EHR and Health IT Consulting
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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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What's Best Way to Boost Health Information Exchange?

What's Best Way to Boost Health Information Exchange? | EHR and Health IT Consulting |

A new report to Congress recommends steps to ease the secure sharing of patient information, paving the way for better coordination of care and improved patient outcomes. For example, the report recommends the creation of incentives to help overcome the "blocking" of data exchange or reluctance to participate.

Although the federal government has spent $31 billion so far on HITECH Act incentives for hospitals and physicians to "meaningfully use" electronic health records systems, Congress has been scrutinizing whether the investment has paid off in enabling the sharing of health information.

Some security and privacy experts say that while the report spotlights some of the key barriers to secure health information exchange, some of the concerns may be overstated.

For instance, Micky Tripathi, CEO of the Massachusetts eHealth Collaborative, says intentional information blocking among healthcare providers is generally not a widespread problem.

"There are bad apples in every group of humans, and healthcare providers are no exception," he says. "In my experience, malicious information blocking for competitive purposes is very, very rare, and is certainly not a big factor or even a major factor impeding health information exchange. The biggest impediment to information exchange up until now has been lack of demand. That has changed, and now that we have strong demand, we're seeing the market respond and I expect interoperability to grow dramatically over the next couple of years."

Report Findings

The Health IT Policy Committee, which advises the Office of the National Coordinator of Health IT, recently submitted its Report to Congress: Challenges and Barriers to Interoperabilityas mandated by Congress.

The report delves into the various technical, operational and financial challenges that the healthcare sector faces in achieving health information exchange. Among the issues related to privacy and security listed in the report are:

  • Misunderstanding about HIPAA and other privacy laws has led some to refrain from sharing information.
  • Applying privacy laws that were originally designed to address paper-based processes to today's electronic transactions has been problematic.
  • Designing electronic systems and rules to accommodate varying state privacy and security laws has been challenging.

The advisory panel makes four key recommendations to accelerate health information exchange:

  • Develop and enhance incentives that drive interoperability and data exchange, such as by focusing on delivery of coordinated care. For example, payers could decline to reimburse for medically unnecessary duplicate testing that could have been avoided if information was shared.
  • Develop and implement health information exchange vendor performance measures for certification and public reporting;
  • Set payment incentives to encourage health information exchange. Include specific performance measurement criteria and create a timeline for implementation.
  • Convene a summit of major stakeholders co-led by the federal government and the private sector to act on ONC's recently unveiled 10-year interoperability roadmap.

Information Blocking

Drilling down on the report's recommendations pertaining to payment incentives to help accelerate interoperability, the HIT Policy Committee specifically addresses the problem of information blocking, which involves healthcare providers refusing to share of clinical information.

Sometimes information blocking is related to misinterpretations and misunderstandings about HIPAA and other privacy laws, the report notes.

"There are many examples where misinterpretations of complex privacy laws inhibit providers from exchanging information that is permitted under HIPAA," the report notes. "Also, many providers do not fully appreciate that the HITECH Act gives patients the right of electronic access to their EHR-stored information. As the Centers for Medicare and Medicaid Services defines new payment incentives ... it should incorporate mechanisms that identify and discourage information blocking activities that interfere with providers who rely on information exchange to deliver high-quality, coordinated care."

Other Recommendations

The document also outlines some previous recommendations made by the HIT Policy Committee to ONC, including:

  • Explore regulatory options and other mechanisms to encourage appropriate sharing of certain sensitive information, including substance abuse and mental health data;
  • Provide guidance about best practices on the privacy considerations associated with sharing of individuals' data among HIPAA covered entities and other community organizations;
  • Guide efforts to establish "dependable rules of the road" and to ensure their enforceability in order to build trust in the use of healthcare big data.
Overcoming Privacy Hurdles

David Whitlinger, executive director of the Statewide Health Information Network of New York - the state's health information exchange - says privacy and security issues clearly represent some of the biggest hurdles to overcome before achieving nationwide data exchange.

"Privacy and security regulations vary across different states, and those difficulties are exacerbated even more in sharing sensitive health data, such as mental health, substance abuse, HIV, reproductive health, and information about minors," he says. EHR platforms don't easily support compliance with varying laws when data is exchanged, he notes.

But he points out that industry players are discussing the use of various technologies that "tag" sensitive information so that patients have more control over what part of their health records can be shared among healthcare providers. Also under discussion are policy issues such as "giving patients complete control over their data, so that they ultimately make the decisions about what subsets of data they'll share," he notes.

Tripathi says the biggest barrier to health information exchange, from a privacy and security perspective, "is the heterogeneity of privacy rules that any particular provider faces, which has a paralyzing effect on electronic information exchange."

For instance, in Massachusetts, HIV and genetic test results require consent from patients for each disclosure, he notes. "So even though a Direct [secure email] transaction doesn't require any special consent, certain types of payloads may trigger other consent requirements. So ... as a healthcare provider ... I will hesitate to send out anything until I understand which laws pertain and whether that data my EHR sends triggers any of those other laws."

What's Next?

Members of Congress now must decide whether to act on the HIT Policy Committee's various recommendations.

An aide to Sen. Lamar Alexander, R-Tenn., chair of the Senate Committee on Health, Education, Labor and Pensions, says in a statement provided to Information Security Media Group: "Sen. Alexander is focused on making electronic health records something that physicians and hospitals look forward to instead of something they endure, and he looks forward to hearing what recommendations [the HIT Policy Committee] outlined in [the] report."

While the report notes that steps could be taken to begin implementing various recommendations within the next six months, some healthcare IT experts say it could take years for comprehensive health information to be securely and readily exchanged among healthcare providers by using health information exchange organizations and EHR systems.

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More EHR Vendors Establish Connections to Massachusetts HIE

More EHR Vendors Establish Connections to Massachusetts HIE | EHR and Health IT Consulting |

Two EHR vendors are the latest to connect their services to the statewide health information exchange (HIE) in Massachusetts, the Massachusetts Health Information Highway (Mass HIway).

Two organizations, athenahealth and NextGen Healthcare Information Systems, join a baker's dozen of health information service providers (HISPs) now connected to the network. The former has connected its national information platform athenaNet to the Massachusetts HIE.

“Through our partnership with Massachusetts HIway we continue to commit ourselves to the free flow of health care data as we expand providers’ ability to effortlessly send and receive a full picture of a patient’s health story throughout the care continuum—regardless of the platform,” the Massachusetts-based company's Vice President of Network Integration Doran Robinson said in a public statement.

For NextGen, its Share platform enables its end users to the more than 350 organizations connected to the Mass HIway.

“The exchange of healthcare data promises to deliver far greater benefits than just the convenience of data mobility,” the company's Executive Vice President and General Manager Michael Lovettobserved publicly. "Through the deployment of NextGen Share, we are lowering the barriers to data interoperability, and the cost to do so, thereby creating the necessary communications channels to circumvent data blockers while complying with state and federal privacy laws."

With their connections, athenahealth and NextGen Healthcare join the likes of Allscripts, eClinicalWorks, McKesson, and others as connected HISPs.

The statewide HIE in Massachusetts open its doors in 2012 and a means of enabling healthcare organizations and providers to securely and efficiently share protected health information.

On the provider side, the Massachusetts Board of Registration approved regulations that tie a physician's license to demonstrate EHR proficiency. Participating as a participant or an authorized user of the Mass HIway is one the ways physicians are able to demonstrate EHR proficiency. Physicians have until 2017 to satisfy the mandate.

As Beth Israel Deaconess Medical Center CIO, John Halamka, MD, MS, wrote on Life as a Healthcare CIO shortly after the launch of the Mass HIway, the statewide HIE has an important role to play in enabling Massachusetts eligible professionals and hospitals to demonstrate Stage 2 Meaningful Use.

"The Massachusetts Department of Public Health will accept public health transactions only through the Mass HIway," he explained. "Thus, though there is no Federal requirement that you be connected to the Mass HIway for Meaningful Use Stage 2, you will not be able to meet core public health requirements for Meaningful Use Stage 2 without being connected to the Mass HIway."

As a result, two major forces are driving participation in the Mass HIway, EHR proficiency and meaningful use. The additional connections of EHR vendors to the statewide HIE are the means to satisfying both of these requirements.

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Health Information Exchange Should Extend Past Meaningful Use

Health Information Exchange Should Extend Past Meaningful Use | EHR and Health IT Consulting |

The efficient sharing of medical data is key to improving patient care across the country, which is why the federal government has pushed forward the development of the state health information exchange (HIE). Ever since the Health Information Technology for Economic and Clinical Health (HITECH) Act was passed in 2009, the healthcare industry has been adopting certified EHR technology and attempting to improve connectivity among healthcare IT systems as well as develop effective medical data exchange.

To learn more about the progress of health information exchange developments, the Office of the National Coordinator for Health IT (ONC) has worked with NORC at the University of Chicago to evaluate the program over a handful of years.

In a finalized report called “Provider Experiences with HIE: Key Findings from a Six-State Review,” a summary of healthcare provider interviews detail the priorities and needs of the medical industry, case studies of health information exchange systems, and the challenges overcome during HIE program development.

Between March and May of 2014, the organization conducted site visits as well as general provider interviews and discussions throughout six states, which included Iowa, Mississippi, New Hampshire, Utah, Vermont, and Wyoming. The discussions revolved around viewpoints on state health information exchange programs as well as general attitudes toward medical data exchange.

A wide variety of medical facilities were visited such as long-term care centers, hospital associations, critical access hospitals, and physician organizations. Several key findings were uncovered. For example, HIE needs go beyond meeting meaningful use regulations or system connectivity. Providers now needs HIE systems to proffer important clinical data at the point of care to enhance the delivery of medical services along with care coordination.

“Meaningful use and payment reform are creating new requirements for health IT-enabled information sharing related to care coordination and management as well as new models for patient care,” the report stated. “Providers anticipate a growing need for vendor provided HIE services and infrastructure as expectations for electronic exchange of health information increase under this shift.”

The provider interviews also found that healthcare professionals encountered a variety of obstacles when it comes to advancing health information exchange at their facility. These challenges include competing priorities, difficulty managing the revenue cycle, lack of training or experienced staff, and insufficient support from their EHR or HIE vendors.

Some positive findings from the discussions revolve around the bringing of awareness for state health information exchange programs and the benefits of data sharing. Essentially, providers see the need for health information exchange. While the EHR Incentive Programs may not have targeted long-term care and behavioral health facilities, state HIE programs did further involve the participation of these providers.

“Awareness of and demand for HIE has been steadily increasing throughout the life of the program,” the report concluded. “Providers we spoke with in previous and current activities reported an appreciation for the State HIE Program’s role in communicating with providers of all types, bringing together stakeholders, and communicating the value of HIE. Now that HIE is better established—both in terms of visibility and available services—providers have identified new priorities and challenges. These have evolved from early issues surrounding basic implementation and awareness of the benefits of HIE into a search for solutions to meet greater demand for information, while balancing cost and multiple information exchange priorities.”

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6.5 Billion Transactions Boost Health Information Exchange

6.5 Billion Transactions Boost Health Information Exchange | EHR and Health IT Consulting |

The quick and efficient access to healthcare data among medical organizations is vital in pursuit of improved quality of care, better patient health outcomes, and lower costs. In general, health information exchange helps reduce hospital readmission rates, target symptoms before a disease progresses, and prevent medical errors across the healthcare continuum.

One announcement from Surescripts – the largest health information network across the country – shows how devoted the medical industry is to advancing health information exchange and quick access to pertinent data in pursuit of better patient care. Last year, Surescripts processed 6.5 billion health data transactions, which was published in the 2014 National Progress Report. The large amount of health information exchange Surescripts conducted amounts to more than either PayPal or American Express handled in 2014.

“Connecting the nation’s healthcare system is a monumental task, and while more work is needed to ensure true interoperability nationwide, there is no question that the Surescripts network is more connected than ever before,” Tom Skelton, Chief Executive Officer of Surescripts, said in a public statement. “Healthcare is evolving and our collective ability to share health information is addressing a major pain point for providers and patients that ultimately saves time and money and improves the quality of care.”

The statistics show it all – Surescripts exchanged data transactions among 900,000 healthcare professionals, 61,000 pharmacies, 3,300 hospitals, 700 EHR systems, 45 immunization registries, and 32 state and regional networks. The health information that Surescripts shared belonged to approximately 230 million patients, which represents seven out of ten US residents.

Through the Surescripts network, 1.2 billion electronic prescriptions were processed by pharmacies and physicians. Additionally, healthcare professionals accessed and shared 764 million medical history transactions and 7.4 million clinical messages.

Throughout 2013, the access of medication history data rose 75 percent in acute care settings like emergency rooms. Some other key information that Surescripts is capable of sharing among healthcare organizations includes patient charts, visit summaries, and referral orders.

When compared with 2013, the amount of clinical messages that were transferred across the Surescripts network rose by 1,300 percent. This type of extensive health information exchange complies with many regulatory policies and raises patient health outcomes across the nation.

Additionally, sharing electronic data access throughout the industry is a major driver toward combatting prescription fraud and drug abuse. Electronic drug prescription plays a huge role in reducing the abuse of prescription painkillers, for example. Paper prescriptions are relatively easy to forge and medical facilities that transfer to electronic prescribing will make it virtually impossible for addicts to transcribe a false prescription.

“I see the physical and emotional toll that opioid abuse takes on patients and their families every day in the emergency room. E-prescribing can be an effective tool in fighting that abuse,” Dr. Sean Kelly, FACEP, CMO, an emergency physician at Beth Israel Deaconess Medical Center, stated in the press release. “Physicians are eager to embrace technology – as long as it is good technology that speeds our workflows and allows us to make better informed decisions that increase patient safety.”

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‘Action First’ Vital in Health Information Exchange

‘Action First’ Vital in Health Information Exchange | EHR and Health IT Consulting |

The conversation within the health IT industry and federal agencies is geared toward health information exchange (HIE) and improving data sharing through EHR systems. More healthcare providers and EHR vendors are joining forces to fully implement the exchange of data between hospitals, laboratories, physician practices, pharmacies, public health agencies, and other entities.

CommonWell Health Alliance, an organization dedicated to developing a vendor-neutral platform for effective health data exchange, recently announced the addition of five new members to its team. Jitin Asnaani, Executive Director of CommonWell Health Alliance, recently spoke with about the organization’s mission of making significant inroads with HIE development.

“The addition of five members who joined CommonWell will improve healthcare data exchange for everybody. Specifically, it raises our ability to connect into acute care settings, ambulatory care settings, and opening the doors to connecting to other care settings,” Asnaani said. “One of the fundamental principles behind CommonWell is that all healthcare data should be focused around the person.”

The inclusion of these additional members will expand data exchange in radiology, eye care, cardiology, post-acute care and more. The movement toward nationwide healthcare exchange is growing, as more healthcare systems and EHR vendors have begun showing interest in information exchange, according to Asnaani.

“We’ve seen a surge of interest [in HIE] over the last couple of years since we formed,” stated Asnaani. “The promise of value-based reimbursement models and greater quality of care to the patient, the healthcare industry is realizing that being able to hoard data and create your own unique view of the patient dependent on the storage of data [is no longer beneficial]. I think we’re seeing that this is eroding. We’re looking towards being able to unlock the data, create a new view of the patient, and do so affordably across the US.”

One new member of CommonWell Health Alliance, PointClickCare, joins as another vendor of cloud-based software. The Executive Director mentioned the advantages of both premise-based and cloud-based EHR technology.

“From my perspective, there are advantages to both cloud-based and premise-based technology models. I think one of the advantages of cloud-based business models is that it is easier to deploy software and functionalities to your customers because of more direct control of the environment in which the software is deployed,” said Asnaani. “Premise-based can have its own set of advantages such as the ability to more easily customize the software to align with the goals of the customer.”

Asnaani also spoke about the major benefits of effective healthcare data exchange and how discussions have centered around HIE development over the last several years. However, while interest in data exchange is high, not enough activities are taking place to advance EHR interoperability.

“Health information exchange and interoperability are concepts that have been discussed for a long time,” Asnaani explains. “They have been a topical focus for the last several years. What some people don’t realize is that there is much more discussion around those topics than there is actual action.”

“CommonWell’s distinguishing factor is that we started and have continued to go down the path of action first and discussion as a complement,” he continued. “We have built real software and services that are serving real clients in the real world for real information exchange.”

HIE development has many key advantages particularly with regard to patient care. The ability to access data in real time enables providers to improve quality of care, reduce medical errors, and account for drug allergies or other key health issues.

“Health information exchange fundamentally enables better care of patients,” said Asnaani. “When a provider needs information that will make a difference in the diagnosis or create a solution for the best care possible, they are often lacking of the data that they need. Health information exchange and real-world interoperability enables that provider to get the data they need to take the best care they can of their patients.”

CommonWell also supports patient-centered care through effective health information exchange and feels that it will lead to greater confidence in providers and ease for patients. With patient engagement initiatives playing a key role in meaningful use requirements, HIE development could be an important part of improving the patient experience.

“It’s not about where the data is. It’s about who the data corresponds to. Our aim is that every person enrolled in CommonWell has data that can be accessed by whoever is taking care of that person no matter where [the data] resides,” Asnaani stated.

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Why Patients, Providers Support Health Information Exchange

Why Patients, Providers Support Health Information Exchange | EHR and Health IT Consulting |

The latest Stage 3 Meaningful Use proposed rule emphasizes the expansion of health information exchange (HIE) due to the significant benefits of greater access to medical data.

The Office of the National Coordinator for Health IT (ONC) offers a multitude of HIE benefits through its website. First, it allows for better tracking and management of patient health records. HIES also serve as a system for reducing medical errors and increasing patient safety.179210469

Healthcare efficiency increases, as health information exchange reduces paperwork and redundant data entry. Additionally, HIEs enhance public health reporting and patient monitoring as well as ensures a functional level of interoperability among EHR systems within individual physician practices and hospitals.

On the other side of the potential benefits from HIE expansion, one study argues that there may be more correlation between HIEs and better patient health outcomes versus a more direct cause toward improved quality of care.

A newsletter from the Indiana University-Purdue University Indianapolis reported on a research paper published in the journal Health Affairs that found little evidence of HIEs directly causing improvements in the medical sector.

Researchers from the university analyzed 27 studies reporting on the benefits of HIEs and found that it may be too early to tell whether health information exchange systems are truly revolutionizing care and lowering costs. The researchers believe there may be more of a correlation between HIEs and medical benefits.

“We need to eliminate any confounding issues implicating the correlation between benefits and HIE,” Professors Nir Menachemi, one of the study’s authors, told the source. “For example, how do we know that the correlation between computerization and good outcomes isn’t really just being driven by the fact that early adopters of HIE are exemplary healthcare providers? We need to rule out those kinds of things.”

Despite any potential criticism of health information exchange, patients themselves are calling for more efficient sharing of medical information across hospitals and physicians. According to a survey conducted by ORC International and released by the Society of Participatory Medicine, 75 percent of polled Americans believe their health information should be readily available and shared among hospitals, doctors, and other healthcare providers.

Additionally, a large majority of respondents – 87 percent – are vehemently against being billed for the exchange of vital health data among healthcare providers. Unfortunately, even after a physician practice sets up the technology necessary to transmit health data, the facility may get charged additionally every time they send and receive information.

Almost 20 percent of polled Americans experienced a problem that they or a family member had when receiving care because their medical records could not be accessed by a different healthcare provider. Many physicians also cite delays in accessing current patient data as a major barrier in offering medical treatment.

Whether health information exchange leads to significant benefits or improves the quality of care, the viewpoints of both physicians and patients is that easily accessible and readily available health information is a necessity.

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What Factors Encourage Physician HIE Adoption, Use?

What Factors Encourage Physician HIE Adoption, Use? | EHR and Health IT Consulting |

Physician HIE adoption hinges on the ability of health information exchanges (HIE) to deliver complete and accurate patient data as well as a return on investment closely tied to meaningful use.

More than 90 percent of physicians value the access to trusted patient data sets, but more than two-thirds (69%) are unable to trust patient information available to them from health information exchanges (HIEs), according to a Black Book HIE survey.

The latter statistic represents a significant gain since 2013 when 97 percent of physicians indicated that they lacked trust patient records exchanged electronically using HIEs either because they deemed these records incomplete or inaccurate.

These findings come at a time when more and more physicians have achieved HIE readiness with the increased adoption of EHR technology. According to Black Book, physician groups with at least ten practitioners are most poised for HIE adoption based on their EHR adoption and implementation rates:

  • 95.8%: 50+ physicians
  • 89.4%: 20-49 physicians
  • 73.2%: 10-19 physicians
  • 56.2%: 2-9 physicians
  • 39.1%: 1 physician

Additionally, physicians are preparing to invest significantly in adopting and expanding their HIE capabilities in the coming year. This coincides with 67 percent of physicians realizing that a lack of provider interoperability is an obstacle in the way of improving patient care — a 20-percent drop from 87 percent in 2013.

Moreover, large/multispecialty will contend with integrated delivery networks, health systems, and academic medical centers in terms of their financial commitment to HIE spending in the next three years. Eighty-nine percent of the former intend to increase their HIE spend in 2015 and are projecting an 100-percent increase in 2016 before it dips back to 92 percent in 2017; meanwhile, IDNs, health systems, and academic medical centers will have their HIE spend taper off significantly by 2017.

Hospital HIE use should serve as an indication of the HIE needs of physicians moving forward. Currently, 82 percent of hospitals report exchanging patient data with “siloed HIE providers,” with slightly less than that number (75%) making use of limited direct messaging functionalities.

When choosing an HIE, physicians are overwhelmingly concerned with achieving meaningful use regarding their return on investment (ROIs) goals: 90 percent. A sufficient gap emerged between this goal and the next three:

  • 35%: Turnaround of ancillary results
  • 23%: Improved performance on risk contracts
  • 22%: Improved eligible & disability determination

Also factoring into a choice of HIE in this organization’s sustainability. Potential end-users are most concerned that HIEs are in their advanced state of operations (100%), have complete pilots stages (100%), and are currently transmitting data via stakeholders (98%). The capacity for supporting data analytics (45%) and quality reporting (42%) and being independent of federal or government funding (41%) are also important characteristics of a sustainable HIE. Patient access to health records and data, on the other hand, is not one such characteristic (10%).

Lava Kafle's curator insight, February 20, 2015 3:17 AM

Deerwalk #DidYouKnow #Physician #HIE Health #Information #Exchange #Adoption!

CMS EHR Incentive Program Modifications to Meaningful Use – 2015 to 2017

CMS EHR Incentive Program Modifications to Meaningful Use – 2015 to 2017 | EHR and Health IT Consulting |

For those of you who spend time caring for patients, rather than keeping up to date on every proposed regulation that comes out of CMS, here are the highlights of one that directly affects you. On April 15, CMS published a proposed rule that makes dramatic changes in Stage 2 of Meaningful Use (MU). Essentially, Stage 2 as we knew it, no longer exists. The final rule, when it is published later this year, will define a new Stage 2 that will be in effect from 2015 through 2017, and possibly longer. The bad news is that everyone impacted by MU is in a holding pattern waiting for the final rule. Once it is published, we will all have to scramble to meet the new requirements before the end of 2015. The good news is that the proposed attestation period for 2015 will be any continuous 90-day period for all eligible professionals (EPs), as opposed to the full year. The proposed rule also addresses many of the concerns we have raised about the excessive reporting requirements contained in the old Stage 2 specification. If you were planning to skip the MU program this year due to the excessive burden of Stage 2, you may want to reconsider. While the final rule will have changes based on comments submitted on the proposed rule, we expect that, overall, it will be similar to the proposed rule.

Here are some of the Highlights:

EHR Reporting Period in 2015 and 2016

First, CMS proposes to align the definition of an EHR reporting period with the calendar year for all types of providers beginning in 2015 and continuing through 2016  and beyond. Specifically, beginning in 2015, this proposal would change the EHR reporting period for eligible hospitals (EHs) and critical access hospitals (CAHs) from a period based on the fiscal year to one based on the calendar year, and thus aligning it with the reporting period for individual EPs.

Second, for 2015 and 2016, CMS proposes to allow all new participants in the EHR Incentive Program (including new EPs, EHs, and CAHs) to attest to meaningful use for an EHR reporting period of any continuous 90-day period within the calendar year. In addition, for 2015 only, all EPs (regardless of their prior participation in the program) will be able to attest to an EHR reporting period of any continuous 90-day period within the calendar year.  So, if you have not begun reporting for this year, you still have time! However, starting in 2016, all returning participants will need to use an EHR reporting period of a full calendar year (i.e., from January 1, 2016 through December 31, 2016).

Finally, CMS proposes changes to many of the individual objectives and measures for Stage 2 of meaningful use, including the following:

  • Changing the threshold from the Stage 2 Objective for Patient Electronic Access measure number 2[1]  from “5 percent” to “equal to or greater than 1″. CMS acknowledges that external factors beyond EPs control can impact their ability to meet this measure. Practices have been reporting since the start of Stage 2 that convincing 5% of patients to perform the specified action is difficult or impossible.
  • Changing the threshold of the Stage 2 Objective Secure Electronic Messaging[2]  from being a percentage-based measure, to a yes-no measure stating the “functionality fully enabled”. As with the patient electronic access measure, practices report that convincing 5% of patients to perform the specified action is difficult or impossible.
  • Consolidating the four Stage 2 public health reporting objectives  into one objective with multiple measure options following the structure of the Stage 3 Public Health Reporting Objective. This provides EPs with much more flexibility in selecting public health reporting objectives that make sense for their practices and for which the reporting capabilities exist.

Essentially, Stage 2 has been completely re-worked to respond to complaints raised by many, and to align it with what is expected in Stage 3. Stay tuned for announcements regarding final CMS decisions on Stage 2 modifications and on Stage 3 requirements.

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Will EHR Incentives Help Spread Health Information Exchange?

Will EHR Incentives Help Spread Health Information Exchange? | EHR and Health IT Consulting |

The EHR Incentive Programs do not incentives long-term post-acute facilities, but they do incentivize eligible professionals and hospitals to meet health information exchange meaningful use requirement which could serve as a means of connecting these non-eligible facilities to other parts of the care continuum.

That is one takeaway from an interview with the co-principal investigator of a University of Missouri Sinclair School of Nursing research into HIE readiness among 16 nursing homes in the state.

"Many hospitals wanted to get involved with our long-term care organizations because they were under pressure for meaningful use requirements to exchange data. Many of them heard about our project and contacted me. I told them what we were doing and they asked how they could help," Greg Alexander recently told

The problem with that strategy hinges on the duration of those incentives, which are set to end for the Medicare EHR Incentive Program in a few years. That reality has Alexander considering an important question.

"Is there a model that we could develop where the acute care and physician practices, which are being incentivized to adopt these systems, could reach out to long-term care organizations to extend those incentives beyond their internal walls?" he asked.

As the research of Alexander et al. has so far proven, the acute and ambulatory sides of the care continuum have an interest in exchanging health information with post-acute organizations such as nursing homes, once the necessary HIE infrastructure is in place.

"We had a stakeholder group and hospitals were on our panel. In the first year, they weren't sure how to be engaged," Alexander explained. "It wasn't until after we got the nursing homes to a certain point, ready technically and the infrastructure right, that things took off."

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Will Altering EHR Incentive Programs Raise EHR Implementation?

Will Altering EHR Incentive Programs Raise EHR Implementation? | EHR and Health IT Consulting |

While the HITECH Act and meaningful use requirements under the Medicare and Medicaid EHR Incentive Programs have truly increased the number of healthcare providers implementing and utilizing EHR systems, new research suggests that these federal regulations may have also led to specific disparities in patient care. A study stemming from Weill Cornell Medical College found “systematic differences” between doctors who were avid participants in the EHR Incentive Programs versus those who did not invest as much time and resources into meeting meaningful use requirements.

The study was published in the June edition of Health Affairs and analyzed more than 26,000 doctors across the state of New York. Additionally, the researchers looked at payment data from the Centers for Medicare & Medicaid Services (CMS) and the state Department of Health.

The payment data analyzed in the study stemmed from the years 2011 to 2012. The results show that participation in the Medicaid EHR Incentive Program increased by 2.4 percent during those two years. However, participation in the Medicare EHR Incentive Program rose much more quickly, showing a 15.8 percent increase in the number of providers taking part in the program and implementing certified EHR technology.

The results show that early and consistent provider participants in the EHR Incentive Programs have more financial capacity, better organization and resources for supporting EHR implementation, and previous experience using health information technology.

While meaningful use requirements pushed EHR adoption forward, the process of using the systems on a constant basis had a new set of challenges that some providers were unable to attain, the researchers said. However, the differing rates of participation in the EHR Incentive Programs is leading to higher quality care at some physician offices while others are lacking and administering lower quality healthcare services.

“The expectation is that physicians and hospitals should be electronic,” senior author Dr. Joshua Vest, an Assistant Professor of Healthcare Policy and Research at Weill Cornell Medical College, said in a public statement. “How would everybody feel if only half of the banks were electronic nowadays? Without additional support to move forward there is the potential to stall out among those who don’t have the resources or capability to adopt EHRs.”

The researchers explained that there is a “digital divide” among different healthcare providers due to the participation in the EHR Incentive Programs. These results may play a role in the future of healthcare policy. Since there are certain providers who dropped out of the Medicaid EHR Incentive Program, it may behoove federal agencies to make some significant changes to the objectives within this particular program in order to keep providers participating.

“Electronic health records are vital not only because of their ability to efficiently provide physicians with a comprehensive portrait of and decision support for their patients, but also to drive new healthcare delivery models that can improve the value and quality of clinical care,” Dr. Rainu Kaushal, Chair of the Department of Healthcare Policy and Research and the Frances and John L. Loeb Professor of Medical Informatics at Weill Cornell, said in a public statement.

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Future of EHRs: Interoperability, Population Health, and the Cloud

Future of EHRs: Interoperability, Population Health, and the Cloud | EHR and Health IT Consulting |

Ever since the Health Information Technology for Economic and Clinical Health (HITECH) Act was passed in 2009 and the Medicare and Medicaid EHR Incentive Programs were established, healthcare providers have been quickly implementing EHR systems and adopting health IT tools. The overall movement toward improved quality of care and greater access to healthcare information will likely stimulate the future of EHRs.

Before predictions regarding the future of EHRs and their designs can be considered, it is critical to examine the history and evolution of EHR technology over the last five decades. The American Medical Association Journal of Ethics discussed how the earliest developments in EHR design took place in the 1960s and 1970s.  Healthcare leaders began forming organizations as early as the 1980s to develop standards for the increased use of EHR systems across the sector.

The very first health IT platforms, developed by Lockheed in the mid-1960s, were called clinical information systems. This particular system has been modified over the years and is now part of Allscripts’ platforms.  The clinical information system was capable of having multiple users on at once due to its high processing speed. During the same period, the University of Utah developed the Health Evaluation through Logical Processing (HELP) system and later Massachusetts General Hospital created the Computer Stored Ambulatory Record (COSTAR).

The COSTAR platform was able to separate key healthcare processes into separate entities such as accounting or billing versus clinical information. The federal government adopted an EHR system in the 1970s through the Department of Veteran Affairs’ Computerized Patient Record System.

Over the last several decades, there have been even more developments in EHR design and implementation, especially since the federal government constructed meaningful use objectives under the EHR Incentive Programs. In 1991, the Institute of Medicine (IOM) published a report analyzing the effects of paper health records and making a case for the use of EHR systems. The report also covered challenges to EHR adoption such as costs, privacy and security concerns, and a lack of national standards.

In 2000, the IOM also published its infamous report To Err is Human in which the high rates of medical errors were discussed and health IT systems were addressed as a potential solution. The history surrounding health IT will likely impact the future of EHRs, as the same principles toward better quality of care, lower costs, and improving patient health outcomes are at the forefront of EHR adoption. spoke with three leaders in the healthcare IT industry to discuss the future of EHRs and the trends to expect over the coming years. Bob Robke, Vice President of Interoperability at Cerner Corporation, mentioned the importance of healthcare data sharing across multiple platforms.

“We’re moving out of the era of EHR implementation and adoption and into the era of interoperability,” Robke said. “Now that we’ve automated the health record, the next phase is connecting all of the information in the EHR. We need interoperability and open platforms to accomplish this.”

The functionalities possible in future EHR systems will also focus greatly on interoperability and Big Data. As telehealth functions spread across the country, patient health outside of the medical facility will be greatly considered.

“Interoperability has the potential to unlock a richer set of data that clinicians can use to help improve the care they provide to patients,” Robke explained. “More than ever, clinicians will need access to information about the patient’s care that happens outside of their four walls as healthcare moves from fee-for-service to value-based models.”

When asked what healthcare trends are affecting the design of EHR systems, Robke replied, “There is a lot of exciting work being done to advance open standards that enable information stored in one EHR to be accessed by other systems. A good example of this is the work being driven by the Argonaut Project to advance the development and adoption of the FHIR standard. We’re big supporters of the SMART on FHIR approach that allows information to be accessed from directly within the EHR workflow, and are enabling that within the Cerner EHR.”

Health information exchange and EHR interoperability will continue to impact the future of EHRs over the coming decades, as the healthcare industry continues to strive toward meaningful use of health IT systems. Robke spoke on the benefits of health information exchange and the strategic actions of the Commonwell Health Alliance, which is geared toward nationwide healthcare data exchange.

“Interoperability is a critical next step in the EHR world. Interoperability can provide clinicians with the data they need to manage the health of their populations and truly put the patient at the center of care,” Robke explained. “For interoperability to succeed, it will require all of the different information system suppliers coming together to find ways to connect their platforms, like those vendors who have joined together in the CommonWell Health Alliance. The great thing about CommonWell is vendors representing 70 percent of the acute market share in the U.S. have joined together to make interoperability a reality.”

When discussing how telemedicine and population health measures will affect the future of EHRs and the development of health IT platforms, Robke stated: “Connecting different information sources are key to successful telehealth and population health management strategies. Health care organizations need to access a patient’s full health history regardless of where that care was provided or what information system houses that information.”

“And yet, when it comes to results, there is an alarming failure in the healthcare industry.  Despite huge investments in enterprise systems, venerable healthcare organizations failing even at the basics like exchanging information electronically, communicating amongst care teams, and engaging patients,” Bush elaborated on the topic. “Some are even going bankrupt!  The shortcomings of software – the cost, the inability to share information at scale, the demands for onsite management and maintenance, and the sluggish pace of innovation—are chiefly responsible for this.”

The revenue cycle in the healthcare industry will also have a great impact on the future design of EHR systems and trends within this sector, Bush explained. The costs of investing in complex technologies will affect the future adoption rates while the financial incentives of the Medicare and Medicaid EHR Incentive Programs will also stimulate hospitals and physician practices.

“That’s why I believe that health care leaders are going to start thinking in terms of the total cost of driving results, not the total cost of ownership, when they contemplate the HIT of the future,” Jonathan Bush explained. “It’s crucial in the current landscape to adopt a cost calculation that accounts for labor and operational costs across several departments, as well as the opportunity costs of an underperforming system. As CIOs and health system boards are increasingly held to account for their investment decisions, I think we’ll start to see a new model for total cost of ownership emerge—and a fleet of next-generation services emerge to keep up.”

When asked what functionalities he thinks health IT systems will be able to obtain in the future, Bush replied: “Malleable IT strategies available from the cloud will reinvent what we ever thought HIT was capable of.  I agree with a recent IDC report and its vision for a future filled with ‘3rd Platform EHRs’ capable of functions we just don’t see in software today.”

“Those functionalities would include easy access to data; population-wide analytics; and network intelligence that crowd sources the wisdom of many to improve overall performance,” he continued. “These functionalities are already being built in to service value-based care organizations.  The promise is better healthcare in an accountable care environment.”

Next, the Athenahealth CEO discussed the importance of connectedness and interoperability when it comes to the design of EHR technology and future trends in health IT.

“Connectedness is a huge barrier to humanity in health care, as well as to the design of intelligent IT systems,” Bush said. “Achieving connectedness, or the meaningful use of health IT, isn’t reliant on getting all providers onto one system.”

“I believe that the one-size-fits all mantra is finally waning and that healthcare will continue to demand what I like to think of as the ultimate ‘backbone’ solution: lightweight technology that can unite data across multiple platforms and support advanced levels of care coordination and connectedness. That sort of infrastructure is not only more cost effective, nimble, and future-proof; it’s also best for patient choice and access and — ultimately — quality care.”

Some of the typical trends that are affecting the future of EHR technology include telehealth, population health management, accountable care, and health information exchange. Population health management in particular will affect the development of analytics software and statistical measurements vital for demonstrating healthcare quality improvements.

“The arrival of population health is, and will continue to be, huge. It’s trending in M&A, has wound its ways into vendors’ capability descriptions, and is on the required ‘must support’ list for healthcare organizations of all sizes,” Jonathan Bush explained.

“To do population health correctly, EHRs will need to gain insight into patient populations, translate that insight into meaningful knowledge for care teams, and enable a new standard of connectedness to manage and deliver care. To do such complex, hairy, and crucial processes, EHRs will have to leverage a combination of software, knowledge, and work.  Software alone simply isn’t cut out to do the job.” also spoke with Practice Fusion Founder and Chief Executive Officer Ryan Howard about future trends in EHR design. Howard spoke about the importance of data sharing among health IT systems.

“The single biggest trend will be cloud-based EHRs. The biggest single problem in the space is not deployment of EHRs. It is sending data back and forth whether it’s for quality and accountable care or sharing data with a payer or a lab or other doctors,” said Howard. “In every spirit of this, data from EHR needs to be shared with another EHR system.”

“The challenges of that is to install software offsite. Most of the major competitors have enterprise solutions. The data is incredibly difficult to get out. A cloud-based model inherently has an exponential cognitive scale that allows it to do this easily,” Howard explained. “In our case, when we connected to Quest, every doctor on our platform has a connection to Quest now because they’re all the same multi-tenant cloud-based systems. I think the biggest problems in health IT will be solved by simple integration into the cloud.”

Howard was of the same opinion as the other CEOs when it comes to the functionalities EHRs will need in the coming years. Interconnectedness, interoperability, or the efficient sharing of health data between disparate systems will become a necessity in the quest to improve patient care and health outcomes.

“The biggest single thing [that will affect the future of EHRs] is that systems need to seamlessly connect to each other,” the Practice Fusion CEO stated. “Most of the systems are pretty robust, but I think the major cloud-based systems will need to interoperate. I think the major cloud-based vendors in the marketplace will connect and all their doctors will be able to interoperate. I think all the doctors will migrate to cloud-based systems.”

“This is only possible in a web-based or cloud-based model where the population data is in one place,” Howard said. “There’s very little value in doing this in a solution that’s installed in the doctor’s office. In that situation, all the data isn’t in one place and, in a population health management program, you’re constantly rolling out new rules and tackling new chronic conditions.”

When asked what healthcare trends will affect the design of EHR systems, Howard replied: “Population health management in addition to the electronic health records role in enabling telemedicine will all be key in the marketplace. Unless you have the patient’s record which only exists in the EHR, then there will be very little value on the telemedicine platform.”

“However, if I’m using a telemedicine platform that’s connected to the EHR, I have all that data in real-time. Most EHRs that are certified do drug-drug and drug-allergy checking dynamically in the system. That’s a good example of the value that comes from the platform.”

In predicting the coming impacts in EHR developments, Howard said, “cloud-based systems, population health management, private care management, and big data” are the major catalysts in health IT design.

“I think most vendors don’t have a population health management solution. The challenges of that is that population health does not work unless all the data is in one place,” Howard stated. “For population health management to work, take a look at diabetes. What the system is doing in a population health management model is that it is constantly monitoring your patient on a day-to-day basis.”

If a patient hasn’t had a required test done, “the system should automatically be reaching out to that patient to drive awareness – get them to book an appointment – and the system should also be prompting the physician with the standard of care during the visit.”

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How Does ONC Plan to Expand Health Information Exchange?

How Does ONC Plan to Expand Health Information Exchange? | EHR and Health IT Consulting |

With the vast amounts of data collected in the healthcare industry, providers, vendors, and other stakeholders are putting more focus into developing health information exchange (HIE) and greater EHR interoperability. The Office of the National Coordinator for Health IT (ONC) released a report to Congress – Update on the Adoption of Health Information Technology and Related Efforts to Facilitate the Electronic Use and Exchange of Health Information – to offer policy guidance on the best ways for optimizing health IT systems and supporting HIEs.

Ever since the federal government passed the Health Information Technology for Economic and Clinical Health (HITECH) Act, the number of hospitals and physician practices adopting EHR systems has grown substantially. Currently, more than half of hospitals have at least a basic EHR system in place while, in 2013, 48 percent of physicians had EHRs at their practice.

Additionally, eligible professionals and eligible hospitals across the country are participating in the Medicare and Medicaid EHR Incentive Programs. While there has been significant progress in implementing health IT, there are still barriers that are halting widespread health information exchange across healthcare organizations and vendor products.

For example, if an individual from Maine takes a vacation in Florida and experiences a patient encounter, their primary care provider from Maine would likely not be informed nor would be able to access the patient’s emergency care data.

The report states that some of the common barriers to EHR adoption and thereby challenges for expanding health information exchange include the cost of purchasing a system, loss of productivity, training difficulties, the costs of annual maintenance, and obstacles related to finding an EHR system that supports practice needs. Nonetheless, in 2013, eight in ten physicians were using an EHR system or planning to adopt one, according to an ONC data brief.

ONC explains in its report that some of the reasons health information exchange is lacking is due to inconsistent structure, format, and even medical vocabulary used across different EHR systems and vendor products. ONC outlines key actions the Department of Health and Human Services (HHS) will need to take to improve nationwide EHR interoperability. These actions include:

  1. Creating new standards that are integral to the development of a connected healthcare system
  2. Requiring more staff in the health IT workforce to support the implementation of electronic records
  3. Improving the sharing of data among providers and public health agencies
  4. Collaborating, advising, and sharing studies with states, communities, and providers to stimulate IT solutions in the healthcare field
  5. Driving patient engagement with their health information

ONC hopes that Stage 2 Meaningful Use requirements will also catalyze a widespread data exchange network within the healthcare sector. By using these five strategies, HHS plans to further advance health information exchange and invest in health IT usability throughout the nation.

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State and Regional HIE Sustainability: One Consultant’s View

State and Regional HIE Sustainability: One Consultant’s View | EHR and Health IT Consulting |

At a time when the broad survival of health information exchanges (HIEs) is in question nationwide, and a number of statewide HIEs are shutting down or in danger of doing so, a small number of such organizations are actually flourishing, among them statewide HIEs in Maine, Michigan, Ohio, Texas, and Colorado.

As noted in the January/February issue of Healthcare Informatics, in the Top Ten Tech Trends cover story package, in the Trend article on HIE sustainability, leaders in those states have created success, even as other HIEs, both statewide and regional within states, have faltered, in the wake of disappearing federal and state funding for HIE development. What was clear in interviews with the leaders from successful HIE is this: that many of the statewide and regional HIEs created with wonderfully high-minded intent, but without a hardheaded business focus on long-term sustainability, are finding it difficult to make ends meet as the grant money begins to wither; but also, that those leaders who have figured out strong strategies for market-based success, are forging ahead and building new models.

Greg McGovern, a director at the Pittsburgh-based Aspen Advisors consulting firm, and a former health system CTO, spoke late last fall with HCI Editor-in-Chief Mark Hagland regarding the current trends in HIE development and sustainability. Below are excerpts from that interview.

When you look at HIE sustainability right now, what kinds of models will prove to be successful?

It’s a little Darwinian, right? If you look at, you’ll see that virtually every statewide HIE has some functionality. But the more successful HIEs are of two types. Of course, there are the enterprise-based HIEs, many of which, like those at Kaiser Permanente, Adventist Health, and Mary Washington Healthcare in Virginia, are showing very strong success; those are sustainable, because they’re built into the cost of business. And Epic’s CareEverywhere is a kind of EHR-based HIE. Then there are regional HIEs, such as HealthIX in New York City, and ConnectVirginia, and one in Cincinnati—they came on early and had sort of a subscriber model where the core players, the hospitals, primarily, agreed to support through subscriptions.

A great model is that of CliniSync in Ohio; so is the model created by HealthInfoNet in Maine. The thing is that, when states provide something, if all that they offer is a way to get stuff from point A to point B, that’s not very useful, because most organizations are able to do that through their EHRs. But if you’re going to offer other services, or direct functionality to long-term care services, for the transmission of continuity of care documents, for example—people will pay for those kinds of things. So folks are coming up with very imaginative, value-added services.

Is the exchange of CCDs [consolidated clinical documents] one example of practical, useful exchange?

Yes, it is. Not every organization has an EHR [electronic health record]; I’m thinking in particular of SNFs, long-term care facilities, and other organizations, none of which are required to have an EHR. And yet the physicians affiliated with those organizations will need to exchange patient data with the physicians in hospitals and medical groups. So hospital-long-term-care collaboration is a very good example of where the ability to exchange CCDs is something that is very useful in an HIE context. You can offer clinicians a mail box, basically, so that hospitals can send you a summary of care or transition of care document, and you can do the same, so you can collaborate with folks without a full EHR.

That’s where the potential is?

That’s what you see people offering. I was involved in the groups figuring out what the service was for California; and one of the things they do offer is direct messaging; and that’s probably the key ingredient for care coordination. How do you monetize that, though? Going back to Mary Washington in Virginia, a lot of times, the big person on the block like the hospital or integrated delivery network offers to the long-term care facilities, for free, HIE services, or subsidizes it. And I’m not sure that works on a state level. What you’ll see, is that some states are offering robust services and way beyond just sharing documents back and forth. Others, like California, are offering minimal services. And in New York and other places, they’re working to help providers lower costs. If I’m a hospital and already have to send reportable events and syndromic surveillance or registry information, to public health, that’s already set up. And ConnectVirginia can offer to be a broker at lower cost. So there’s some savings in moving to an organization paying for it.

What is Darwinian, though, it’s that it’s kind of like the ISP wars of the 90s—everyone was an ISP, and everyone offered you an e-mail box, but now it’s down to one or two carriers. So you’ll see convergence, but the more likely sustainability model is regional, in that organizations tend to revolve around communities in their markets. So when you see a regional HIE come up, as in central New York state—generally, it’s on a regional or community basis. So if you manage a logical region, there’s generally more value, and you’ll stick around as a player. And Maine is like that; it’s a regional HIE. It’s a fairly small state, and everybody in Maine works with each other. Larger states aren’t like that.

So the real sustainability will continue to be on the local level?

Yes, except in the cases like HealthIX and others where they’re working with state governments that are putting line items in their budgets for sustainability, usually to provide specific services like a patient portal. So, yes, state funding. But at the end of the day, you have to go around and talk to actual people like a hospital CIO and say, if I could do this for you, would you pay me for it? And they’ll say, well, either I’ve got Epic or can do this for myself; or, yes, and I’ll pay a subscription for it. Those have the best likelihood of continuing.

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How Can Providers, HIEs Partner to Achieve Interoperability? |

How Can Providers, HIEs Partner to Achieve Interoperability? | | EHR and Health IT Consulting |
Choosing a partner for data interoperability and health information exchange depends on an organization’s long-term objectives.
Interoperability is a popular topic among healthcare stakeholders, but with all the different organizations offering to help providers achieve efficient, effective, and viable health information exchange (HIE), choosing a partner can be a daunting task.  Between private, local HIEs and state-level exchanges, third-party commercial offerings and EHR vendors in the cloud, providers have any number of options to help them along the road towards freely flowing patient data that supports safe and coordinated transitions of care.
“I don’t think there’s ever going to be a singular nationwide system that does everything for everybody,” said Jeff Miller, Executive Vice President and General Manager of Clinical Network Services at Surescripts to HealthITAnalytics. “You can look at the telecommunications industry as an example of that.  We don’t have a singular communications network for the country.  We have some people that offer a very broad set of services – voice, data, video – and they offer it nationally. And you have some people who look and offer regional service and maybe only focus on a smaller set.  Some people offer wired and wireless; some are only wireless.  So I think the market will settle out and will offer services where they can generate value for their constituents.”
“We shouldn’t try to be too prescriptive as an industry about this, because the last thing we want to is to exchange information just to exchange information,” he added.  “The whole goal behind health information exchange is to ensure that we can appropriately impact the quality and effectiveness of the healthcare system, not just to ensure everybody can exchange all the information with everybody.  Because I’m not sure that is cost effective or even necessary.”
For providers looking for a solution that meets their particular needs, looking towards the community in which they primarily operate is a good first step, says Charles Fennell, Vice President for Information Management and Chief Information Officer at St. Joseph’s Hospital Health Center in Syracuse, NY.   “There are a number of independent community-based providers that choose to practice at St. Joseph’s, and our objective was to make our organization and our network of services the easiest system to practice in,” he said.
“With the understanding that we are going to live in a heterogeneous environment, we needed an interoperability strategy to work with community-based providers.  We recognized the opportunity to adopt and to promote the Direct protocol to distribute results in a way that fits into the physician’s workflow. Healthcare providers need to choose the means by which they accomplish that, whether they use their local RHIO or health information exchange, or whether they use a third party like Surescripts.  Different communities may have different answers to that question,” he said.

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