Column: New incentives for providers to exchange data

by Christina Galanis

A month ago, I went to the emergency room with chest pains. Fortunately, I was not having a heart attack, as I feared. But the ER visit allowed me to experience our health care system as a patient. I discovered the ER had not yet completely entered the Information Age. While awaiting treatment, I was given pages and pages of forms to fill out: medical history, medications and allergies ”” all information that could be easily accessed online by connecting to my doctor”™s electronic health records. The ER staff had the ability to do that, if only they had known they could!

Both the hospital and my primary care doctor participate in HealthlinkNY, the regional health information exchange I helped found in 2002. It”™s a network that lets different electronic health records based on different platforms “talk” to each other while protecting patient privacy and keeping data secure. Although 30 hospitals and 343 clinical practices in 11 counties ”” including Westchester ”” connect to HealthlinkNY, few providers take full advantage of its data exchange capabilities. In a non-life-threatening case like mine, the patient experience (and thereby satisfaction) was negatively affected. In a critical medical situation, lack of data exchange can delay treatment and lead to harmful medical errors.

Incentives to ”˜make the horse drink.”™

In its effort to transform health care and redesign Medicaid, the New York state Department of Health has made communitywide health networks a priority. It requires all hospitals to connect to their region”™s health information exchange by the end of 2016; all outpatient clinics must be connected by the end of 2017. Unfortunately, simply being connected doesn”™t mean providers are making full use of the network”™s capabilities. In other words, the Health Department mandate can lead the horse to water, but it can”™t make it drink.

So the state has given HealthlinkNY and other information exchanges a pool of money to offer as incentives to encourage data exchange. Some providers can qualify for incentives as high as $40,000 for exchanging data via an exchange. A second incentive, based on volume, is available for image exchanges between providers over the network. However, the pool of money is not limitless, and is available on a first-come, first-served basis.

Dramatically reducing waste

A Brookings Institution study published this spring in the Journal of the American Medical Informatics Association showed that in one emergency department, exchanging data via a New York State health information exchange much like ours reduced duplicate laboratory tests by 52 percent and radiology examinations by 36 percent. Not only does this lower cost ”” a great concern as hospitals move from fee-for-service to value-based payment models ”” it also reduces a patient”™s needless exposure to radiation and discomfort during lab tests.

Record look-up also can be life saving when someone is taken to the emergency department while unconscious or in a state of confusion. The staff can look up that person”™s medical records, which include previous diagnoses, past encounters, procedures and problems, lab results, transcribed reports and current medications. Even if a patient is conscious and coherent, it is far more efficient to print out the patient”™s medical record and ask the patient to validate it with you.

Look up records statewide

As of this month, clinicians can use HealthlinkNY to access the statewide health information network of New York, a state-funded project to link all HIEs together. This allows medical records to follow patients statewide, with their consent, if they need care away from home or another provider.

For example, a visitor to Niagara Falls from Yonkers with diabetes falls ill goes to an ER in Buffalo. Now that ER can query the patient”™s history from the person”™s primary care practice or hospital records from Yonkers.

Now that everything can be connected, HealthlinkNY”™s job is work with hospitals and other providers to use the tool, particularly in Westchester and the Hudson Valley, where health information exchange adoption has been slow. We will be working with hospital CEOs, CIOs, medical directors, and quality improvement officers to make HIE record look up part of the intake process.

Our second task is to educate providers to ask patients to consent to share records among providers. Our experience is that 95 percent of patients readily consent to make their records available. We also will rollout an online consent form this winter.

But in cases of emergency, no consent is needed unless patients have specifically requested that their records may not be shared at any time. So hospitals should ensure that record look-up is part of the ER intake process. This will make a positive difference in the quality of care, cost, and patient experience in your institution.

Christina Galanis is president and CEO of HealthlinkNY, an 11-county, nonprofit health information network formed by the merger last year of Southern Tier Healthlink and the Taconic Health Information Network and Community. She can be reached at 607-651-9150 or cgalanis@healthlinkny.com.