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Lessons learned from program to improve healthcare information exchange


One major piece of interoperability is the expanded use of admission, discharge, and transfer (ADT) notifications across provider networks.

One major piece of interoperability in healthcare is the expanded use of interstate, cross-state, and regional admission, discharge, and transfer (ADT) notifications across provider networks.

In 2016, four health information organizations (HIOs) were awarded $2.5 million from the Office of the National Coordinator for Health Information Technology (ONC) to improve ADT notifications within their states and to neighboring states.

A health information organization is government-led, nonprofit group that creates interoperability and EHR exchanges on a state, regional and national level. They usually are helmed by a board of leaders from different sectors of healthcare.

Over 10 months, the awardees worked toward solutions between hospitals, long-term and post-acute care, behavioral health, and emergency medical providers. In August 2017, they shared


from the different approaches toward interoperability and to define standards that can be used throughout the healthcare system.

ADT interoperability barriers

One of the barriers program participants identified was costs of establishing ADT feeds with providers and health information organizations, which can be up to $10,000, according to Peter Ashkenaz, spokesperson at ONC. Also, costs surrounding reporting key metrics and utilization can be significant to HIOs.

“Interface costs are probably one of the largest barriers to financial sustainability,” Ashkenaz says. “Somebody needs to pay for the development costs associated with connecting an EHR system to an HIO. Providers often balk at the price and HIOs don't have the funds to pay those costs for every provider.”

Other barriers to implementation identified by participants include inconsistent policies across states, poor and missing data, different states preferring different models, the complexity of legal agreements, and standardizing interstate legal agreements.

Pros and cons of competition

Competition between HIOs and vendors could drive innovation, leading them to create new services or specialize around use cases, says Ashkenaz. But an aggressive market could also lead to more fragments in exchange networks.

“For example, providers affiliated with a large health system or a hospital that adopts its own exchange capabilities may not join an HIO because they feel the hospital exchange meets their needs,” Ashkenaz says. “However, they may not be able to access patient data from outside their network as a result. Likewise, providers might feel that EHR-based exchange networks … meet their needs, but those networks don't necessarily support all of the use cases that an HIO does.”

HIOs that participated in the program stated that vendors providing HIE services is a growing concern for them.

Models that work

HIOs identified four models that help ADT transfer easier between provider networks:

  • Point-to-point models are basic connections between two HIOs within the same state that establish a VPN connection to send and receive ADT messages;

  • Hub models allow for HIOs to send messages through a routing hub based on ZIP codes and states in the region;

  • Patient-centered medical homes are “a terrific vehicle” to eventually create a nationwide data exchange; and

  • Master patient index query creates a more target way of routing ADT messages based on patient identity.

The ONC concluded that the development of ADT connectivity has become a valuable part of increased interoperability across all areas of healthcare. “From this expanding national ADT connectivity, many HIOs have coordinated to achieve inter-[health information exchange] ADT-sharing as a manageable and incremental method for achieving statewide, regional, and perhaps eventually, nationwide data exchange,” Ashkenaz says.


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