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Population Health Management: The True Value of an HIE
By Daniel Newman, MD

Meaningful use hangs heavy over the US medical establishment. A key stipulation of the HITECH Act, meaningful use is viewed by hospitals and other health care organizations as both the carrot and the stick that will compel them toward a more coordinated technological future—more specifically, for acquiring and utilizing an EHR system.

While some see health information exchanges (HIEs) as nothing more than an easy way to satisfy the meaningful use requirement, such thinking overlooks an HIE’s true value. In fact, the economic, operational, and clinical benefits of an HIE are significant—more than enough to justify its adoption, whether or not federal regulations demand it.

As the HITECH and Affordable Care acts move forward, population health management will become the core of a new health care strategy, one in which organizations will be rewarded for maintaining specific populations in ever more efficient ways. HIEs, the glue that makes interclinical population health management possible, not only facilitates the exchange of information but also a host of analytical processes. These processes can identify opportunities for improvements in areas such as workflow, patient outreach, quality of care, and cost containment.

The ability to derive insight from EHR data obtained through HIEs is immense. A small sampling of opportunities includes the following:

• Establishing best practices: Using information from large groups of patients, analytics can review similar cases and outcomes to uncover which procedures and drugs can achieve results at a lower cost or avoid expensive alternatives that don’t.

• Reducing readmissions: Analyzing data from HIEs can provide alerts regarding patients with chronic conditions such as COPD, congestive heart failure, and diabetes who are at high risk of hospitalization or admission to nursing homes and post-acute care facilities. Noncompliance or undercompliance with medications and therapy appointments, for example, are items that can be flagged for case intervention.

• Enhanced medication management: HIE analytics can reveal numerous ways to reduce costs and increase the effectiveness of prescribed drugs. Records can be reviewed for contraindications, avoidable side effects, and opportunities for generics and formularies. Patient education, including informing patients as to when side effects should prompt a call to their primary care physician, is another benefit.

• Facilitating screenings: Evidenced-based care is critical in population health management. Identifying patients who are missing immunizations, mammograms, cholesterol tests, colonoscopies, and other screenings is an important factor analytics can uncover.

• Increasing patient engagement: Innovation is a natural outgrowth of strategic understanding, and HIE data analysis can jump-start the kind of fresh thinking that strengthens partnerships between providers and patients. Financial incentives for screening participation, engaging portal-based services, new educational opportunities, and better postdischarge interaction are just some of the ways organizations are responding to HIE insights.

• Managing eReferrals: In addition to coordinating care, using eReferral tools layered on top of HIEs can speed follow-up visits, reduce no-show incidences, decrease transaction times, and facilitate collaboration between primary care physicians and specialists.

With US health spending consuming 17.6% of the gross domestic product (GDP) in 2010—1.5 times more than any other industrialized country—the current system is unsustainable. Waste is a major problem, and administrative complexity, overtreatment, care coordination failures, care delivery failures, fraud, and abuse are expected to drive health care costs to more than 20% of the GDP by 2020, if left unchecked.

As a tool to reduce this waste while achieving population health management goals and lowering overall health care costs, HIEs are more than a silver lining to the HITECH imperative. They are a solution every health care organization should look forward to adopting. Properly implemented and used, they can transform meaningful use from a government requirement into a powerhouse that positively impacts every link in the health care value chain.

— Daniel Newman, MD, is chief medical information officer for health information systems provider MEDfx, where he sets clinical product strategy and directs development of new, innovative tools for population health management and accountable care.