Five tips for connecting your senior care facility to an HIE

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Lee-Ann Ruf
Lee-Ann Ruf

Note: At the permission of the presenters, this was adapted from a presentation at the SUMMIT 2015, PointClickCare's annual user group meeting in Palm Springs, CA, delivered by the author and PointClickCare customer Richard D. Tuvell, MSN, RN, director of clinical quality and informatics at Reliant Senior Care, an Eddystone, PA-based senior care provider with 20 locations across the state.

With payers – both public and private – increasingly requiring more care coordination, quality reporting and better-informed handoffs, many healthcare providers are finding it more important than ever to plug into health information exchanges. Many senior-care providers will be looking for HIE partners this year to participate in bundled payment programs.

HIEs provide the data pipes between these healthcare providers. This is the health data interoperability puzzle piece that completes the picture of residents' care paths between primary care practitioners and specialists and hospitals and senior care facilities.

HIEs not only improve patient care by giving senior care providers more information, but they can help providers receive more appropriate reimbursements. Reliant Senior Care recognizes how the correlation of “better quality and greater access to information” can lead to better care and lower costs. To help accomplish those goals, Reliant Senior Care joined the Centers for Medicare & Medicaid's Bundled Payment Care Improvement (BPCI) initiative, which links payments for the multiple services beneficiaries received during an episode of care.

In order to participate in this cutting-edge reimbursement program, Reliant needed to be on the same network as other statewide participants. That brings up an important point for your organization: Because different HIEs have varying levels of connectivity and costs, it's important to choose the best fit for your needs. In Reliant's case, they chose a regional HIE that already included many hospitals with which they need to exchange data were on its network. Reliant hopes to grow its HIE connectivity throughout the U.S. via health data interoperability initiatives such as the Sequoia Project, which manages patient identities through different data systems.

But it takes more than contracting with an HIE to untether a provider's data from its servers.  For Reliant, it took a year of thoughtful planning and determination to define the scope of the project to understand how the contract would be written. Reliant and PointClickCare shared lessons from ongoing HIE projects for other senior care providers who are exploring HIE connectivity.

Here are some of the key learnings:

  • Don't reinvent the wheel. Before ‘flipping the switch,' visit your prospective HIE's annual user group meeting and gather implementation strategies from HIE members who are ahead of you in their implementation process. Reliant didn't have to reinvent the wheel when it came to connecting to a particular HIE and participating in data exchange. It took an implementation team, development of a memorandum of understanding (MOU) between the prospective HIE, and an understanding of what would work for the HIE.
  • Get help from your vendor. A good vendor will also serve as a good partner. By working together with your vendor, your team will be able to establish the appropriate steps for building and implementing a secure and successful HIE integration.
  • Connect the dots. Find the HIEs whose participants are in your referral network. Sometimes HIEs are private, hospital-based or public nonprofits, or public-private entities backed by a number of stakeholders – knowing the difference matters. Residents can benefit and bundled reimbursements can be shared only when the data goes to the referral partners who also are seeing those residents.
  • Determine what data will go where. What will pass from your network to the HIE? Consider what makes sense for your organization and determine what relevant data types are important depending on payer requirements and the data systems you're using.
  • Count the costs. When choosing an HIE and determining timelines for connecting to it, a provider needs to take the following costs into consideration:
Initial integration and setup, which Reliant estimates to be between $20,000 and $50,000;
Ongoing HIE subscription fees, which vary from HIE to HIE and also scale down as the provider puts more patient records on the HIE's network;
The size and scope of the implementation team needed for the project;
Training on how to use the HIE for the appropriate employees; and
As always, legal fees.

Reliant and PointClickCare's collaboration ensures that Reliant's rural senior care communities will now enjoy the free flow of health data across the continuum of care – including the primary care physicians, hospitals, long-term care facilities and nursing homes. This organized, connected effort will ultimately help caregivers provide better care through better access to more complete data, which wasn't available before.

While it may seem like a lot of time and effort, if you keep in mind all along that you are helping caregivers make more informed care decisions that will enrich the care of the seniors, it will be obvious that joining an HIE is worth the dollars and sweat equity it will require.

Lee-Ann Ruf is the senior product manager, HIT at PointClickCare.

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