How health information exchange serves diverse New Mexico
New Mexico is a place of contrasts. It has far more sheep and cattle than people—there are only about 12 people per square mile. By contrast, New Mexico is also the home to two large national laboratories that have provided innovations from the atomic bomb to national security, space exploration, nuclear fusion, renewable energy, medicine, nanotechnology and supercomputing.
As would be expected in this complex and rural place, there are challenges with access to healthcare. Many of the state’s healthcare locations are geographically dispersed, spanning a multitude of remote areas and sovereign nations. They use numerous forms of paper and electronic health records, and their willingness to share and collaborate varies widely. This effectively creates barriers to delivering high-quality, safe and coordinated care.
The New Mexico Health Information Collaborative (NMHIC) was created as a community resource with the goal of providing high-quality, comprehensive, secure information and knowledge when and where it is needed to facilitate optimal healthcare for state residents.
NMHIC has come a long way—with information flowing in from more than 80 percent of all the hospital admissions and emergency department visits, as well as local and national labs and imaging service providers. Leveraging a data management platform from Orion Health, NMHIC has created a real-time integrated longitudinal health record for more than 1.7 million people.
This integrated record provides unique community-centric views of health and healthcare that are not possible to get within any one healthcare system. The real-time aspect of the data makes it ideal for doing process and quality improvement. Previously, much of this work was done from claims; however, claims typically have delays of months before the information is available. This delay made it very difficult to continuously improve quality.
Today, this data can be accessed via an easy-to-use web portal. In addition to routine use by providers, the New Mexico Poison and Drug Information Center uses this information to review patient history during an emergency. This information has aided in the avoidance of improper diagnoses and administration of costly antidotes.
Additionally, the data has helped Supplemental Security Income and Social Security Disability (SSI/SSDI) Outreach, Access and Recovery (SOAR). SOAR is a program designed to increase access to SSI/SSDI for eligible adults who are experiencing, or are at risk, of homelessness and have a serious mental illness, medical impairment and/or a co-occurring substance use disorder. The SOAR specialists have used NMHIC to significantly improve and speed up the application process.
NMHIC also provides Direct Secure Messaging. The Centers for Medicaid and Medicare Services (CMS) and the Office of the National Coordinator for Health IT (ONC) approved secure encrypted email that enables communication between providers. This has proven to be valuable when transitions of care occur with organizations that were not a part of the CMS electronic health record (EHR) Incentive Program and may not have certified EHR products that include Direct Secure Messaging (i.e. long-term care, hospice, homecare, physical therapy, first responders and the like). NMHIC can easily get them set up for Direct Secure Messaging using a web client for a very reasonable cost per mailbox. This has enabled hospitals and provider groups to meet their goals of sharing information for transitions of care for meaningful use (now known as Promoting Interoperability).
NMHIC has a replicated clinical data repository that enables it to do analytics without impacting the transactional performance of the system. NMHIC analytics are providing integrated, clean data sets to Accountable Care Organizations (ACOs), payers and providers. An ACO was able to use this data to help increase its CMS Star Rating by one star. A payer has used this data for risk stratification and care management, resulting in a hospital admission rate below the benchmark for well managed care. Its 30-day “all cause” hospital readmission rate now runs at half the national and local benchmarks.
However, NMHIC has faced many of these challenges in different forms today.
Almost everyone sees the tremendous potential value of a health information exchange. Despite that, there are organizations unwilling to share information and participate. Their many reasons include: the costs to build interfaces; distrust in sharing information with competitors and payers; and concerns with increased liability when sharing information. Some of these challenges result in holes in the data that reduce its perceived value. Though there are HITECH 90/10 matching funds for interoperability that could help overcome some of the cost challenges and make value-added functionality available, New Mexico is one of the few states that has not yet taken advantage of this program.
The world of healthcare interoperability is a complicated one. There are a variety of different national efforts underway to provide interoperability, such as CareEquality, Commonwell, eHealthExchange, SHIEC Patient Centered Data Home and more. There are many strong opinions over which is the best path forward. And, as we know, when there are low levels of hard evidence, strong opinions can greatly impact decision making. There is a clear need for evidence about what information is important to share and how it should best be accomplished.
Usability remains a huge challenge. We have access to vast amounts of information about all aspects of people’s lives. Providers have 10 minutes in clinic to make a diagnosis and optimal treatment decision, and throwing tens or hundreds of pages of PDFs, CCDs or CCDAs at them is not a viable solution. Systems of the future are going to have to be built on a solid foundation of knowledge and AI defined by subject matter experts in order to effectively fish through all of the data and provide key pieces of information relevant to a particular encounter, diagnosis and problem.
Despite current challenges, NMHIC is committed to its mission to provide high quality, comprehensive, secure information and knowledge when and where it is needed.