Many industry stakeholders try to over-simplify the dynamics of the health information exchange market, contends Kenneth Kleinberg, a managing director at The Advisory Board Company, a consultancy. “Some say that public HIEs don’t have sustainable models,” he notes. “The reality is there are some public HIEs that are viable and some private HIEs that have proven unsuccessful.”

During a roundtable session at HIMSS13 in New Orleans, Kleinberg will walk attendees through the quickly evolving public and private HIE markets.

And there are distinct types of HIEs, as well. A database-centric model where data elements are exchanged would be an advantageous model for an accountable care organization if agreement can be reached among participants on populating a central database, as that facilitates data analytics for population management and surveillance. A document-centric model of HIE readily supports transmitting Continuity of Care Documents between loosely affiliated or even competitive providers, giving good information about a patient but not conducive to extracting and analyzing data elements. A third model is use of the federally developed Direct Project protocols for secure messaging over the Internet, and some regional HIEs have given up on other models and are just pushing information via Direct.

Kleinberg also will speak of the importance of HIEs to help providers meet patient engagement requirements in future stages of the electronic health records meaningful use program, starting with Stage 2 when providers must quickly make clinical information available to patients. A multi-hospital delivery system, for instance, may have many different acute and ambulatory patient portals, but an HIE could offer a consolidated portal to meet meaningful use criteria.

Other issues to be discussed include the role states play in HIE, the debate over opt-in and out-out consent models, and whether we’ll ever have a national HIE and what it might look like. The roundtable session, “Health Information Exchange: Reality and Future,” is scheduled at 12:15 p.m. on March 4.


AAFP Readies an Early Look at its Data Repository for Family Docs

The American Academy of Family Physicians expects in the second quarter of 2013 to launch a data repository for its members that will support analysis of benchmarking data. Explaining the repository is the focus of an educational seminar at HIMSS13 in New Orleans.

About 40 physicians in 11 practices have been pilot testing the repository, which currently is populated with claims data from 60,000 family physicians, courtesy of claims clearinghouse/revenue cycle management vendor Emdeon. AAFP members are being asked, but not required, to contribute clinical data, says Steven Waldren, M.D., senior health I.T. strategist at the association and presenter of the session at HIMSS.

Emdeon, the largest medical clearinghouse with connections to the most health payers, also can offer laboratory and medication data pulled from claims, and has interfaces with many electronic health records vendors. The three-phase pilot started with claims data, then brought in labs and medications, and now Emdeon is working with a couple of EHR vendors to pull clinical data.

But the repository when officially launched will remain a work in progress for some time, Waldren notes. Physicians initially will have access only to data generated in their own practice, and the lab data, for now, comes from claims and does not include results. But just having knowledge that a test was done, combined with medication history, “allows us to do a significant amount of additional analytics that are just too challenging without that information,” he adds.

Over time, however, physicians will have access to data from other providers, such as mammography claims data from a local hospital or diagnostic imaging center. AAFP is working on consent models to pull preventive data from other providers, as well, Waldren says.

Data analytics will be a critical tool for family physicians as they move toward new payment arrangements, enabling practices to better target performance areas that need more focus, Waldren says. “Without it, I don’t see us being effective in the areas of accountable care and value-based payments.”

Education session 53, “Improving Outcomes with Benchmarking Data: The AAFP’s Clinical Data Repository,” is scheduled at 12:15 p.m. on March 4.


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