Last Updated: Jul 6, 2018
By Tara Gensemer, CAHIMS; Practice Support Specialist for PAMED’s Practice Support Team
This article is the second part of a two-part Pennsylvania Medical Society (PAMED) series on Health Information Exchanges (HIEs). Part one in the series provides general information on how HIEs work and offers a checklist for practices who are considering participation. Part 2 offers clinicians details on the four HIEs that are operating in Pennsylvania. Read Part 1 Here
A community of regional health information organizations (RHIOs) in Pennsylvania is ready to support the data-driven demands put upon clinicians and staff. RHIOs offer a solution — a Health Information Exchange — which can streamline the process of information flow in and out of a practice.
HIEs can help clinicians address coordination of care, closing care gaps, and value-based payment models, all while decreasing overhead and maximizing efficiency.
What Is Happening in Pennsylvania?
There are five regional health information organizations in Pennsylvania: HealthShare Exchange, ClinicalConnect HIE, Keystone Health Information Exchange, Mount Nittany Exchange, and Central PA Connect Health Information Exchange.
The RHIOs coordinate with the Pennsylvania eHealth Partnership — the organization that maintains the Pennsylvania Patient and Provider Network (P3N) — to enable statewide health information exchange. P3N is considered the “hub” to allow secure health information to be exchanged between participating providers, the public health gateway, regional health information exchanges, care coordinators, and facilities across the state.
RHIOs work as a community, providing secure delivery of information to those who participate. It is a collaborative effort, notes Kim Chaundy, director of operations, Keystone Health Information Exchange. “We don’t want to be an analytic tool; we want to feed into the tool to bring data together for the benefit of care coordination and workflow improvement opportunities. This is a key element RHIOs can offer,” Chaundy says.
Here’s a closer look at each of Pennsylvania’s five HIEs:
1. HealthShare Exchange (HSX), incorporated as a nonprofit in 2012, services facilities and providers primarily in eastern Pennsylvania, specifically Greater Philadelphia, but is expanding its Exchange activities to South Jersey and other areas. The health information organization began its journey with Direct Secure Messaging, and now has more than 9,000 practitioners connected by its Provider Directory. It also has information on more than 5 million regional patients in its Clinical Data Repository (CDR), which provides longitudinal records of the recent medical history of these individuals.
HSX connects health plans and nearly all the hospitals and health systems (and their owned practices) in its service area, as well as behavioral health, long-term care, and Accountable Care Organizations (ACOs). More than 100 independent ambulatory practices are also included. It includes federal and city health clinics.
With emergency department and hospital admission data from its membership, HSX provides an Encounter Notification Service (ENS), which now includes more than 3 million patients, to alert members when their patients interface with a medical center anywhere in its region.
Martin Lupinetti, executive director, HSX, says, “There was a lack of information flow that needed to be addressed. A movement was started between hospitals and plans to find a better way.” HSX was built to aid providers in better care coordination and communication efforts, especially during transitions of care.
HSX’s CDR continues to grow, as more of its members also contribute Continuity of Care Documents (CCDs) in association with patient encounters. HSX has an implementation team that assists members in deploying its services, which are integrated whenever possible in the provider’s existing clinical workflow. The HIE provides 24/7 support and has a fee schedule based on organization type, patient volume, services selected, and other factors.
2. ClinicalConnect HIE services western Pennsylvania, spanning from Erie to the border of West Virginia and as far as Ohio to Muncy. The organization, which recently celebrated its fifth year of service, was founded by nine major hospitals in the Pittsburgh area that put competitiveness aside and collaborated on the project.
Today, ClinicalConnect HIE offers the longitudinal patient record, aggregating data from all member organizations. Additionally, ClinicalConnect HIE supplies data from its external trading partners using the federal and state data-sharing systems.
There are more than 3.2 million patients who are part of ClinicalConnect HIE. More than 1 million charts have been viewed using the Exchange. Direct Secure Messaging, a standard for exchanging clinical data through secure email, is also offered.
There are challenges with every HIE implementation, but ClinicalConnect HIE works to meet the HIE needs of participating providers with phased onboarding, flexible cost, and an experienced team. “Our goal is to see HIE incorporated as normal practice for clinical workflow,” says Laura Mosesso, outreach manager, ClinicalConnect HIE.
3. Mount Nittany Exchange (MNX), based in State College, provides support for hospital systems, ambulatory practices, long-term care facilities, post-acute care centers, federally qualified health centers (FQHCs), and free clinics, with an emphasis on small entities that do not have much in the way of IT support services.
To service clinicians who may not have the infrastructure to integrate an HIE into their day-to-day workflow, the Exchange offers a browser-based provider portal to close the gaps in the electronic continuum of care.
The Exchange also offers EHR integration for EHR systems that can consume Consolidated Clinical Document Architecture (CCD-A). CCD-A is the mandatory content used to create a CCD. A structured clinical document — typically sent through an HIE — will be delivered by CCD-A to provide patient data to a clinician querying the Exchange to coordinate patient care.
MNX also has the ability to deliver ENS alerts to connected providers to provide timely notification regarding patient hospitalization.
MNX transmits Direct Secure Messaging, allowing participating providers to send secure messages to other providers to communicate care coordination. The HIE also delivers a mobile app alert system, notifying providers of emergency department visits and inpatient admissions. Membership in this HIE is available to participants for a nominal fee. Delivery of training is web-based for those who are authorized to access patient data within the practice.
4. Keystone Health Information Exchange (KeyHIE) was established in 2005 and supports single physician practices,FQHCs, critical access hospitals, and large health systems.
KeyHIE connects approximately 100 unique health care organizations, 26 hospitals, 335 physician practices, 29 home health agencies, 89 long-term care facilities, one pharmacy, four EMS services, and three insurance payers throughout Pennsylvania. This connectivity serves more than 5 million patients, across 53 counties, gathering data to provide a longitudinal medical record for care coordination and earlier treatment decisions by authorizing secure access across multiple platforms.
Recently, KeyHIE announced the availability of their Information Delivery Service (IDS). IDS provides a streamlined approach to delivering clinical information and pushes data directly to an EHR, where it will either be parsed to a holding tank for review or directly to a medical record, limiting staff research hours and maximizing efficiency. The RHIO has expanded its IDS to support a learning health system and value-based payments, including population health management, ACOs, and Bundled Payment Care Incentives (BPCIs).
Clients of KeyHIE can select from a basic package, which provides a browser-based clinical document viewer, to an advanced package that offers the clinical document viewer, plus Direct Secure Messaging, notifications and reminders, and EHR integration. All packages include MyKeyCare, a multi-facility patient portal that allows patients to access documents and lab results, request prescription renewals, and send secure messages to providers.
KeyHIE extends various training platforms that are tailored to the needs of staff, including customized workflows. Along with training, this HIE offers marketing tools, technical support, and a competitive fee schedule.
5. Central PA Connect Health Information Exchange (Central PA Connect HIE) is a dedicated health information organization focusing on improving patient care and outcomes in their community and throughout Pennsylvania. Established in 2008 to exchange data between Lancaster General Health (LG Health) providers, Central PA Connect HIE is expanding services to include providers outside of the LG Health population, primarily in Lancaster, York, Lebanon, Berks and Dauphin counties.
The HIE is targeted to join the P3N as a certified HIO in the first quarter of 2019. In addition to its existing connections with LG Health and its owned physician practices, Central PA Connect HIE is slated to onboard 35 additional practices in the community, as well as a behavioral health and a rehabilitation hospital in 2019.
Users of Central PA Connect HIE can expect to leverage their EHR in order to access CCDs, sharing of orders and results for lab, radiology, select cardiology, and clinical notes. Connections can also be made to the Public Health Gateway (PHG) to submit data to state registries. Alerts via ENS will be available in the future offering notification to providers when a patient has been hospitalized.
Education and support services are on hand to provide guidance on workflow, patient materials, and patient privacy.
The patient-centric HIE fosters interoperability connecting providers to allow for more valuable visit time spent with patients. “We exist to ensure that the patient receives all of the benefits of interoperability; not to gain the most market share or become the biggest HIO in the state. We view our role as one to promote the sharing of data to support the continuum of care and make transitions of care as seamless as possible. We always focus on making the relevant data available to providers to maximize the patient’s care across the community.” says Keith Cromwell, M.Ed., Program Manager, Central PA Connect HIE.
Investing in new technology can likely appear to be an expensive, laborious process. Each RHIO is prepared to aid a practice or facility to make that transition as seamless as possible, at a reasonable cost.
“We are all in the business of the dollar in many ways; an HIE pays for itself in less than a month,” Dr. Artz points out. “We have had to reserve additional parking spaces to provide care based on the ability to capture patients coming out of the hospital from HIE notifications. Not only is this good for our business, it generates better patient care.”
Interested in Participating?
Here’s who to contact at each HIE:
Contact Name: Laura Mosesso
HealthShare Exchange (HSX)
Contact Name: Russ Allen
Keystone Health Information Exchange (KeyHIE)
Contact Name: Joseph Fisne or Kim Chaundy
Mount Nittany Exchange
Contact Name: Michael Martz
Central PA Connect Health Information Exchange (Central PA Connect HIE)
Contact Name: Keith Cromwell
For more information regarding HIEs, please visit these websites:
PAMED members with questions can also contact our Knowledge Center at 855-PAMED4U (855-726-3348) or KnowledgeCenter@pamedsoc.org.
A version of this article appeared in the winter 2018 issue of Pennsylvania Physician Magazine, PAMED’s print magazine, and was reprinted with permission.