Electronic health records (EHRs) have improved patient care in healthcare institutions, and in many places long-term care (LTC) facilities are reaping the benefits of health record exchanges. These benefits include increased portability, accuracy and accessibility, as well as a reduction in record duplication and operational costs. Although EHRs have become more widely used in the past decade, interoperability—or the ability for different healthcare facilities or systems to share data—is still a challenge.
NorthShore University HealthSystem, one of Illinois’ most prestigious health systems and an early adopter of health information technology, was one of the first providers to engage the services of the Illinois Health Information Exchange (ILHIE), a statewide, secure electronic transport network for healthcare providers to share patient records and clinical data. In late 2013, NorthShore engaged ILHIE to coordinate the exchange of information between acute care sites and the 14 regional LTC facilities to which patients are most commonly discharged.
This step toward interoperability was natural, according to ILHIE. “NorthShore is a major health system and a very astute group from an IT standpoint,” says Raul Recarey, executive director of the ILHIE Authority. Sharing data outside its system also represented a way for NorthShore to achieve the Stage 2 meaningful use objectives spelled out by the Centers for Medicare & Medicaid Services (CMS), setting the stage for meeting the government’s Level 3 goals as well. Meeting Level 3 criteria by 2015 is required for meaningful use participants to receive maximum CMS payments and avoid penalties in the future.
While the ILHIE system provides several platforms for the exchange of information, NorthShore and its LTC partners chose a process called ILHIE Direct, a web-based, encrypted messaging system that complies with the security and privacy rules required for EHRs by the Health Insurance Portability and Accountability Act (HIPAA).
For NorthShore, communicating with the LTC facilities was an essential step in improving patient care. “NorthShore has used an EMR [electronic medical record] system for 10 years, and we are always looking for ways to leverage it and use it,” says Dan O’Mahoney, director of application services at NorthShore. “To us, part of the idea of meaningful use is to communicate with other organizations. We do a lot [of electronic communication] internally, but it made sense to look outside our system to provide seamless transitions beyond our organization.”
Specifically, he explains, given the amount of patient movement between NorthShore’s facilities and LTC providers, the electronic exchange of healthcare records made sense. “These 14 [LTC] facilities received the most transfers of care outside our organization. We had an intimate working relationship with them, so it was logical to connect with them in this way.”
Ian Crook, vice president of operations for Glenview Terrace Healthcare and Rehabilitation Center in Glenview, Ill., says, “By improving our communications with NorthShore and receiving messages with continuity of care, discharges and transition of care information before the patient arrives, we are confident that this will improve patient care coordination.”
ILHIE Direct had many advantages for NorthShore and its partners, Recary explains, including security and cost. “With Direct messaging, NorthShore has standardized messaging within a HIPAA-compliant electronic system. It is much more efficient, cheaper and advantageous to the patient, because now, when a patient leaves the hospital to go to an LTC facility—or vice versa—the patient’s records arrive even before the patient does. It is as fast as sending an email.”
Adoption was made easier because Direct’s messaging process required no system upgrades or expensive software. Sending and receiving records via the ILHIE portal requires only a computer, browser and an Internet connection. “With so many providers in the state, it was important to bridge the gap between advanced and non-advanced technology,” Recary says.
A second level of communication, Integrated Direct, incorporates Direct’s messaging into an EHR platform. In this way, the care providers can skip the step of opening their browser, and can simply send messages within the EHR system’s electronic chart.
Users are charged by the mailbox at a rate of $10 per month, per mailbox. Smaller organizations find that they require only one mailbox and dedicate a point-person to retrieve, disseminate and send information to the correct providers within the organization.
In addition to the benefit of improved quality of care, in the past few years, providers have had a financial incentive to adopt EHRs. Part of the 2009 federal stimulus package, the Health Information Technology for Economic and Clinical Health Act earmarked $36.5 billion to create a nationwide network of EHRs. It also set standards and incentivized EHR adoption and use. The act promises maximum CMS payments to providers who use certified EHRs. Moreover, providers who do not adopt EHRs by 2015 will be penalized one percent of Medicare payments.
According to the U.S. Department of Health and Human Services, as many as 280 HIEs are operating already across the country. Regional and state HIEs are often publicly financed—through grants made available in the 2009 stimulus—whereas local HIEs are usually privately financed through providers and/or insurers. Roughly half of the nation’s hospitals are now participating in regional, state or private HIEs. A further 71 percent plan to purchase new HIE technology in the next two years, according to Health and Human Services.
Like many states, Illinois used its federal funds to establish ILHIE. It was given the power by that state’s legislature to establish a centralized method for the healthcare providers to exchange information. Currently, nearly 4,000 of Illinois’ 50,000 healthcare providers use ILHIE healthcare information exchange services. Recary estimates the number will be 15,000 by the end of this year. ILHIE is the information exchange of choice for Medicaid in Illinois, so those in that state who want access to electronic Medicaid data must get it through ILHIE.
The greatest challenge to implementation is not technical, but attitudinal, Recary says. “People are naturally averse to change, so changing workflow patterns and habits is the most difficult part. There is a minimal learning curve. The system looks and works like email but [is] HIPAA-compliant with its protocols and security,” Recary says. “If a person can navigate Gmail, they can do this. However, it takes a determined leader at each organization to say, ‘This is what we’re going to do.’ ”
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