By Jay Greene
The health care and business communities in Michigan may be on the cusp of realizing the ultimate benefit of the free flow of online medical electronic data: Managing the health of patients as they move through the health care delivery system across the state and multiple care providers.
As Michigan’s six health information exchanges continue to tailor their individual business plans for customers — typically, hospitals, physicians and health insurers — HIEs are moving closer to using clinical patient data to analyze population health, improve care coordination and more effectively identify patient risks for readmissions.
Meeting these goals is important to providers because they ultimately can help reduce individual premiums and cut employer health benefit costs, said Tim Pletcher, executive director of Lansing-based Michigan Health Information Network Shared Services.
“Before, people didn’t have incentives to share information. As they have gone from fee-for-service, paid for volume, to be paid financial incentives for quality and outcomes, there is a desire to look across their borders” and work together to exchange clinical and cost data, Pletcher said.
“Historically, doctors have only known 27 percent of the time when their patients have been in the hospital,” Pletcher said. “How do you do care coordination when you don’t know your patient has been sent home?”
Pletcher said the use of electronic health records and health information exchanges by hospitals and doctors is radically changing how medicine is delivered.
At the Connecting Michigan for Health 2014 conference in Lansing in June, more than 40 electronic data exchange experts from Texas, Rhode Island, Maine, Indiana, Illinois and Michigan described the evolutionary ups and downs in creating a national electronic health data highway.
Doug Dietzman, executive director of the newly merged Great Lakes Health Connect, said HIEs will reach their full potential when providers, including hospitals and physicians, start accepting financial risk for taking care of patients.
Great Lakes was formed through the merger of Grand Rapids-based Michigan Health Connect, the state’s largest HIE, and Great Lakes HIE, or GLHIE, based in East Lansing. It is one of the largest in the nation, accounting for 80 percent of the state’s total licensed beds with 120 member hospitals, 20,000 physicians, 3,000 clinics and offices and consolidated revenue of $8 million, Dietzman said.
“This is an opportunity for me to offer you services to help you meet that need,” Dietzman said to representatives of hospitals, physicians and other providers at the recent HIE conference. “(HIEs) exchanging data will help you reduce risks, manage capitation risks and conduct population health management for out-of-network” patients.
But Andrew Rosenberg, M.D., chief medical information officer at the University of Michigan Health System in Ann Arbor, said technical barriers and incentives to participating in health information exchanges first need to be overcome.
“The technical barriers are reducing rapidly, not only for the big health systems but also for the smaller provider organizations and individual provider offices that are on certified electronic medical records,” Rosenberg said. “Once we do this (and hospitals, doctors and other providers share patient data), the clinical and cost containment benefits of managing population health can be achieved.”
Rosenberg said some hospitals participating in HIEs are not sending all potential medical data because of data security concerns or worries that competitors will use the information against them.
“We send huge amounts of data to Great Lakes Health Connect,” Rosenberg said. “Some providers don’t have sufficient incentives” to fully participate.
Over time, however, as financial incentives align between providers to jointly improve quality and manage costs under shared managed care contracts, Rosenberg said, the ability for physicians and hospitals to monitor population health will improve.
Pletcher said hospitals are realizing now that they have incentives to share data because of hospital readmission penalties if patients are readmitted anywhere within 30 days.
“HIEs will help stop that patient from being readmitted, and that helps” hospitals financially, Pletcher said. “This is one of the early benefits of data exchange. The longer-term effort will be on population health.”
What is population health management?
Many definitions exist, but population health management has two key components: First is the ability to coordinate and track patient care to improve clinical quality and health outcomes. Second is managing that care to lower costs by reducing duplication of services and diagnostic testing and avoiding medical errors.
But population health, by description, also means managing large groups of patients — 10,000, 20,000, 50,000 or more — through some risk-based contracting mechanism.
“One-third of our patients (at the University of Michigan Health System) are taken care of by providers outside of our health system,” Rosenberg said. “If we are to manage their health in risk contracts, we need to have exquisite information on them outside of our health system.”
For example, what if a Detroit Tigers fan from Petoskey gets injured in a car accident after a game and is rushed to the emergency department at Detroit Medical Center?
Data exchange on that patient through an HIE could enable the DMC to have immediate access to the patient’s health care history. This information could reduce costs and avoid potential medical errors, Pletcher said.
Then, two days later, that fan is discharged from the hospital and goes home. But what happens to his or her medical record at the DMC? If the DMC is able to send that patient’s ATD (admission, transfer and discharge) document to an HIE, then it would be possible for that information to be shared with providers in Petoskey for follow-up care, Rosenberg said.
Sharing patient data like this will help hospitals and physicians lower costs, coordinate care, improve quality and reduce service duplication, Pletcher said.
“They are trying to make a decision (about care), and the safest route is to admit the patient to make sure nothing is wrong,” Pletcher said. “If I have access to what is going on with patient, I can do something to stabilize patient and then tomorrow have patient go to cardiologist. I don’t have to admit.”
A recent University of Michigan study found that patients who visited the emergency departments of two hospitals participating in HIEs within 30-day periods reduced repeat imaging for computed tomography (8.7 percent), ultrasound (9.1 percent) and chest X-rays (13 percent).
About 20,000 patient visits at 37 hospital emergency departments were studied in the report, “Does Health Information Exchange Reduce Redundant Imaging?” in the March issue of the journal Medical Care.
“You need access to (clinical and claims data),” said Tony Colarossi, a partner at Southfield-based Plante Moran PLLC, who leads the firm’s acute health care consulting services practice. “The information itself is not population health. It is how you use the data.”
Shaun Alfreds, COO of HealthInfoNet, Maine’s HIE, said 34 of the state’s 37 hospitals, 34 federally qualified health centers and 400 other outpatient clinics contribute data to the state’s all-claims payer database.
“Hospitals want to look at population health. We are crunching the data now to get the information into care management workflow. The goal is to know the risk of readmission before a patient is discharged,” said Alfreds, adding that early studies show the readmission predictions have been fairly accurate.
Like a growing number of HIEs, HealthInfoNet’s data include patients’ encounter history, laboratory and microbiology results, radiology reports, adverse reactions and allergies, prescription medication history, diagnosis, conditions and problems, immunizations, vital signs, dictated/transcribed documents and continuity-of-care documents.
Jim Lee, vice president for data policy at the Michigan Health and Hospital Association, said the ultimate use of patient care data is to coordinate care and manage patients wherever they go.
Maine’s all-payer claims data-base is important to help hospitals analyze risk, Lee said. “We (hospitals) don’t have that data. The insurers have it,” he said. “Sometimes the past is a predictor of the future to know what your potential needs are.”
