No Room for Skeptism or Doubt, Lane Tells HIE Stakeholders

Kizer Cites Increased Sense of Urgency for Data Exchange

DirectTrust.org: An Open Source Effort to Help HISPs Work Together

Direct Project: Real World Applications in an Established HIE

Pilot Uses Data from EHRs to Address Population Health Quality Measures

 

No Room for Skeptism or Doubt, Lane Tells HIE Stakeholders

Pamela Lane, Deputy Secretary, Health Information Exchange for the California Health and Human Services Agency (CHHS), urged HIE stakeholders to remain steadfast in the face of continuing challenges to statewide health data exchange in California.

Speaking to the Annual Redwood Mednet Conference “Connecting California to Improve Patient Care,” Lane addressed the potential for discouragement given the many challenges, such as finances and interoperability, that stand in the way. But she urged the audience, which included many of the state’s leading figures in HIE, to remain committed and optimistic. “Do not bring skepticism and doubt” to this effort, she said. “We need to all continue to work hard and remember, it is about the patients. We need a renewed focus on the goal,” she said, which is improving patient care.

Lane noted that CHHS is transitioning management of current and planned HIE programs under the federal HIE Coorperative Agreement to the UC Davis Health System’s Institute for Population Health Improvement from Cal eConnect, whose board determined that it could not move quickly enough to implement approved programs. The change is an opportunity to “write a new chapter” in California’s HIE story, Lane said.

Lane said that her late father, a nurse and former hospital administrator, urged her to take on the challenge of the eHealth Initiative position when she was uncertain about the huge challenge of connecting myriad disparate parts of the health care system in a state as big as California. “He told me, ‘This is the most important thing health care has ever faced,’” Lane related. She told the audience: “I hope you believe that too.”

Lane discussed the updated vision and goals for HIE in California whch emphasize patients rather than technology.

California’s Vision
Improve the health and well-being of all Californians.

California’s e-Goals
• Enhance individual and population health outcomes through results-oriented programs.
• Ensure secure data access that protects patient privacy and data integrity.
• Engage patients and families as partners in care.

“These are meant to send a message that government wants HIE in California to accelerate,” Lane said. “We are about the business of HIE,” Lane told the audience.”We are not in state government to say no …  or to create barriers.”

 

Kizer Cites Increased Sense of Urgency for Data Exchange

As the California Health and Human Services Agency transitions to the Institute for Population Health Improvement (IPHI) as its new partner in health information exchange (HIE) efforts, there will be a “more tangible sense of urgency,” according to IPHI Director Kenneth Kizer, MD, MPH. The program will continue the strategic focus it has had for the past few years, but seek faster progress, Dr. Kizer told attendees of the Redwood MedNet HIE conference.

Among other goals:

• Greater focus on integration with other health care reform and public health efforts;
• Focus on health IT and HIE as tools, not outcomes, and on improved health outcomes through their use;
• Greater communication between private and publicly funded HIE activities; and
• Review of past strategies and tactics to see if they continue to work in light of changing circumstances.

“That’s not because we think they were wrong,” he said of the effort led by Cal eConnect. “Things are moving so fast, we continually have to reappraise …what we are doing.”

The Institute for Public Health Improvement was created in March 2011 as a resource for health care reform, health policy and clinical quality improvement. It assists government health-related agencies and programs, as well as supporting leadership and conducting research in public health. The organization has a particular emphasis on the wide range of factors that impact health besides the actual provision of health care, such as education, employment and environment.

Along with its new responsibilities taking on the HIE project, the institute also works on quality improvement with the Medi-Cal program, manages the California Cancer Registry, manages public health programs for the state, conducts surgical safety assessments, among other projects.

Dr. Kizer has a long history of involvement with public and private sector work in health information technology, health care quality improvement and population health. He has served as Under Secretary for Health in the U.S. Department of Veterans Affairs, where he led the VA’s successful transition to electronic health records. He also was founding president and CEO of the National Quality Forum, and served as chairman, president and CEO of Medsphere Systems Corp., the nation’s leading commercial provider of open source health care information technology.

DirectTrust.org: An Open Source Effort to Help HISPs Work Together

Direct Messaging is emerging as an essential accelerator of HIE by offering providers a simple way to send and receive secure messages. But as its use has grown, so has the need to ensure that Direct service providers are complying with HIPAA and other security standards. DirectTrust.org, an effort to provide a national-level answer to the trust problem, is an open source project being carried out publicly through a wiki site that is open to any contributor, David Kibbe, president and CEO of DirectTrust explained at the July Redwood Mednet Conference.

Direct services are provided by health internet service providers (HISPs). “Currently HISPs are just serving their own subscribers,” Kibbe explained. “We’re just now bumping into the problem of what happens if they want to share information with another HISP.” Before a HISP shares sensitive patient information with another HISP, it needs to know that data will be handled securely, according to accepted standards. “Without trust services Direct will not grow at scale,” Kibbe said.

The benefit of having a central, open source answer for Direct trust services is to avoid having every pair of HISPs make separate agreements with one another. Trust services offer third-party verification that a HISP complies with HIPAA and other security standards.

DirectTrust.org is an independent non-profit trade association, which is converting to a membership organization; its wiki has had participation from more than 185 representatives from HISPs, health information exchanges, certificate authorities, consultants, state agencies, EHR vendors as well as Direct users. The organization is also working on a national accreditation program for HISPs, certificate authorities and registration authorities.

The effort is gaining support, but its goal is ambitious. Still, Kibbe was upbeat about its prospects, particularly considering the huge potential for Direct to help bridge the gap between providers with EHRs that do not easily interact. “We really want to push this ball over the goal line,” he said.

 

Direct Project: Real World Applications in an Established HIE

The Direct Project has introduced a simple, secure messaging option for sharing health records, with many potential uses. The question is, what is its place in a mature health IT environment where health information exchange is already taking place among sophisticated users?

In New York Sate, the Hudson Valley Initiative is finding that Direct Messaging has its place even where more complex and advanced technology is in play, according to John Blair, MD, CEO of MedAllies, a technical support organization. Blair gave an update on the Hudson Valley Initiative’s exchange activity at the Redwood MedNet Conference in July.

The Hudson Valley HIE has been in place for a decade, in an area with unusually high EHR adoption rates among providers. Still, the relatively new Direct Project is filling a need there. “We’re moving very strongly into Direct,” Blair said. “It’s about interoperability…we’re using Direct to connect disparate EHR systems.” The more providers have electronic records, he said, the more they want to share information with other providers, and Direct can be a quick, easy solution for some types of transactions.

“We do not think traditional HIE will go away,” he said. “Direct does not replace traditional HIE, they are different.” Blair offered a use case example of a hospital discharge summary being sent to the primary care provider, or a closed-loop consultation referral between doctors – situations where the provider knows what the other provider needs. More complex interactions – such as those involving complex, chronically ill patients with detailed histories -- will still require the middleman of an HIE organization, Blair suggested.

Pilot Uses Data from EHRs to Address Population Health Quality Measures

A pilot project in Maine is pulling reportable public health quality information out of a health information exchange in a way that can be easily adopted by providers.

“The Centers for Disease Control built the environment but it is available to anyone,” explained Taha Kass-Hout, MD, director of the CDC’s Division of Informatics Solutions and Operations, at the Redwood MedNet Conference. “This can help you meet meaningful use quality reporting requirements.”

CDC’s goal was to see whether data could be pulled from HIEs on several prevention measures, providing a timely, efficient and low-cost way to monitor whether certain clinical preventive services are being provided. The project established connectivity between an HIE in Maine, HealthInfoNet, and the Maine Health Department using Nationwide Health Information Network (NwHIN) procedures. A live data feed was transmitted successfully from the HIE to Maine CDC.

The test involved reporting de-identified, population-level preventive care data. It used an open-source application call popHealth to de-identify, anonymize, aggregate and securely transmit the information.

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