HIE as an Essential Building Block to Active Technology Enabled Care Coordination

By Alan Gilbert, MPA, FHIMSS, Managing Partner, Health Catalyst Consulting, LLC

The healthcare industry and the technology enablement of the delivery and payment of care has permeated into our general consciousness of the country.  Some discussions about the fiscal cliff and the component of the cost of healthcare on the Gross National Product and Gross Domestic Product focus on the value for the cost of healthcare and what can be done to lower the overall expenditure of care.

The parallels of the development of HIEs networks are very similar to the development of the Internet.  From Wikipedia, the origins of the Internet in the 1960s by the U.S. government was to build distributed computer networks.  The Internet has no centralized governance in either technological implementation or policies for access and usage; each constituent network sets its own standards.

HIEs are growing on the same path, from local exchanges, to regional exchanges, to state wide exchanges, to federal exchanges, to public-private exchange partnerships.  Again each group is setting their own standards, and while consistent standards have been proposed, they have not been universally accepted, embraced and implemented.

The train tracks of HIE infrastructure have been laid down across the country over the past 15 or so years.  While there are still many more trains tracks to be installed before the proverbial final “Golden Spike” is hammered in, the new world order of  “Fee for Value” initiatives including ACOs, Patient Centered Medical Homes, Bundled Payment, Global Payment and Clinical Integration require that very specialized trains run on top of these new tracks.

These locomotive and caboose of these trains is Active Technology Enabled Care Coordination.  The data that is gathered by a HIE within the “Fee for Value” initiatives is then able to be utilized for the active management of population based care for both the chronically and non-chronically ill.

Components of Active Technology Enabled Care Coordination leveraging HIE data include the following five steps:

  • Create and Assign Multi-Disciplinary Teams to address a given population or given chronic condition – Care in the past has been delivered more in siloes of care
  • Set up Rules and Roles for the newly formed Multi-Disciplinary Teams – Assignment of security and access controls are well as creation of specific agreed upon care protocols, care plans, and care pathways
  • Deliver Care as Cohesive Multi-Disciplinary Teams – Providers, Care Coordinators, and Patients all work for a unified plan of care to assure better delivery of care.
  • Proactively Coordinate Care – Actively pushing clinical, financial, and administrative alerts to the entire care team including the patient about for example, upcoming appointments, abnormal test results, transition of care plan, or primary to specialist referral
  • Manage Overall Organizational Performance through Clinical and Operational Analysis and Reporting – Multi-Disciplinary Team Based Reports including
    • Enterprise Reports
    • Practice Reports
    • Provider Reports
    • Patient Reports

HIE-enabled Active Technology Enabled Care Coordination is one of the drivers in the future of healthcare delivery that is changing more than it has changed over the last 20 years.