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(HealthNewsDigest.com) – As new healthcare data regulations such as meaningful use and breach notification requirements take effect, being part of a health information exchange (HIE) can enable participants to easily comply with these regulations. Unlike paper-based systems, an HIE automatically documents interactions with data, which can help providers accurately track, record and report as required.
The Brooklyn Health Information Exchange (BHIX) was established in 2007 as a consortium of hospitals, nursing homes, home health providers, health insurers and consumer representatives. Originally incubated by grant funding awarded to Maimonides Medical Center in Brooklyn, BHIX has grown its membership to include organizations serving patients in neighboring boroughs of NYC such as Queens and Manhattan. BHIX continues to actively participate in the development and expansion of the NY State Health Information Network to support patient mobility between and among providers.
With 2.5 million residents, Brooklyn, the most populous borough in New York City, was a challenging place to start an HIE. The borough of Brooklyn alone – not to mention the additional geographies currently served by BHIX — has a larger population than many big cities, states, and even some countries. Many residents have multiple healthcare providers and travel within the borough and outside of Brooklyn for care. The area is highly diverse, with multiple languages spoken by residents. It serves about 20 percent of the state’s Medicaid patients and 11 percent of its residents are 65 or older.
Establishing a health information exchange for the diverse and mobile population found in NYC requires a technology platform that integrates data from various sources and makes it available to participating organizations. For any exchange to be successful, participants must trust the reliability of the system, the quality of the data and the governance practices that ensure privacy and security.
The most daunting challenge in establishing and maintaining an HIE in this environment is to accurately identify the same patient across multiple systems, link records and create unique patient identities that can be accessed at any point of service. It requires an electronic health system that identifies the same patient across different institutions to help take patient data from an institution and share it across borders, subject to applicable patient consent rules. This system must be able to do this even if the patient’s name is spelled differently from one facility to another, addresses have changed or records have typographical errors.
In addition, you must address the need to implement a transparent data governance structure that protects patient privacy, facilitates comprehensive consent and information flow policies and enables participation by a large number of health care providers who have been authenticated and provisioned in alignment with statewide and BHIX policies.
To facilitate this, we decided on a standards-based information exchange platform that included a patient registry with the ability to manage millions of records while ensuring patient privacy and supporting current and future growth. This combination of technology creates a comprehensive view of all records across an HIE’s participating entities and helps make them available to clinicians connected to the HIE. Participating clinicians can treat patients more effectively by securely accessing records from various clinical locations and sources. When you have integration with disparate systems and the accurate matching of patient identities with features and functionality that accounts for typographical errors or mis-keyed information, an HIE can achieve the four key objectives for patient identification. These include:
Scalability: Supports millions of records and transactions as well as disparate health information systems.
Accuracy: Creates unique patient identifiers across an extremely diverse set of systems with inconsistent and unreliable data quality.
Flexibility: Enables a hybrid data governance and data exchange model across sometimes competing stakeholders.
Security: Protects patient privacy by enabling unique data governance rules.
What does this mean in the real world? How about when you have a constantly changing landscape and are always rethinking and updating systems to support new interdependencies?
For us, these new capabilities help to improve coordination and quality of patient care, , facilitate effective management of chronic disease conditions and reduce the amount of time providers and payers spend hunting and pecking for information. We maintain strict privacy policies regarding the use of patient care data within the exchange. At each member organization, only authorized users who have been granted user name and password access can view or print information about their patients. Accurately identifying and linking patient records has proven critical to ensure that the right records are being accessed by the right provider.
As of July 2010, BHIX results include:
The system manages approximately 5 million messages per month;
The patient registry supports 19 systems in 13 facilities across Brooklyn and Queens. As provider organizations and practices transform their internal systems and adopt new EHRs, BHIX works to help integrate new systems into the exchange.
Data being shared includes patient demographics, advance directives, clinician directories, and, allergies, medications, problem lists, diagnoses, procedures, laboratory results, radiology reports, discharge and transitional care summaries
We have prototyped a connection to NYS Medicaid medication history data, as well as a connection through the national health information network to trade data with a HIE in another State
BHIX’s solution can easily evolve over time, with additional implementations; our HIE is expanding in a number of ways:
Providing clinicians with access to patient records through interoperable EHRs, authorizing data access to new providers, and increasing the types and sources of patient information.
Educating patients and the community concerning the patient consent process, thereby increasing the uptake in patients consenting to participate in health information exchange.
Developing a variety of marketing collateral and educational materials in languages that reflect the vast multicultural populations within the region.
Developing and supporting enhanced care management programs for geriatric patients and those with chronic diseases.
Facilitating Patient Centered Medical Home (PCMH) and Accountable Care Organization (ACO) models to improve the coordination of care.
Layering value-added services such as community-wide quality reporting and referral management on top of basic HIE to improve outcomes of participating providers.
A successful HIE is about enabling clinicians to access the most accurate and recent patient data in one complete view at the point of care. Inherent in this vision is the need to link data of patients who receive care at various unaffiliated provider organizations. Coordinating care across unaffiliated entities will help save time, reduce errors, lower costs, and improve outcomes. BHIX is a model for communities that want to provide integrated, community-wide medical information – regardless of its original source — to improve the quality, efficiency and safety of medical care.
About the author: Irene Koch is the executive director of the Brooklyn Health Information Exchange. BHIX is using IBM Initiate® Patient as its patient registry and the foundation of the health information exchange.
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