Posted by: AllinHIT
EHR, EHR adoption, health insurance exchange, HIE, HIX
In this post-presidential election year, there has been a lot of talk about HIEs: both health information exchanges and health insurance exchanges, though insurance exchanges are often referred to as HIXs in order to avoid confusion. States are discussing and developing information and insurance exchanges for two separate reasons.
As we know, October 2013 is the deadline for states to provide consumers with a health information exchange plan. The Affordable Care Act (“Obamacare”) requires all 50 states to provide health information exchanges. These exchanges will serve as marketplaces for residents without health insure to acquire it.
At the same time, health industry pundits are aware that state governments, eligible physicians (EPs) and eligible hospitals (EHs), through public and/or private partnerships, are creating – or attempting to create – health information exchanges for sharing patient health data. Sharing patient information is a crucial component in the re-design of our health delivery system. Access to patient records at point of care will be crucial for lowering cost of care, especially considering the millions of patients coming into the system post Obamacare. Additionally, sharing patient records plays a vital role in meeting Medicare requirements (think Meaningful Use) and commercial payers pay-for-performance programs. Its importance is reflected in the stage 2 meaningful use requirement: sending an electronic “summary care record” (Continuity of Care Document or Record etc.) for 10% of patients when referring and/or transferring their care has now moved from a menu item to a core requirement! I suspect the stage 3 meaningful use requirement for this measure will increase drastically, increasing the need for health information exchange.
Although the aforementioned exchanges are completely separate state efforts, both share the HIE acronym. However, these exchanges should be sharing much more than the same abbreviation! They should be sharing information and resources!
Insurance exchanges should have an element of health information exchange. First, let’s approach this from a practical and real-world perspective and say consumers will access these insurance exchanges annually (open enrollment), and thus could potentially move from one insurance provider to another. In that scenario, consumers, payers and primary care physicians (PCPs) would theoretically love the ability to exchange patient personal health information for seamless continuance of care. Understandably, another way of getting this done would be with the patient’s PCP EHR system, possibly via a CCR/CCD record. However, that would require too many interfaces to individual systems and would exclude payer specific information. Though not a perfect “mirror” of data, each separate silo can almost serve as a redundant system of the other.
Another point for collaboration: both insurance and information exchanges can share resources, possibly lowering the cost of their development. For example, both entities can share the cost of creating one master patient index solution, since both serve the exact same population! Additionally, they can share knowledge pertaining to governance and technologies, and share the state’s most valuable resource, state employees involved in each project!
Both these efforts would best serve their particular state, being developed with mutual collaboration, an integrated mindset, similar timelines, and associated milestones, in a perfect, utopian alignment of the stars. If not, the fear of wasted resources, budget overruns, ineffective technologies, and operational inefficiencies will be justified.