Physician Group Takes Charge Of Its HIE Destiny
By Ken Congdon, Editor In Chief, Health IT Outcomes
North Texas Specialty Physicians proves that HIE (health information exchange) isn’t only attainable by hospital systems or regional/state organizations. This physician group built its own HIE and is reaping countless benefits.
Back in May 2012, in its public comments on CMS’ proposed rules for Stage 2 Meaningful Use, the AMA (American Medical Association) essentially stated that HIE (health information exchange) was outside of a physician’s control. The AMA cited that physicians’ limited ability to exchange data with other healthcare partners due to a lack of affordable system interfaces as a key barrier to meeting many of the Stage 2 criteria. Perhaps the AMA should have consulted North Texas Specialty Physicians (NTSP) before issuing these comments.
While few would call it “affordable,” this Independent Physician Association (IPA), comprised of nearly 600 primary care and specialty doctors, made the investment to build its own HIE back in 2006. The exchange went live in 2008, and NTSP deems the investment an undeniable success based on the positive impact the HIE has had on physician reimbursement and overall patient care.
REIMBURSEMENT & CARE QUALITY CONCERNS SPARK HIE PROJECT
Prior to 2006, NTSP exchanged health records the way most doctors’ offices still do today. If a specialist needed a patient record from a primary care physician (or vice versa), a nurse or physician’s assistant (PA) would call the partnering office to request a faxed copy. The same process was followed to request hospital records. This process was not only time consuming and inefficient, but inevitably doctors did not receive the records in time for their appointments with patients.
However, it was more than just mere inconvenience that drove NTSP to investigate HIE solutions. It was the desire to improve patient care, as well as the financial performance of the IPA. “NTSP has been involved in managing Medicare risk contracts and other risk contracts since 1995,” says Dr. Tom Deas, gastroenterologist for NTSP. “Under these scenarios, there is a very strong financial incentive to provide higher-quality, cost-efficient care. We needed a tool to help us better manage our chronically ill patients and support preventative wellness programs. In 2006, we identified that HIE technologies were sufficiently advanced to help us improve our delivery of care.”
Back in 2006, there was no state HIE and few RHIOs (regional health information organizations) in Texas, so NTSP decided to build its own HIE, using the physicians in its IPA (and the hospitals they worked with), as the foundation for the exchange. The IPA leveraged a few select technology components to build the HIE, including the Cloverleaf integration engine by Healthvision (acquired by Lawson in 2010) and IBM Initiate to provide the patient identifier functionality. The IPA also decided to roll out the HIE technology in conjunction with a joint EMR initiative.
“We developed Sandlot, our subsidiary company, to develop the technical skills necessary to build the SandlotConnect HIE and assist our early adopter physician members with EHR implementation and training,” says Deas. “This was a substantial undertaking financially. We’ve been putting five million dollars a year into this initiative over the past five years. Approximately two million dollars per year of this investment has been allocated for the development of the HIE; the rest went towards EMR licenses and support.”
INCENTIVES PROMPT PHYSICIAN HIE USE
NTSP’s SandlotConnect HIE went live in 2008 and exchanges clinical information interoperably with the EMR systems in use within the NTSP ecosystem. Currently, four EMR platforms are used throughout NTSP. The specialty and primary care physician offices use NextGen, Allscripts Enterprise, or eClinicalWorks. The hospitals that partner with NTSP use Epic.
With the HIE, clinical data is transmitted from one EMR to another using the CCD (continuity of care document). When a physician completes or updates a patient record in their native EMR, an updated CCD is immediately transmitted to the HIE. The CCD includes critical updated patient information, including new problems/ symptoms, medications, lab results, allergies, etc. Physicians without an EMR can also access this CCD via SandlotConnect’s online portal.
“When a patient is scheduled to see me in my office, my appointment calendar sends a request for that patient’s current CCD,” says Dr. Deas. “That CCD is then automatically transmitted into my Allscripts EMR. I don’t have to take any action to receive it. Having access to a complete patient record that is constantly being updated by multiple sources (e.g. physician EMRs, laboratories, radiology groups, hospitals, etc.) provides a wealth of information and is an invaluable tool in treating patients effectively.”
NTSP’s work wasn’t done once the HIE went live. Instead, the IPA quickly realized that one of its biggest challenges still lay ahead — getting its physicians to actually use the HIE. “In many cases, the physician groups and hospitals in our community have been life-long competitors,” says Dr. Deas. “As a result, many providers resisted sharing their patient data with the HIE and changing their routine workflow processes. We overcame this resistance by providing physicians with financial incentives to use the system. We established payfor- performance measures that aligned with the desired outcomes of our Medicare Advantage risk contracts. Our physicians soon realized that point-of-care patient information via the HIE gave them more control over whether or not they met these performance measures.”
DECISION SUPPORT & POPULATION MANAGEMENT: THE NEXT PHASE OF HIE
Today, more than 2 million patient records reside in NTSP’s SandlotConnect, which is accessed by 27 hospitals and more than 2,500 physicians. According to Dr. Deas, the impact of the HIE on patient care has been nothing short of dramatic.
“Having a complete patient record at your fingertips via an HIE is not only powerful … it’s potentially life saving,” says Dr. Deas. “For example, patients come into my office all of the time having forgotten some of the medications they are taking. Recently, I was ready to schedule a colonoscopy for a patient who neglected to tell me she was on Warfarin, an anticoagulant. I was notified of this prescription via the CCD I received from the HIE, and it made a huge difference in how I managed that patient.”
Over the past year, NTSP has taken steps to embed several decision support capabilities into its HIE. These tools use the HIE patient database to prompt physicians to take specific actions depending on the patient, their conditions, and the information contained in their patient record. These tools help physicians manage chronically ill patients by providing doctors with the information they need to ensure they achieve quality outcomes and avert potential medical complications. In the near future, NTSP plans to leverage the HIE to manage entire populations of patients. “Soon, I should be able to use the HIE to identify all of my patients with cirrhosis of the liver and see how often they come in to see me, if they are compliant with their medications, and if they are adhering to a preventative care plan,” says Dr. Deas. “If they aren’t, the HIE data can prompt us to contact the patient and encourage compliance.”
SandlotConnect has done more than improve the level of care the IPA delivers to its patients. It has also proved to be a sound financial investment for NTSP. According to Dr. Deas, the HIE has helped NTSP maximize the reimbursements it receives through its Medicare risk contracts, providing a solid return from the technology investment. Furthermore, the HIE has provided a new revenue stream for the IPA. Sandlot Solutions now offers other medical communities throughout the country the same type of HIE solutions and services NTSP built for itself.