Health Information Exchange (”HIE”) means many things to many people. Ask 10 people what they believe to be the definition of HIE and you might well get 10 different answers. Some will define HIE as a noun, some will define HIE as a verb. Some will define HIE as a public initiative, some will define HIE as a competitive advantage-adding technology, and some will simply suggest HIE is merely a way for large consulting firms to make money as they write and then evaluate massive RFPs. All that said, make no mistake, the fundamental mission of HIE is to improve care coordination.
But, what do I mean by care coordination? Coordinating care can involve coordinating the care of an entire population, a specific population with a given disease state, health surveillance for a geographic region, or coordination across the provider payor relationship. All such care coordination efforts are critical and significantly impact the cost and quality of care; and, all these examples benefit from HIE. At the foundation of all care coordination, however, is the physician patient relationship. Specifically, the quality of care coordination is largely defined by the quality of information flow between care providers along a specific patient’s care continuum – care from provider to provider, provider to patient, facility to facility.
So, allow me to offer this: health information exchange is absolutely necessary to improve care coordination if for no other reason than HIEs, such as MobileMD’s offering, liberate clinical information from its source system silos and delivers all the right information to the right provider at the right time within the context of a care community. Without HIE, clinical data remains highly compartmentalized; care coordination is thus significantly hampered due to lack of timely, context-based information flow. The result is redundant procedures, unnecessarily long hospital stays, unnecessary ER visits and hospital readmissions, ill-informed clinical decisions, increased patient and physician risk, increased costs, and decreased care quality.
While there are several good examples, allow me to highlight a particularly obvious example. Psychiatric patients often visit numerous specialists as a result of their health condition. As one might expect, each specialist makes care decisions based on the information available at the time of care. If a psychiatric patient visits a psychiatrist, a neurologist, and a gastroenterologist, potentially multiple times over a three month period, due to symptoms from both the underlying condition and medication side-effects, how can each care provider possibly deliver quality, comprehensive care without requesting redundant procedures and without prescribing contra-indicated medications, for example, if each provider is not offered a complete care picture for that patient? Traditionally, patient health information has been sourced by the patient and, if lucky, partial patient chart information sent via courier or fax. The result: each provider must fly, so to speak, without proper instrumentation.
If, however, each provider along the continuum described above has real-time, ready access to complete patient health information, better informed procedures are requested, accurate diagnoses are more easily derived, and medications are better aligned, to name just a fraction of the care considerations that lend to quality and cost and emanate from a coordinated care effort.
As the rapidly emerging primary medium for clinical information flow, Health Information Exchange serves as the cornerstone for care coordination. Better care means less expensive care, thus rendering to the shadows those that would suggest care must be rationed to control costs.
With that, I request that you “tune in” to a future post for more about “right care at the right time” vs “care rationing”…
