, which means that they’re not consistent across the nation and therefore they’re not interoperable.

How can Ingenix’ approach help to address the lack of interoperability? What will this mean to Ingenix’ customers?

Ana English, Ingenix, Senior Vice President, EDI Solutions: The key to interoperability, at least in Ingenix’ approach, is to ensure that whatever is put in place by Ingenix is going to be a very open environment. It’s not going to block certain entities from being able to access data.

We’re addressing what we see as all of the clinical data requirements, all of the administrative requirements, and then building an infrastructure that is neutral. It can interface with whatever anyone needs. It’s not going to lock down the type of applications that are going to be able to access it. That’s the key here, to be open and flexible, so that anyone that wants to tie into it can do so. We’re looking at what exactly health information is and we’re looking at how to facilitate the exchange of that information.

Last year, the Office of the National Coordinator for Health Information Technology released a request for proposals for HIE architectures. Four were chosen as potential prototypes. How does Ingenix supplement that work?

Kepa Zubeldia, MD, Ingenix, Senior Vice President, Interoperability Technologies: Our goal is to be interoperable with those four architectures and other architectures that are de facto standards in the industry right now. We make sure that our products and services operate within those architectures and also allow those different architectures and different sites to communicate with each other.

We want to make sure that there is an infrastructure in place that allows the connectivity of all of these systems for both clinical and administrative transactions and supports all of the different models that they have implemented. In some cases, there is a centralized data repository, in other cases there is a master patient index with federated data storage. We will support all of those architectures in such a way that it provides interoperability among the different sites.

What qualities does the Ingenix approach provide to customers that are truly unique to Ingenix?

Ana English: First and foremost is interoperability. Second, Ingenix currently has toolsets in just about each and every area – both clinical as well as administrative – within the health care industry. The key is really bringing all of that together, establishing that framework, and making modifications to the architecture to bring it to the next level.

We’re bringing in all of our solutions: the existing Ingenix tools plus the current networking capabilities. It’s a great framework to build upon.

Kepa Zubeldia: Ingenix already has a lot of the technology in place. For instance, on an infrastructure that transfers clinical and administrative information, we plan to offer a service to detect fraud in real time. We already offer products that allow providers and payers to verify that payments are made according to the existing contracts. Once the infrastructure is in place, the deployment of other products is easy. The goal is to improve the quality and reduce the cost of health care. We believe we can accomplish that by simplifying and lowering the cost of administration of health care, and providing better clinical content where the content is needed. All of this can happen in a secure environment.

We’re providing a solution that helps customers move into the future of clinical and administrative information exchange in a national environment, regardless of how the architectures develop. It’s a solution that Ingenix customers can start with today and then evolve into whatever the future brings to health information exchange.

Ana English: Ingenix is directly connecting health care providers and payers in a unique way and delivering a simpler, more efficient way to do business.

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