Communications, Connected Care and HIEs, Part 1

If you've been following our blog for any length of time, you've probably noticed an evolution in our message, towards communications. We've written about many topics under the umbrella of health care reform, including of course eye care EHRs. But in the big scheme of things, health care reform is not really about EHRs. Lest that sound like heresy, let me explain. 


Of course EHRs are at the core of reform. The incentive money is all about EHRs, so they must be - and they are - important. As my colleague Dr. Jim Grue likes to ask, "You don't think, do you, that the federal government is putting you through all this so you can have neater exam forms?" No way. There's more to it. In the end, it's about sharing what ends up in your EHRs. That's why we prefer to call it connected care. Communications. And that's why we've launched a National Eye Care Communications Project. What will follow over the next few posts is a series of talking points. For sake of brevity, we'll have to carry the point across two or more posts. We begin with HIEs.

Health Information Exchanges (HIEs) are structured for communications. How should you connect to your State HIE?

HIEs are possibly the most confusing area to understand amidst all the changes occurring in health care delivery and reimbursement. It is worth taking a few minutes to contemplate this topic though as, once you understand the variations and the reasons for them you will have a much stronger picture of how to position your practice for inclusion. You may also identify opportunities where your leadership could bring substantial recognition for your practice.

Every state is somewhere in the process of developing a state level health information exchange, which will eventually allow providers to securely exchange patient health information within the state. The plan is to tie all states together so, ultimately, any provider anywhere in the country can share secure patient health information with any other health care provider. Does this sound futuristic? You may be surprised to learn that Optometrists right now are participating in the first national eye care communications project and that Optometry may be the first profession to successfully connect providers in all 50 states. HIEs are not a thing of the future; they are a current reality, they are functioning and providing services to patients throughout the country.

What forms do we see HIEs taking?

Every state has received funds from the federal government earmarked for the development of a health information exchange. By accepting these funds, the states committed to the creation of a state-level exchange that will ultimately connect to a national exchange. There is one requirement of particular significance to eye care.  Every state that accepted federal funds must include and support ONC Direct as one of its communications methods. Exchanges may support as many methods as the state feels appropriate but must include ONC Direct. (We'll treat ONC Direct as a separate talking point to follow.)

Federal funding is not the only driver though. Large health systems have been exerting significant efforts to influence the way state exchanges work. It is important that we recognize large health systems have different communications needs than independent practices. What is best for a large health system may not be best for independent providers. We also must recognize that when all providers within a large health system utilize a single EHR, all those providers are already capable of sharing the patient health information of every patient within the system. There is no need for an outside system to supplement what they are already capable of doing. However, here is the problem still faced by this system, and all providers within it: they still have no way to communicate with providers outside the system.


To be continued ...


Alistair Jackson, M.Ed.