Challenges in Obtaining Complete Medical Record Data

By Lesley Brown, SVP of Product Management at Halfpenny Technologies

As previously discussed the potential benefits to health plans of compiling a complete picture of their member’s health status are abundant.  The more data and information you have about your members, the better help and guidance you can give them to ensure they receive the most appropriate and best care without redundant replication of services.  And without unnecessary cost!

Being able to obtain a comprehensive medical record for a member from a physician’s practice is one avenue that health plans can take to enrich their member’s health records.  Yet, technical and business challenges aside, being able to gather a comprehensive or full medical record from an EMR can be difficult.  Experience has demonstrated that all too often much of the key clinical information about a patient is missing from the “structured” components of Electronic Health Records.  And this occurs even when data is retrieved using “industry” standard formats such as the HL-7 C-CDA template and document structure.  This missing clinical data ranges from lab result interpretations, medication detail around frequency and dosing, allergy information to physician signatures.  An additional challenge is the inability to distinguish and interpret between actual missing data in a record from “null” data elements such as “no information documented” or “no known information”.  This absent information can be very challenging to find and retrieve from within an EHR system.  Experience has shown that reliance on “industry standards” such as the C-CDA templates isn’t sufficient.  Add in the fact that many different EMR’s are in use today by physician groups and hospitals, and these medical record systems are built in a proprietary way, making the challenge of finding that missing or incorrect information different between EMR systems and hence physician practices.  As a result of these challenges, healthcare providers who would like to gather clinical data in order to compile a more complete picture of their member’s health are faced with a project that is time consuming, extremely expensive, frustrating and can often result in disappointment and incomplete personal health information.

Looking to obtain a complete medical record on your members?  Halfpenny Technologies has been in the clinical data exchange business for more than 15 years and over that time have built reusable interfaces that connect to 90%+ of the top EHR vendors and LIS/HIS systems.  Halfpenny Technologies comprehensive clinical data exchange platform uses a multi-faceted methodology to obtain clinical record data.  We do not rely solely on the use of the C-CDA standard.  Halfpenny Technologies completes a quality assessment at each data retrieval stage identifying how full or complete a medical record is and highlighting missing sections or data elements.  We can then work with our customers to identify ways to ensure that clinical data is being acquired and stored correctly.  Halfpenny Technologies’ vendor agnostic approach allows the receipt of any EHR medical record data format and in return health plans can receive clinical data in the layout of their choice. Our continued investment in innovative solutions has uniquely positioned the company as a national provider of clinical data exchange solutions to the health care industry.

 

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Looking to build a complete picture of your member’s health?

By Lesley Brown, SVP of Project Management at Halfpenny Technologies

The potential benefits to health plans of compiling a complete picture of their member’s health status are plentiful. 

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It really goes without saying that the more data and information you have about your members, the better help and guidance you can give them. You can ensure they receive the most appropriate and best care without unnecessary replication of services.  And importantly… without redundant costs!  For a long time, health plans have been reasonably content with the data that they obtain from medical claims.  But as payers become more engaged in actual care management and strive for value based care for their members, many are realizing that the data from claims offers only a part of this comprehensive picture.  Some of the pertinent detail, such as a lab test value, is often absent from a claim. Some care may not always result in an insurance claim.

The utilization of clinical data, such as that obtained from a continuity of care document (CCD) from a physician’s practice, can help enrich this health record for your members.  And the brilliant thing is – you do not need to wait for that first visit to the doctor with you as their medical insurer to occur.  If the member has remained with their doctor but changed insurance plans, their historical information will still be in their clinical medical record.

Unfortunately, gathering all this clinical data from multiple sources in order to take advantage of it is not as easy as it may sound.  There are many health information systems, such as EMR’s and LIS’s, that are in use by physician groups and hospitals. These medical record systems are built in a proprietary way in order to ensure a market share or niche for the vendor.  As a result, they use different templates and store common data elements in different formats. This is all thanks in part to variations in the interruption of industry standards.  Due to this variation these electronic record systems struggle to communicate with each other, never mind a vested third party that might be looking to take advantage of this goldmine of clinical data.  You’ve heard the term – there is a lack of “interoperability” in healthcare.  As a result, health plans that are interested in gathering this clinical data so they can compile a more complete picture of their member’s health are faced with a project that is time consuming, extremely expensive, and often results in failure.

Looking for some assistance in collecting clinical data?  Halfpenny Technologies (HTI) has been in the clinical data exchange business for more than 15 years. Over that time, HTI has built reusable interfaces that connect to 90%+ of the top EHR vendors and LIS/HIS systems.  HTI’s vendor agnostic approach allows the receipt of any EHR or LIS data format and in return health plans can receive clinical data in the layout of their choice. Halfpenny Technologies’ continued investment in innovative solutions has uniquely positioned the company as a national provider of clinical data exchange solutions to the health care industry.

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What is the state of Clinical Data Exchange for Health Plans?

By: Lesley Brown, SVP Project Management at Halfpenny Technologies

As health care in the U.S. evolves, health plans and other risk bearing entities such as ACOs, have shown an ever increasing desire to acquire clinical data for their members.   This need is fast becoming more than a necessity, as value based care begins to drive reimbursements, revenue adjustment factors and quality performance, to name just a few.   While many health plans already have access to select quantities of clinical data (think Lab results, maybe even ADT data) their appetite is now evolving towards obtaining member Continuity of Care (CCD) data.  CCD is now heralded as the “superset” of clinical data, all the medical history, test results, medications for a member in one document.

Too bad then that the coordination and exchange of this clinical data from physician practice EHRs has become a significant pain point for many health plans and clinical data integration into payer systems has made minimal advancement in the past few years.  The challenges that health plans need to overcome range from technical ones, a lack of real clinical interoperability despite Meaningful Use (MU) Stage 2 and HL7 C-CDA requirements & specifications, to business ones, often a lack of clear business value and use case evaluation can stymie the best of endeavors.

Where and how to start?  Some of the common approaches payers can take for clinical data integration include building out point to point integrations (but who has time or resources for that!), accessing a state or local HIE (this is often limited by HIEs demands for standard data structures as well as a lack of data normalization) or partnering with one of a wide variety of vendors who claim they can facilitate non-claims based clinical data integration (many of whom fall short when attempts to validate data exchange are attempted).  Regardless of the integration arrangement health plans should be advised to start small and stay focused, successful data exchange projects have a value proposition and can demonstrate cost savings or increased revenue.  Examples include, risk adjustment factors that could benefit from the diagnosis list contained in a physician practice medical record or replacement of expensive chart reviews with defined data elements from an EHR.

Halfpenny Technologies (HTI) has been in the clinical data exchange business for more than 15 years and over that time have built reusable interfaces that connect to 90%+ of the top EHR vendors and LIS/HIS systems.  HTI’s vendor agnostic approach allows the receipt of any EHR or LIS data format and in return health plans can receive clinical data in the layout of their choice. Halfpenny Technologies’ continued investment in innovative solutions has uniquely positioned the company as a national provider of clinical data exchange solutions to the health care industry.

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Access to Actionable & Complete Lab & Clinical Results Data Enables Health Insurance Organizations to Improve Care Management

Health_plan_cardThrough truly interoperable lab and clinical data exchange, health insurance organizations (payors) can better manage individual care, support shared savings models, and deliver measurable and actionable outcomes.  Access to complete lab and clinical test results can help health plans drive down the cost of care and ultimately improve population.  Halfpenny Technologies offers comprehensive solutions to empower health plans with the right technology to tackle these initiatives and analytics tools for predictive modeling to address compliance and improve financial outcomes.

“Health plans struggle with the many challenges of health information exchanges and coordination of care,” Halfpenny Technologies President and CEO, Tim Kowalski, said.   “The clinical data integration solutions from Halfpenny Technologies, fuel health plans by giving them more complete access to the critical lab and clinical results data required for effective care management.  This data combined with powerful analytics and modeling tools empowers health insurance organizations to be more competitive and improve financial outcomes.”

Health insurance organizations are further burdened with constant challenges due to a rapidly evolving health care landscape fueled by change from compliance initiatives, health reform and an unstable economic environment.  To tackle these challenges, Halfpenny’s solutions provides access to clinical data and the necessary analytics tools to allow health plans to effectively manage patient risk and ensure better care coordination.  A health insurance organization’s ultimate success will be determined by its ability to:

  • Predict shifts in membership-base
  • Manage the cost of care
  • Collaborate more effectively with providers
  • Increase NCQA and HEDIS quality scores and Medicare Five-Star rating

Address health insurance organization’s need for complete clinical data

All health plans are facing the need to integrate clinical data such as lab results that is currently in disparate data warehouses across the enterprise.  Halfpenny Technologies aggregates, normalizes and consolidates laboratory and clinical test data so it can be seamlessly overlaid with quality report data, disease management data, population health data and claims data to gain holistic insights at the member level.

Tools to support collaborative care and shared savings models

Halfpenny solutions supports both the accountable care organizations (ACOs) and patient-centered medical homes (PCMHs) models to help health plans to drive down the cost of care.  Our solutions toolkits focus on improving quality and controlling cost of care by aligning the interests of health plans, providers and members.  Additionally, Halfpenny Technologies health plan tools:

  • Promote evidence-based medicine
  • Provide comparative effectiveness
  • Enable the seamless exchange of data for better integrated care
  • Offer analytics to support pay-for-performance initiatives

Measure return on investment with Halfpenny Technologies’ analytics tools

Real-time data exchange between health plans and providers is paramount to enable collaborative delivery model operation and measurement.  With Halfpenny Technologies solutions, health plans can analyze outcomes and address compliance through automated reporting for patient centric care analysis & recommendations based on nationally accepted recognized clinical guidelines.

Halfpenny Technologies solutions help Health plans face the challenges in measuring the return on investment of programs that provide “difficult-to-quantify” savings, such as wellness, case, care and disease management.  The clinical decision support, population health and revenue enhancement reports enable health plans to work more closely with providers to coordinate care, develop performance metrics, and implement long-term data tracking systems and processes.

For more information on these solutions, please visit us at http://www.halfpennytech.com/health-plan.html

by Patricia Brown

Director of Marketing

Supporting Shared Savings Models, Care Coordination & the Actionable Exchange of Lab Data with LOINC®

lab_test_tubesOften, when I make a presentation to healthcare executives and lab people, I’m struck by the level of unfamiliarity regarding the Logical Observation Identifier Names and Codes (LOINC®). It is not that all are unfamiliar with it; lab directors and some managers and medical technologists are familiar but, overall, most are not. This is a telling fact about the state of our preparedness for data sharing, coordinated care, and advanced analytics. As a further example, a group of senators recently sent a letter to the Centers for Medicare and Medicaid Services (CMS) requesting a re-evaluation and “reboot” of the Meaningful Use (MU) program citing, among other things, concerns regarding the program’s ability to achieve meaningful interoperability. LOINC® is part of the solution.

LOINC®: The Cornerstone for Interoperability

The cornerstone of interoperability is the use of standardized data structure and coding schemes. Since clinical laboratory data comprise the bulk of an individual’s medical record and are essential for healthcare decision making, one would expect it to be prominently featured in all interoperability discussions. In the realm of clinical laboratory data exchange, specifically for lab results, two standards come to mind immediately:

  1. The Laboratory Reporting Initiative (LRI) as a structure standard, andLOINC-maooing_CTA
  2. LOINC® as a coding standard.

While both are mentioned in MU regulations and the accompanying Office of National Coordinator (ONC) standards documents, they are not widely recognized as critical for interoperability progress – but they are!

The History of LOINC®

The Logical Observation Identifier Names and Codes (LOINC®) system was created in 1994 at the Regenstrief Institute, associated with Indiana University. Initially focused on laboratory observations (all laboratory categories and Veterinary Medicine), it has also expanded to include other clinical observations made on patients.

  • LOINC® has been endorsed by the American Clinical Laboratory Association (ACLA) and the College of American Pathologists (CAP).
  • It has been adopted for test reporting by large commercial labs such as Quest, LabCorp, Mayo Medical Laboratories, and MDS Labs; large HMOs including Kaiser Permanente and Aetna; governmental organizations including the CDC, DOD, VA, and NLM.
  • Internationally, LOINC® has been adopted as a national standard in many countries, including the United States, and has been translated into many languages.

Interoperability has two cornerstones:

  1. standardized structure
  2. standardized content.

LOINC® was created to solve the problem of laboratory data interoperability by promoting standardized content. To date, most labs use proprietary order and results codes. In the past, when results were manually transported or faxed, standardization was not an issue. However, in our emerging electronic healthcare setting without content standardization there is no interoperability. LOINC® mapping can help.LOINC_mapping

Facts about LOINC®:

  1. LOINC® is the “new” standard for lab results and lab orders
  2. It is critical for Meaningful Use
  3. It can me key to the success of independent and hospital labs
  4. LOINC® is large and complex – Test dictionary builds and LOINC® mapping are specialty skills that require lab and LIS expertise as well as LOINC® expertise.

The prudent approach by hospital and independent labs is to be proactive and prepare while there is still time. That is why my colleague, Halfpenny Technologies Clinical Data Specialist Jane A. Burke BSMT (ASCP) and I have co-written a white paper positioning LOINC® with respect to care coordination, meaningful interoperability, the exchange of actionable data, and supporting shared savings models. We hope that this white paper entitled, Supporting Shared Savings Models, Care Coordination and the Actionable Exchange of Lab Data with LOINC®, provides the foundation for LOINC® knowledge and offers you the important questions you need to ask regarding LOINC® mapping and test dictionary creation for your organization.

Find a LOINC® Mapping Expert

For those that conclude that they do not have the skill set and/or the infrastructure to support LOINC®, alternatives do exist and should be examined. Most LIS vendors do not offer such services to support their software systems and most labs are left to fend for themselves. However, some third-party vendors offer services for the initial dictionary build, LOINC® mapping, ongoing maintenance, as well as, middleware solutions that can bridge the gap in current capabilities of existing LISs.

Being able to positively answer the above questions or, at least, have a roadmap to achieve them within the first year of the start of MU stage 2 (2014), will prepare the lab for the realities of providing clinical services to physicians in the era of accountable care.

For more information, on LOINC® Mapping and Test Dictionary builds, please contact Halfpenny Technologies at 855-277-9100 or visit us online at http://www.halfpenny.com.

Gai Elhanan, M.D., M.A.

Chief Medical Information Officer

*LOINC is a registered United States trademark of Regenstrief Institute, Inc.

Access to actionable lab data is essential for the success of care management for Health Plans & ACOs

Lab_data_health_plansHealth insurance and Accountable Care Organizations (ACOs) are faced with constant challenges due to a rapidly evolving health care landscape fueled by change from compliance initiatives, health reform and an unstable economic environment.  To tackle these challenges, health plans and ACOs need to develop go-to-market strategies and analytics solutions that define the organization’s future position and answer critical questions surrounding growth, profitability and sustainability. The ultimate success of these organizations will be determined by its ability to:

  • Predict shifts in their customer-base
  • Manage the cost of care
  • Collaborate more effectively with providers
  • Increase NCQA and HEDIS quality scores and Medicare Five-Star rating

Access to actionable lab data plays a significant role in the success.

Health plans utilize care management programs that typically implement a variety of interventions tailored to needs of specific groups of affected individuals.  A model that identifies those individuals who have high risk of complications has the greatest potential to impact outcomes and lower healthcare cost. Complete and real time lab results can help health plans model individuals who have high risk of complications, greatest potential to impact outcomes, and lower healthcare cost.

It is necessary for health plans to access to lab results to help them better determine the effectiveness of care management programs.   Some of the challenges and opportunities regarding lab data include:

  • Health Plans and ACOs typically experience difficulty receiving clinical data from labs.
  • Clinical data can have a significant impact on a health plan’s Medicare Five Star Rating, NCQA and HEDIS quality scores.
  • Health plans and ACOs seek laboratory data to reduce instances of drug contraindications, generate clinical alerts, and populate personal health records.
  • Lab results can demonstrate the efficacy of care management programs.
  • Ability to provide clinical data can be an important factor for a lab to achieve in-network status with a health plan or ACO.
  • Health Plans and ACOs share in a unique position to help a lab understand leakage (testing performed by out-of-network lab).

Health plans and ACOs need a true interoperability solution for lab and clinical data which can better enable their organizations to manage and lead in the coordination of individual care, support shared savings models, and deliver measurable and actionable outcomes that help health plans drive down the cost of care and ultimately improve population health.

Brian Muck is the SVP of Sales & Marketing for Halfpenny Technologies

Interested in more?

EHR Adoption for All – Now and Not Later!

The American healthcare system is fragmented, costly, hence underperforming. Despite significant islands of excellence, overall demographic measures position the U.S. far from the top of the developed countries, while health expenditure is the highest, and rising at an accelerating rate. There is a broad consensus that these trends are unsustainable and a change is mandated.  And while the type of change is still open for debate, the current law is threatened with repeal, and incentive payments may be cut or scaled down, it is generally agreed that health information technology (HIT) must play a significant role.

Despite playing a leading role in the development of health information systems and healthcare informatics research, such advances were slow to trickle down to the rank-and-file physicians in the US, and the adoption of electronic health records (EHR) lags significantly compared to other nations. Among the many reasons for this gap are lack of orchestrated effort and cost.  In the last several years we have witnessed a major change.  Government initiatives endorse and mandate the use of HIT across the continuum of care. The flurry of activities is accompanied by numerous new regulations that are difficult to comprehend and to comply with, especially by the providers that are supposed to implement them. They also result in higher development and implementation cost of new HIT systems and sustain a large and costly echo-system, thus maintaining a significant barrier to wider adoption.

Coupled with the technology initiative, there is also a move towards more comprehensive, integrated, community-based care delivery systems. ACO (Accountable Care Organization) is the new buzz word that describes a population-based, yet patient-centric, approach that promises to deliver cost-effective, comprehensive care. This has been long overdue. For many decades, healthcare delivery has been moving away from the community-based Primary Care Physician (PCP) model towards the partialist/specialist model coupled with healthcare consumerism.  Unique to the government’s ACO approach, is the combination of HIT and reporting measures to ensure quality of care and measure population health improvements. This initiative is attractive to practices and healthcare organizations since it promises to split any realized savings with the ACO.

Reviewing the draft regulations for ACOs, it appears that relatively small groups of physicians can form such an ACO. After all, this is a community-based approach, and a minimum of 5000 Medicare beneficiaries is required. However, a high bar is set by requiring appropriate administrative and clinical systems to be in place. Since only about 10% of physicians have even the most basic form of sanctioned EHRs, the cost of the required technology is likely to exclude many community physicians from participating in this community-based initiative.

The most basic building block of the HIT initiative is a compliant EHR whose data is standardized, potentially sharable, and can be queried in any meaningful way. The government EHR adoption incentive programs mostly address eligible providers. There are many physicians who are not eligible for participation. Thus, with or without incentives, the cost of EHR technology is still a significant barrier, most likely to postpone wide spread adoption, at levels such as in the Netherlands or Great Britain, for many more years. In turn, reduced levels of adoption will reduce and delay the effectiveness of many initiatives such as quality measures and ACOs.  As CMS and ONC ratchet-up the technology and compliance requirements, it is even more important to ensure faster and wider adoption of EHR technology by all physicians.

For effective delivery of coordinated healthcare in the community, there are many more participants than the physicians. Care coordinators, dietitians, social workers and many others are involved. Most are not eligible providers, but require supporting technological solutions that are not covered by current initiatives. It is quite likely that initiatives such as the adoption incentives and shared savings for ACOs will not cover the cost of the initial investment in technology required for effective population-based community healthcare. Perhaps it is the time to reassess our current approach, and focus more on wider adoption of EHRs and other first-line support systems for all providers (physicians and non-physicians) rather than follow, at this time, increasingly sophisticated schemes.

Gai Elhanan, MD is Chief Medical Information Officer at Halfpenny Technologies, Inc., a leading provider of clinical data exchange solutions.