The Need for a New Type of HIE

Chilmark Research is advocating new thinking about health information exchanges and the value they can bring to healthcare organizations. “With few exceptions, existing EHR and HIE efforts have not delivered the breadth of clinical or financial benefits that healthcare organizations (HCOs) have envisioned,” the firm contends. In a recent report, Chilmark makes the argument for a new type of HIE and a new name: Clinician Network Management.

Expanding Horizons Expanding Horizons

Up to now, HIEs have focused on point-to-point data exchange rather than the information requirements of networks of clinicians working together to improve the efficiency and effectiveness of care, Chilmark argues. Success for an HCO, regardless of size, will depend on how well it supports and manages its clinician network (owned and affiliated) across the care continuum with standardized, evidence-based care pathways to better manage risk, reduce variability and provide higher patient-centric care.

The Goal The Goal

“Our goal is to encourage HCOs of all sizes to reconsider their HIEs as something more than information exchange, namely a platform to support a variety of clinician information needs at the point of care,” according to Chilmark. The network should enable patient-centric longitudinal data viewing, patient risk scoring, care-gap analysis, clinical care guidance, care team coordination, physician performance score cards and total cost determination for the population being served. The network is not about managing clinicians, but giving them the most relevant information possible to meet organizational objectives.

Distributing Intelligence Distributing Intelligence

Changes to the functions of HIE are necessary because the transition to value-based reimbursement is real. It will not be sufficient for an HIE to simply exchange information. HCOs need to leverage their HIE infrastructures along with I.T. systems supporting analytics, clinical, financial and operational functions to ensure clinicians across the network have the information to make decisions that support mutual goals and objectives. “Intelligence must be distributed in a complex, sophisticated manner.”

Workflow is Everything Workflow is Everything

“Closely coupled with delivering the right data is delivering it in context, at that point in the clinician’s workflow where it is most useful,” report authors advise. “Notifications about the existence of relevant data, delivered at a point in the workflow where it can be used effectively, are missing from most HIE implementations. These notifications will provide more than just patient data under value-based reimbursement. They will provide clinicians with guidance and reminders about their role in treatment protocols that are part of broader multi-HCO care plans.”

Competitive Forces Remain Competitive Forces Remain

Transitioning to a Clinician Network Management model brings new data requirement challenges. Chilmark interviews with senior leaders across 13 HCOs reveal that they recognize the need to share data yet still are leery of disclosing data to competitors--and they don’t trust payers enough to give them access to EHR data. Providers would like payer data that can detect revenue leakage, but the payers have been reluctant to share that. One executive said the message from an insurer basically was, “Yeah, we have this data and it’s part of what makes us better than you.”

Vendors Lag Vendors Lag

Providers interviewed for the report would prefer to see clinician network management solutions from their HIE or EHR vendors, but most are skeptical that the vendors can deliver quickly enough to support value-based reimbursement models. These missing pieces fall into three core categories: analytics, care coordination and workflow/process management. Adoption of best-of-breed IT solutions are likely and established EHR and HIE vendors will have to move quickly if they want their share of the pie.

Accepting the Inevitable Accepting the Inevitable

All HCO executives that Chilmark interviewed understand the value of clinician network management as the level they must get to as fee-for-service payments fade away. And while the animosity they feel toward insurers was surprising, they realize that payers have data sets and skills could be helpful in a value-based reimbursement environment. Many physicians may have to face a different inevitable situation: transitioning to the prescribed EHR of the HCO.

More Information More Information

The Chilmark report, which five vendors with a strong HIE focus sponsored, is available here.

Chilmark Research is advocating new thinking about health information exchanges and the value they can bring to healthcare organizations. “With few exceptions, existing EHR and HIE efforts have not delivered the breadth of clinical or financial benefits that healthcare organizations (HCOs) have envisioned,” the firm contends. In a recent report, Chilmark makes the argument for a new type of HIE and a new name: Clinician Network Management.

 

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