HIE Case Study: Use of Data Analytics for MACRA - Rochester RHIO

Rochester RHIO was founded in 2006. Rochester RHIO is a secure, community health information exchange (HIE) serving authorized medical providers and more than 1.4 million patients in 13 counties in upstate New York. It has more than 1,500 organizations as participants. The types of participating organizations span from health systems to community care and LTPAC centers. Rochester RHIO is one of eight (8) qualified entities (QEs) in the Statewide Health Information Network for New York (SHIN-NY).

The Rochester RHIO is overseen by a community Board. Board members include representation from across the healthcare community including health systems such as the University of Rochester and Rochester Regional Health, health plans such as Aetna and Excellus, representation from the Chamber of Commerce, and major employers such as Xerox and Paychex. The Board also includes representation from the physician community, public health, consumer community, home health and the long-term, post-acute care communities as well. The Board sets the policies for the HIE and the CEO ensures the execution of these policies.

Healthcare organizations are often challenged to provide electronic reports in support of quality measurement requirements (eCQM, MACRA/MIPS, and others) across their patient populations that affect value-based payment models.

Jill Eisenstein, CEO and President of Rochester RHIO, was interviewed for this case study because HIEs are well positioned to support a healthcare organization’s ability to collect and aggregate data from disparate EHRs from across their community, though they have varied capability of leveraging this data in support of electronic reporting requirements.

The regulations for MACRA reporting are relatively new and the community is still analyzing what is needed to support the CMS requirements. Rochester RHIO’s objective is to support the community with respect to patient-centric data needs as the patient moves from one care setting to another. Without the HIE, the data is facility-centric and only available to providers who were directly sent a copy of the data. Thus, the RHIO’s primary goal is to facilitate the movement of data to build a longitudinal patient record. RHIO supports both “Push” and “Pull” models for data flow. There is a Clinical Query Portal for accessing longitudinal care information of the patient, and the data is also delivered to clinical practices as needed. The RHIO also provides DIRECT Secure Messaging (DSM).

While there is currently no direct support for MACRA provided specifically, Rochester RHIO does have the ability to provide the required data to their participants and to the community in order to support their need to have more complete and robust data to meet MACRA requirements.

The roadmap for Rochester RHIO’s support of quality measures reporting is to develop collaboratively with the participants as well as with the state Department of Health. Requests from the community and the state Department of Health are taken via committee meetings, reviewed, and then prioritized into the roadmap. The review process takes many factors into consideration including community priorities, overlapping goals, state mandates, and the effect on providers and participants.

This is not part of the current offering; however, Rochester RHIO plans to have this capacity in two different ways:

  1. Rochester RHIO performs gap analysis on the data needed for the requirements and requests the needed information from data sources. As health systems and practices provide the additional data required for these measures out of their own EMR systems, it makes the HIE data more robust.
  2. If a health system does not have their own analytics systems, Rochester RHIO will be able to help with analytics as an added service.

One of the bottlenecks for using HIE data for MACRA reporting is the QCDR (qualified clinical data registry) Accreditation process. This process is very stringent and has very specific deadlines. Rochester RHIO may not be able to receive this accreditation for at least one year. Today the RHIO can still support providers by providing them with community-level data, but to be a reporting-level agency they will need this accreditation.

The ROI for supporting MACRA is unknown at this time because it is new. The use of HIE data in clinical settings routinely improves internal workflow, supports a longitudinal understanding of patient data, and provides a more accurate history of where a patient has received care. If the community requests support with MACRA reporting, Rochester RHIO will be in a position to deliver this service for a fee. This fee will be used to cover the expenses incurred in setting up the capability.

Rochester RHIO’s Core services are covered by state funding and are valuable in improving overall efficiency and cost of community healthcare delivery. The Rochester RHIO works to cover costs as it looks to return value to the community. Using Rochester RHIO services generally improves clinical workflow, reduces duplicate testing, and supports better transitions of care.

The Rochester RHIO receives state funding, in addition to fees for specific value-added services that support the RHIO’s mission to support healthcare delivery and efficiency with HIE services in the region. Funding supports specific core services that are provided at no charge. RHIO charges for value-added services, including secondary use of data for quality reporting. Public health reporting is provided at no charge in most cases.

The vision for the Rochester RHIO is to be a sustainable community asset, foundational support to the transformation of regional healthcare delivery. The business plan includes the imperative to meet the New York State Core service requirements that we share with all eight RHIOs in New York State, while laying out the priorities identified by our regional stakeholders. 

For 2017, our priorities include:

  • Support the Delivery System Reform Incentive Payment (DSRIP) program, an initiative in New York State to accelerate Medicaid transformation
  • Enhance regional HIE services for VA facilities and providers in our region
  • Expand capacity to provide data analytics services to RHIO participants
  • Develop MACRA reporting services

The mission of the Rochester RHIO is to provide the greater Rochester community with a system for a secure health information exchange that allows for timely access to clinical information and improved decision-making. Their primary goal is to share patient healthcare information in a secure environment to improve patient care and to reduce system inefficiencies.

The Rochester RHIO is a critical link in the Statewide Health Information Network of New York (SHIN-NY), seeking to collaborate with health information exchange efforts across New York State.

HIMSS is a global, cause-based, not-for-profit organization focused on better health through information technology (IT). HIMSS leads efforts to optimize health engagements and care outcomes using information technology. The inclusion of an organization name, product or service in this publication should not be construed as a HIMSS endorsement of such organization, product or service, nor is the failure to include an organization name, product or service to be construed as disapproval. The views expressed in this white paper are those of the authors and do not necessarily reflect the views of HIMSS.


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