7 Best Practices for Hospitals Implementing Health Information Exchanges
By Sabrina Rodak
Health information exchanges are important for meeting meaningful use standards, improving the coordination of care and potentially lowering costs. In fact, the Office of the National Coordinator for Health Information Technology listed achieving adoption and information exchange through the meaningful use of health IT as one of its top goals in the Federal Health Information Technology Strategic Plan: 2011-2015. Glenn Keet, president of Axolotl, part of OptumInsight, shares seven best practices for hospitals implementing HIEs.
1. Avoid hospital-centric approaches. Mr. Keet says hospitals should view their HIE as a clinical network for clinicians and the hospital rather than only a tool for the hospital to transmit data. "Failed strategies are those [in which] hospitals think about how they could deliver their hospital data out to physicians and not focus on helping physicians' workflow," he says. For the HIE to be effective, both the hospital and physicians need to integrate the system into their workflows. Physician practices' and ambulatory centers' workflows are significantly different from that of hospitals, Mr. Keet says. He recommends the hospital recognize this difference and facilitate the incorporation of the HIE into physicians' daily tasks. "[Hospitals should] broaden their focus to make a clinical network that really benefits physicians and the patients of the community, and in doing so, they will be more likely achieve their hospital-centric goals" he says.
2. Connect nearly 100 percent of area physicians. The hospital's HIE needs to try to connect all of the physicians in the area, not only the ones who have adopted electronic medical records, Mr. Keet says. Full participation by the physician community enables them to interact with each other to improve the coordination of care. It causes a network effect that makes the entire HIE more valuable to everyone. The opposite is true also; missing any significant portion of physicians on the network will inhibit other physicians' workflows. "Physicians need to find their medical trading partners online, which builds the value in the system," Mr. Keet says.
To include physicians without EMRs in the HIE, Mr. Keet suggests hospitals provide physicians with "EMR Lite" systems or clinical messaging applications that are simpler versions of an EMR. "Offering or supplying an inexpensive and easy-to-adopt [system] compared to traditional EMRs is imperative to achieving high utilization rates of the HIE," Mr. Keet says. This technology allows physicians who don't have EMRs to participate in the HIE without spending a lot of money or time or reengineering their workflow, he says. In addition, the EMR Lite or clinical messaging applications can help physicians transition from paper to electronic records more easily so they can eventually implement full EMRs.
3. Create a community index. As HIEs should include all area physicians, HIEs should be designed to include information for all patients in a community, Mr. Keet says. Instead of limiting the HIE to the patients the hospital treats, the HIE should be open to all patients who receive care in the community. Their inclusion will provide more robust data when analyzing the health of a population and can eventually allow patients to access their personal health records. Moreover, including the broader patient population is important to achieving higher adoption rates of the HIE by physicians, many of whom will have patients not seen at the hospital. If they are not included, physicians will have different systems for different patients, which is very problematic, according to Mr. Keet.
4. Allow physicians to select their EMRs. Mr. Keet suggests hospitals provide physicians with guidelines for what kind of EMRs the HIE will connect to instead of encouraging a particular system or requiring them to choose among several options. "More than 25 percent of EMRs get rejected in [physician] practices or fail in their implementation in practices; A lot of that blame will go to the hospital if the hospital was involved in the selection," Mr. Keet says. "It's a much better choice to allow the [physicians in a] practice to choose one themselves that meets the basic guidelines the hospital sets out." Giving physicians the freedom to choose their EMRs will help the hospital work towards the goal of 100-percent physician participation in the HIE.
5. Bolster the marketing department. An important factor in the success of an HIE is awareness among physicians, Mr. Keet says. Awareness will help ensure wide adoption of the HIE, which is essential for the system to be useful. "It's very important that the HIE gets to a level of critical mass in a reasonable amount of time in terms of usage and users. To get there, you need to take into account the resources that that would take," he says. He suggests hospitals bolster their marketing departments by combining the resources of other departments, such as the physician liaison, health information management and health IT departments, to promote HIE usage. "If hospitals attempt to roll out an HIE with just their IT and their marketing department — if they treat this as just another application, it is certainly a recipe for failure," Mr. Keet says.
The CMIO should also play a role in marketing the HIE by talking to physicians in medical staff meetings about the HIE — how it will be used and how it can benefit them and their patients. "You have to think about [the HIE] as serving the physician and the patients as well as the hospital," Mr. Keet says. Showing the value of the HIE to physicians is critical for gaining their buy-in. "There needs to be enough value in the application and data to have [physicians] come back and immediately use it and change their practice workflows to use it."
6. Plan to use the HIE as a strategic tool. "Many hospitals look at an HIE as driven by the CIO or the information systems department as a tactical way of dealing with data movement and data access, but an HIE can be a much more strategic tool to be utilized in their region," Mr. Keet says. For example, the HIE can facilitate physician-hospital alignment to coordinate patient care. "Many hospitals that undertook deploying HIEs in the past few years had a connectivity strategy; they really missed the boat on the alignment strategy of physicians," he says. "Now these hospitals are doubling back and doing more feature-rich [HIEs] so they can get point-of-care decision support and population analytics."
Hospitals may also be able to use HIEs to meet healthcare reform goals, as initiatives such as accountable care organizations aim to improve population health. Implementing a comprehensive HIE system will allow hospitals to more easily identify and treat the most vulnerable patients. "You need a more robust [HIE], something that does much more than simply enable access to data or delivery of data to physicians with an EMR," Mr. Keet says.
7. Lead with the C-suite. As HIEs are strategic tools, implementation efforts need to be driven by the C-suite, according to Mr. Keet. The CEO, CFO and CMIO should take the lead to ensure implementation meets the hospital's strategic goals. Mr. Keet suggests the CMIO lead data analytics and decision support applications that can be connected to the HIE. The CFO should assess the financial implications of HIE adoption and compliance issues such as the Stark Law.
CEO leadership is particularly important for the success of HIE implementation because he or she can focus the hospital on using the HIE to connect to the community, which can raise the likelihood of physician participation and eventual patient participation in personal records. "Because [HIE implementation] is often a strategic process, it is something that leadership can tout as a community-based effort in something that will tie them together," Mr. Keet says.
The CEO's framing of the HIE initiative as a collaborative project can prevent the hospital from using it as a tactic to gain a competitive edge. "Unless [the project starts] at the CEO level, these things are often utilized as a competitive and marketing advantage against their competing hospitals," he says. "In some cases, you want to work with your competitors to establish a better playing field to compete on, not to compete on data movement and data acquisition amongst the physicians.