HIT Leaders Tackle Tough Issue: 'Meaningful' Data Sharing

Under the HITECH Act's upcoming Meaningful Use Stages 2 and 3, health data exchange requirements are expected to become even tougher. That's why healthcare providers and health information exchange organizations need to take a close look at their data exchange strategies sooner rather than later.

While proposed regulations for Stage 2 and 3 Meaningful Use compliance are still being hammered out by government committees in Wash. D.C., health IT executives speaking at a recent InformationWeek Healthcare IT Leadership Forum in New York City shed some light on the data exchange trends and strategies among healthcare providers and health information exchanges (HIEs).

The ability to securely share patient data can help clinicians access more complete and timely information, which will hopefully enable professionals to provide better, safer care and eliminate ordering costly and unnecessary tests and treatments. Upcoming Stage 2 and 3 regulations will likely specify and expand upon the types of health data that need to be shared.

For large healthcare providers like Tenet Healthcare, which is based in Dallas but has 49 hospitals and 84 outpatient centers in 11 states, a multi-prong strategy for health data exchange is at work, said Elizabeth Johnson.

Johnson, Tenet's VP of applied clinical informatics and a member of the Health IT Standards Committee that's evaluating the upcoming Meaningful Use Stages 2 and 3 criteria, explained Tenet's approach at the recent InformationWeek Healthcare event. Her organization takes a market-by-market approach since the maturity and availability of HIE organizations and services vary from region to region, and from state to state.

In some places, Tenet participates in regional, community, or state health information exchanges, including the Nebraska Health Information Initiative and MidSouth eHealth Alliance in Memphis, said Johnson.

However, in other regions, Tenet leverages HIE products from vendors that allow data exchange among providers in those areas, including the use of RelayHealth in San Ramon and Medicity in the Atlanta market, Johnson said. In addition, Tenet also uses a "Tenet-driven" data exchange approach in other regions, using NextGen EMR and HIE products, she said.

"We try to utilize regional or state HIEs when we can," she said. When asked about what drives Tenet's HIE adoption strategy, Johnson mentioned improving the quality of care Tenet clinicians provide patients; physician attraction and retention; and compliance to HITECH requirements.

Among Stage 2 and 3 data exchange recommendations submitted to ONC by the HIT Standard Committee in June was a reminder to keep the standards simple; there were also proposals about HIE metadata headers, such as privacy flags and patient identifiers; and standards for provider directories, said Johnson.

Johnson also emphasized that, "patients want to be able to opt in, not opt out" of having their data shared among healthcare providers participating in HIEs. So, upcoming regulations potentially could address that, she said. "Privacy and security requirements haven't been figured out yet," she said.

Meanwhile, HIE organizations are also looking ahead to future Stage 2 and 3 requirements, as well as the services their members will be seeking in the months and years to come.

In New York City, the two-and-a-half year-old New York Clinical Information Exchange, or NYClix, has been expanding the services it offers members--which include nearly 20 leading local healthcare providers--to help them share and access data on the more than 4 million patients that they serve, said Tom Moore, NYClix technical manager, at the forum.

Through a federated database and central master patient index technology model, current services offered by NYClix include data exchange related to events notifications, secure messaging, test results delivery, patient transfers, e-prescriptions, and clinical records such as discharge summaries, allergies, medications, and sometimes continuity of care documents.

However, looking ahead, NYClix plans to expand its service offerings to include clinical decision support and collaboration tools, tighter workflow integration, semantic interoperability, and public health analytics, said Moore.

NYClix is one of the more than 200 health information exchanges in the U.S., many of which have emerged over the last couple of years as the HITECH Act allotted grant money to states and state-designated entities to launch or expand HIEs.

Trust agreements are the most important aspect in the early months of a new HIE, "even more so than the technology," said Moore, about the early challenges of HIE organizations to get buy-in from healthcare provider members to participate in the data exchange efforts, which often can have hospitals and doctors sharing data with competitors.

As more providers participate nationwide in HIEs, "in the future, I expect there will be more blending together of HIEs and EHRs," said Moore, explaining that the aim for HIEs like NYClix is to make it easier for clinicians to view patient data from HIEs as part of an individual's health record.

Johnson isn't sure what type of "blending" of HIE and EHRs could happen, but thinks that a "standard medical document" other than the usual e-health record could emerge for data sharing. That record could include summarized, yet broad, information about a patient from many different sources.

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