HIE: Is it a bridge to better care or a bridge to nowhere?


By Mayil Dharmarajan, Senior Director of Enterprise Data & Analytics, Keck Medicine of USC, Diane Nguyen, Principal Analyst, Keck Medicine of USC, Amanda Schmitz, Director of Dept Applications & Enterprise reporting, Keck Medicine of USC

Our patients expect their medical care from us (providers), to be timely, of the highest quality, and value. With the digitalization of the patient chart with electronic medical records (EMR), tremendous progress has been made, and now with two decades of EMR use and a decade of incentivizing providers to make it used meaningfully with the federal ARRA act of 2009, there still remain gaps that require fulfillment to achieve our patients’ expectations. Health information exchange (HIE) is a platform to share & interoperate patient’s medical data between provider systems. It serves as one step closer to achievement. Along with the Cures act in 2016, the CMS was motivated to rebrand the meaningful use (of EMR) program to Promoting Interoperability program, which incentivizes providers to share data.

Need for HIE and the role of emerging technologies

Electronically access and share patients’ vital medical history, no matter where they have received care. With the HIE platform, we can view and exchange patient data from connected sources ranging from health care venues such as state and national registries, PACS systems for image viewing, other regional HIEs, and CommonWell Health Alliance®, regardless of EHR.

HIE capabilities also provide the functionality and standard formatting to share Immunization records, Allergies, CCDs, PDFs, HL7®messages, images, scanned documents, H&Ps, discharge summaries, and clinical notes, which can help provide safer, more effective care tailored to patients’ unique medical needs. It also minimizes gaps and errors in patient history with comprehensive medical information from multiple care settings. Shared patient information in a timelier manner, can lead to more informed decision-making.

Ongoing regulatory changes require adoption to increase accessibility to patient data.

HIE cannot be efficiently done without digital technologies, emerging technology solutions like identity management using master patient index (MPI), FHIR interface technologies for information exchange, and 3rd party vendor system that uses AI/ML to identify the patient accurately and improve the quality of the data that is being exchanged.

Having an HIE system in place does not mean that the accessed data is usable; patient care and safety cannot be supported if the data shared are useless.

Most pressing data integration and interoperability challenges

The need for a complete set of medical information that our clinicians can assess to provide the best care for our patients. We want to make sure that the right patients are not only matched and enrolled, but also that they are seamlessly accessible to our clinical care teams.

Having an HIE system in place does not mean that the accessed data is usable; patient care and safety cannot be supported if the data shared are useless. In our organization, more than 50% of the data received through HIE is unusable without going through a data cleaning process. This may be due to incompatible data formats, incomplete data, misidentification/loss of data categorizations and labeling, and data duplication.

We have engaged clinical and technical teams that assist us to ensure that robust MPI tools and reporting are being used for patient matching and enrollment. This includes record locator and record exchange services based on accurate patient matching.

For accessibility and user adoption, we have embedded HIE access via specialized screens & pages within our EMR system. Additionally, our HIE supports federated (distributed), centralized hybrid data models to ensure data connections are established as a foundation to enable better & cleaner data exchange. In addition, the EMR and other 3rd party vendors are releasing products that interface between the HIE and the EMR to do the cleaning, creating context and appropriate matching processes for member matching, and leveraging AI/ML for the data cleaning.

How to build a successful data integration strategy?

The following are the key pillars for the data integration Strategy

  1. Organizational Business Strategy
  2. Care delivery processes
  3. Data Governance
  4. Data Privacy & Regulatory Compliance

Beyond the federal incentive program for interoperability, improving the care and providing value for the patients is a core of our healthcare providers’ business strategy. The data integration strategy should be infused into this business strategy to successfully achieve it.

Understanding the care delivery processes, people involved, and the data generated & used by it provides answers to the questions to address in the data integration strategy.

Implementing data governance to govern data through its entire life cycle from when it is created, managed, used, and archived. The governance facets should also include the data quality, data security controls, and the data architecture for seamless integration across the systems.  

When consent for data sharing, patients should feel confident that their data privacy is maintained to the federally mandated Regulatory & compliance rules. The strategy should include automation of these regulatory and compliance processes and audit records to track the data usage.

These key pillars along with the appropriate digital technologies road map should help the organization build a strong strategy.

Once the strategy is built, the proper execution of the strategy is also vital to reap the benefits of the data integration. We found it is more successful when the strategy is broken into multiple programs and projects that can provide quick wins to show the value of the integration.

With the right integration strategy, data governance processes & using emerging technologies, we all benefit from HIE, and it is a bridge to better care for our patients.

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