According to an informal poll of participants in a recent National eHealth Collaborative webinar, these are the top concerns among hospitals and providers trying to implement a health information exchange (HIE) within their organization: health IT systems that doctors aren't using, interoperability difficulties, and the lack of understanding of the role that HIE and electronic health record (EHR) vendors play in providing security and access management solutions. During the webinar, titled Top 10 ways an HIE can go wrong, speakers addressed these concerns and provided strategies for avoiding the pitfalls in HIE implementation.
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Setting up a health information exchange can be challenging for health care organizations, for many reasons. However, by educating an exchange's users, managing security issues and getting the initiative on a solid financial footing, providers can build successful HIEs, presenters said during the webinar.
The poll results underscore the importance of educating physicians about the benefits of health information exchange, said John Moore, founder and managing partner at Chilmark Research. Many organizations implement systems assuming that doctors will immediately see the benefits, and therefore they don't take the time to make sure that every physician understands the goals behind the initiative.
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To ensure that physicians fully utilize new HIE systems, organizations need to pay more attention to how staff will interact with them. An HIE implementation is not simply a technology issue, Moore said. It is a change that will affect the way physicians practice medicine. "I don't think enough attention is paid to workflow," he said.
Organizations also should be sure not to overlook security and access management issues when they implement a health information exchange. Many organizations mistakenly assume that their HIE or EHR vendor will provide solutions for dealing with security and access management issues, said Eric Smith, HIE implementation manager at BluePrint Healthcare IT and webinar co-presenter. However, the reality is that providers need to develop their own solutions to these problems. "You need to have tools to manage and audit who has access; that does not come from the vendor," he said.
These considerations are particularly important when it comes to managing the access to data of employees exiting the company. Many employees today are given remote access to information through HIEs, Smith said. Ensuring that this access is terminated along with the individual's employment is important in avoiding compliance issues.
Of course, these considerations are secondary to the bottom line, the speakers agreed. If an organization is unable to find a business model to sustain its health information exchange, the initiative is doomed to crumble. Providers have struggled with the question of how to fund an HIE for as long as HIEs have been around. Speakers at the event agreed that finding reliable funding sources plays a central role in exchanges' long-term success. Some groups rely too heavily on temporary grant money to fund their HIEs, said Kate Berry, CEO of the National eHealth Collaborative. This is not a consistent way to guarantee long-term sustainability, however.
One often-overlooked revenue source is payers, Chilmark Research's Moore said. They can derive a significant amount of value from HIEs, and that being the case, they should be expected to play a role in funding the initiatives and keeping them operational.
Health information exchange systems can provide payers with a reliable data source from which they can develop evidence-based interventions and identify patients who could benefit from case management. Insurers and other payers currently look to claims data to develop these types of interventions, but clinical data taken straight from electronic records is generally regarded as a more relevant and richer source of information, Moore said.
As they take these things into consideration when developing HIEs, providers shouldn't forget the role of the patient or overlook the impact of data exchange on care quality, Berry cautioned. After all, these are the primary reasons a practice would seek to get involved in data exchange in the first place. "The whole reason to do HIE is to deliver better care," she said. "We have to keep that in mind."
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