Successful Health Care Information Exchanges Hinge on Actionable Data

The American Recovery and Reinvestment Act of 2009’s (ARRA’s) designation of $300 million to support the exchange of health care data has infused the health care industry with renewed enthusiasm for efforts to advance regional health information organizations (RHIOs), health information exchanges (HIEs) and other data repository and exchanges. As RHIO/HIE efforts begin to move forward, however, the industry must address the shape these exchange infrastructures will take and what health care objectives they will help the industry meet.

“The goal of exchanging clinical, administrative and public health data is to help providers take action at the point of care to improve the health of individuals,” said Kepa Zubeldia, M.D., senior vice president, interoperability technologies, Ingenix. “Likewise, if we develop an exchange that allows connectivity but does not produce data that improves the health of individuals, then we have not met that goal,” he asserted.

The health information technology provisions in ARRA also include incentives from $42,500 to $63,750 over a five-year period for physician offices to implement electronic health records. To be eligible for reimbursements, however, physicians must demonstrate “meaningful use” of EHRs to improve patient care.

The Office of the National Coordinator for Health Information Technology will define the meaningful use standard by the end of 2009, but many experts believe that the ability to share and access patient-specific clinical information over HIEs and similar networks will be a crucial part of the equation. After all, the long-held goals of HIE – to improve patient care, avoid duplicative testing and check dangerous drug interactions, decrease administrative costs and reduce tedious and redundant manual processes – closely match the intent of the ARRA and the ongoing health care reform efforts of President Barack Obama.

Climate is right for sustainable data exchange

There is a broad awareness of inefficiencies in the current health care system. State and federal governments, industry groups, academic institutions, IT vendors, health care plans and providers have engaged in discussions regarding health data exchange for several years. However, because health information exchange efforts have been disjointed in the past, with the federal government moving in one direction and the states and regional communities moving in another, progress has been slow and some efforts have failed.

The government’s renewed focus on and financial support for health care technology’s role in reducing inefficiencies, combined with growing demand from consumers, payers and providers for reliable information on heath care cost and quality, could boost the long-term viability of HIEs, RHIOs and other exchanges that will be part of the National Health Information Network.

At this juncture, the industry should learn from its past missteps, move forward and identify sustainable models, according to Zubeldia. “We can achieve savings and better performance by leveraging existing administrative and clinical infrastructures, and by using scalable standards that support direct connections as well as data interchange through clearinghouses, and that work in both centralized and federated RHIO models,” he said.

“Administrative exchanges through clearinghouses have very well-defined, sustainable models that deliver value to participants,” he added. “Further success can be realized by integrating administrative and clinical data into the same infrastructure, adding only a small incremental cost for clinical transactions.”

Another component of a sustainable HIE is collaboration among stakeholders who often have competing interests. The federal government’s support for data exchange efforts appears to be spurring increased cooperation among these stakeholders who now recognize that working independently and without compromise largely has not been a winning formula.

WHIO takes collaborative approach

The Wisconsin Health Information Organization (WHIO) serves as a solid example of what a multi-stakeholder organization that unites payers and providers, purchasers and the state toward a common goal can accomplish. WHIO has created a statewide repository or “data mart” of payers’ health claims data and will soon report on the quality of care delivered in the state measured against evidence-based guidelines and other standardized benchmarks. “Competitors in the marketplace are trying to make policy decisions in an environment where they do not typically exchange ideas and data, but they are beginning to recognize the power and value of doing so,” according to Julie Bartels, executive director of WHIO.

The concept for the WHIO data mart began in the late 1990s, Bartels said, when large, self-funded employers, purchasing cooperatives and the brokerage community balked at rising physician rates during negotiations, and asked physicians to produce metrics that demonstrated the quality of care they were delivering. “The physicians produced self-reported clinical measures that were aggregated and reported for use in negotiations,” Bartels explained. “Purchasers said, ‘We like this quality information, but where’s the data on cost so we can see the full picture?’ That was the spark behind why WHIO exists.”

WHIO was incorporated in 2006 and set out to create a source of measurement to be used broadly by all players in the Wisconsin health care market. Through WHIO, payers and providers in the state can answer questions about quality, cost and relative performance based on facts, and Wisconsin citizens can get standardized information to encourage value-based provider choices. WHIO members have unrestricted access to all of the de-identified patient data. “Everybody gets to see everything ? it’s transparent to all,” she said.

Still, health plan stakeholders might ask why they should share their data and participate in a local entity like WHIO. “The response to that question is many-fold,” Bartels said. “Your clients expect you to, consumers are demanding that you do and, quite honestly, you need to, because you can’t get to the bottom of a fact-based discussion with the provider community without statistically relevant information,” she asserted.

Transforming data through analytics

So what is the key to gleaning actionable intelligence from health data exchanges to drive both meaningful use and sustainability? Data analytics, according to Dogu Celebi, M.D., MPH, chief medical officer at Ingenix.

Data analytics will play a significant role in helping providers meet the meaningful use standard, he noted, because they take the information physicians will have access to in a connected environment and transform it into actionable intelligence that helps identify at-risk patient populations, manage pre-visit, point of care and post-visit patient encounters, and analyze their performance.

Ingenix, which currently is helping WHIO aggregate and develop reports based on health claims intelligence, contends that the definition of meaningful use should go beyond interconnectivity or an exchange of information to include advanced measurements – powered by analytics – of how effective physicians are at providing appropriate patient care.

“There is a distinction between having access to data and actually deriving benefit from that access,” Celebi said. “There are doctors who may have all of this information at their fingertips, but if they don’t use it, it really isn’t helping anyone. That’s why analytics are vital to meaningful use.”

Advanced analytics combined with powerful end-user tools that identify trends and best practices contribute to the business value that will be the foundation for HIE sustainability. In the Ingenix view, the future health care system will enable information to move in a frictionless manner to all people when they need it, where they need it and through whatever channel they choose to acquire it, in a private, secure and standardized manner. “Actionable data analytics will bring the change we need to achieve this vision for HIE,” Zubeldia remarked.

Today, Ingenix is delivering innovations across the entire spectrum of health care data that will positively affect and connect payers, providers, hospitals, group practices, employers, clearinghouses, vendors, the public sector and consumers. “Ingenix provides advanced data warehousing, data aggregation, analytics and networking expertise to the industry as it fosters dialogue about where to take HIE development,” Celebi said.

“From connectivity to advanced data warehousing to patient-centric, predictive and retrospective analysis,” he said, “Ingenix can provide anyone in the industry with the support and the technology that they need to move forward with a first-rate HIE strategy that makes a difference at the point of care,” he concluded. “After all, health care organizations don’t just need to connect – they need to connect with a purpose.”

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