Efficiency, Interoperability Are Hallmarks of Ingenix Vision for HIE

When considering the future of health information exchange (HIE), many health care stakeholders have the same items on their wish list: an infrastructure that would allow doctors to share patient information easily, a user-friendly interface that would empower patients to manage and control their own records, a platform that would give health plans a way to seamlessly communicate with providers and patients, and a secure network that would reduce both administrative headaches and costs for all parties.

Although that list may seem out of reach today, Ingenix is actively working toward making it a reality, building on its successful electronic data interchange (EDI) model to add clinical data and interoperability.

“Other entities working on HIE are trying to develop the clinical exchange system first, without a sustainable business model,” said Dr. Kepa Zubeldia, senior vice president, interoperability technologies, at Ingenix. “However, Ingenix is taking a different approach – using the existing administrative electronic data interchange (EDI) infrastructure to build the clinical exchange, which we believe will share today’s sustainable business model.”

The “bottom-up” strategy Ingenix is using includes EDI for claims processing; eligibility, remittance and related clinical information attachments; the Internet; secure web services; and the company’s existing technologies and data resources. The company then plans to add capacity and functionality to accommodate complex, bandwidth-intensive clinical information and connectivity.

“We have a comprehensive, long-term vision that may require some shifting in the way the industry thinks,” Zubeldia said. “But within the next two or three years we will be the most effective and efficient way of moving both clinical and administrative information.”

Benefits of HIE are myriad

Recognizing the inefficiencies of the current health care system, state and federal governments, industry groups, academic institutions, IT vendors, health care plans and providers have been taking steps toward a national HIE that would provide a seamless flow of data across a multitude of networks, applications and interfaces.

The concept of HIE is still evolving, but it is believed that when complete, HIE will afford opportunities for improved patient care, decreased administrative costs and a reduction in tedious and redundant paperwork.

In a best-case scenario with a fully evolved HIE, all physicians would have timely and complete access to their patients’ medical records, and their practice staffs and hospitals could access patient health plan eligibility and benefits in real time and get the claim adjudicated in seconds, according to Ingenix. Further, even though the creation, adoption and implementation of HIE will require new and groundbreaking partnerships, HIE’s potential is industry-changing.

Indeed, the transformation the health care industry is trying to achieve with HIE is similar to transformations in other industries. A December 2006 report from the Markle Foundation, “Connecting Americans to Their Health Care: A Common Framework for Health Care Personal Health Information,” affirmed that allowing consumers to play a bigger role in managing their own records can lead to rewards for many.

“Opening up online access to previously proprietary networks, such as real estate listings and flight schedules, has precipitated dramatic new conveniences for consumers and efficiencies for industry,” the Markle report stated. A survey conducted by Lake Research Partners and American Viewpoint for the Markle Foundation in November 2006 found that nine out of 10 Americans believed that online health records would be important in reducing the number of unnecessary or repeated tests and procedures they undergo.

Barriers to HIE must be addressed

In 2001, the National Committee on Vital and Health Statistics (NCVHS) issued a report, “Information for Health: A Strategy for Building the National Health Information Infrastructure,” which called for involvement from all stakeholders, including the federal government, to achieve “a comprehensive, knowledge-based system capable of providing information to all who need it to make sound decisions about health.”

Zubeldia, who served on the NCVHS Workgroup on the National Health Information Infrastructure, said that at the time the group issued the report, it called on the federal government to fund the HIE infrastructure. Although the government has furthered work on technology standards and funded pilot programs, the progress made to date on the HIE has been slow.

To reach the benefits of HIE sooner, industry stakeholders may need to become more involved. “Ingenix started working in this area years ago – focusing on making health care more accessible and affordable by leveraging industry standards and technologies that focus on bringing intelligence to health care,” according to Zubeldia. “The backbone of these technologies is a standards-based system that improves the electronic interchange of data.”

However, throughout the industry, those working on the administrative side of HIE and those involved in developing standards for clinical messaging often are disconnected.  The financial, technical and cultural barriers that are holding back many entities must be overcome to result in a more cohesive, fruitful effort.

Ingenix is tackling the financial and technical barriers by using its investment in EDI to start building a sustainable, open standards system for HIE. The company recently created its own foundational platform for HIE by merging the expertise of two key businesses: Claredi, an innovative leader in EDI software applications, and ENS Health, a full-service, provider-oriented clearinghouse.

“Those investments are being put to work by allowing us to deploy connections and experiment with health care technology information exchange, to the point that we know what works and what will not work for health data exchange,” Zubeldia explained.

He added that another important part of the Ingenix strategy is supporting standards work, which is done in different domains and is being coordinated by the American National Standards Institute’s Healthcare Information Technology Standards Panel.

“There is a tremendous amount of work being done in this area right now by standards organizations,” Zubeldia said. “They are trying to simplify the technical requirements and achieve technical interoperability.”

Cultural barrier tough for consumers, physicians

Financial and technical issues notwithstanding, the cultural barrier is probably the hardest to overcome, he said, and it affects both providers and consumers. “What is being proposed is a change in the traditional concept of ‘ownership’ of the health information from various providers or payers to the patient or consumer being the owner of the information, and consumers are not used to being the owners.”

To help consumers become more familiar with their health care information, Ingenix is collaborating with Intuit to build Quicken Health^SM, which combines Intuit's experience building consumer-friendly financial management tools with innovative Ingenix health care technology and experience. This unique, web-based tool guides consumers through the process of understanding and managing their health care finances.

Security also is an important cultural and technical issue for consumers, who do not wish to see the confidentiality of their very personal health data breached. Resolving the security issue is likely to be an ongoing process, according to Zubeldia. “There has to be airtight security and consumer control of which physicians can see which records,” he said, conceding that although consumers need to have confidence in the system, “there likely will be hesitation to use electronic records at first.”

Providers may be more likely to see the advantages of HIE, but they also may be concerned about the cost of becoming connected. “Providers see all of this with trepidation – they don’t want to be an island and become isolated from their peers, but they know the cost of becoming interoperable may run from $50,000 to $100,000 per provider – with margins being cut, such an investment can be tough to stomach.”

Unfortunately, many physicians currently have proprietary systems that will not allow them to even read basic electronic data from other providers. “One thing we’ve learned over the past several years is that the tradition of having a proprietary system to gain a competitive advantage has become a disadvantage,” Zubeldia said. “Having a nonproprietary system that can communicate with other systems is the competitive advantage right now.”

Ingenix is an agent for change

The road to HIE may be rocky and full of obstacles, but that is not preventing Ingenix from moving forward with its vision. “We are investing in technologies applicable across all constituencies of health care and we are integrating and enhancing those technologies to help positively disrupt and change the way that health care is provided and administered,” Zubeldia stated.

Ingenix is committed to reducing the costs of health care by contributing to a national HIE, he said. “Our core mission is to make health care simpler, more affordable, accessible and of a higher quality for the whole country.”

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