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Health IT data-sharing standards have implications for payers


Heterogenity is a huge hurdle for healthcare organizations that hope to capitalize on the wealth of data they possess.

On the bright side, according to Lynne A. Dunbrack, program director with IDC Health Insights, a market analysis firm, there are health information exchange (HIE) technologies available that facilitate interoperability. She says plan executives should look for flexible architectures.

"The technology's ability to evolve is critical, too, because some HIE initiatives start out in a federated model-in which all information is stored and maintained by the originating source organizations, so the HIE can be deployed fairly quickly and avoids the commingling of data, mitigating some privacy concerns," Dunbrack says. "But down the road, HIE organizations often want to move into a non-federated model that stores data in a central repository, which some believe offers better quality measures and population health reporting."

Clearly, data security is one of the biggest areas of concern surrounding HIEs. What organizations know less about is the need to adapt their internal systems to account for the upcoming shift to clinical codes, according to Bruce Taffel, MD, Shared Health's chief medical officer.

Healthcare organizations' inability to use clinical data effectively isn't merely hindering the development of HIEs, it prevents many companies from making better business decisions for their own firms, according to Charles Ruetsch, president and chief science officer of Health Analytics. The company uses the government's comparative effectiveness (CER) research model to analyze patient data, such as adherence to medications and therapies, to measure outcomes.

"Healthcare executives are sitting on an enormous amount of data, and we need to find new and innovative ways to share and analyze that information," he says.

For example, research has shown that treating people with opioid dependence in a hospital setting is the standard of care for many health plans. But that can be an unnecessary waste of resources, because most cases can be treated on an outpatient basis, providing better outcomes and lower costs.

"That kind of information exists inside of every health plan; it just needs to be accumulated and analyzed so executives can use it to make better policy decisions," Ruetsch says.

In a 2009 Health Industry Insights report ("Best Practices: Lessons Learned from HIEs Actively Exchanging Health information"), IDC's Dunbrack offers recommendations for organizations that want to establish an HIE:

Although it's no easy task, healthcare organizations are going to have to prepare for electronic health information exchange sooner or later, Dunbrack says-particularly if the Obama administration achieves the goal of having electronic medical records in place for all Americans by 2014.

"Standardization is coming soon," Dr. Taffel says. "If I were a health plan executive, I would walk into my IT department today and ask two questions: First, how prepared are we for ICD-10 codes? And second, how prepared are we for dealing with clinical codes? Health plans might be up to speed on the administrative side, but most are very ignorant about the use of clinical codes."

In addition to facilitating the exchange of information between stakeholders, codes play a vital role in Shared Health's data security, including strict control of who has access to sensitive patient data.

"In addition to excluding certain data prohibited by state and federal laws, access to Shared Health information is basically restricted to clinicians, and data from hospitals and providers is never shared with payers without patient/provider permission," Dr. Taffel says. "Each user has a role, and all of the information that person needs to provide high-quality care and make treatment decisions is available. But that data is also limited to what they need to do their job effectively, and no more."

For example, in a typical physician's office, front-office personnel are able to access patient records-but the system's security will limit that access to demographic information. In addition, Shared Health must ensure that any member who has concerns about privacy has the ability to choose to keep their information out of the system.

Despite the fears, remarkably few people choose not to participate in the HIE, Dr. Taffel says. Only about 1% of all patients opt out-which is good news for those who wish to use healthcare data to track patient outcomes and improve the quality of care.


Health Analytics, for example, recently performed an analysis of pharmacy and medical claims to estimate the economic costs of untreated opioid dependence and the benefits of buprenorphine-medication assisted therapy (B-MAT). After controlling for health status and other variables, annual costs for B-MAT patients were dramatically lower, offering better outcomes and a savings of about $11,200 per patient.

Although Dr. Ruetsch believes that better access to patient data will enable similarly beneficial discoveries in all areas of clinical care, no one can charge forward without doing the rigorous scientific research first.

"Changes in healthcare policy have enormous implications for population health," he says. "Improvements might not happen as quickly as we would like, but it's more important that those changes we do make are backed by solid clinical and scientific data. People's lives are at stake."

Michael T. McCue is a Virginia-based freelance writer.

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