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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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?

Where There is Change, There is Opportunity

As I was coming into Vegas, it occurred to me that never before in my 20 plus years of lab it experience have I seen so much change occurring in such a short period of time. We have ACOs coming at us, ICD9 to 10, there is the 4010 to 5010 conversion happening soon, the HITECH Act, stimulus funds, bending the healthcare curve, meaningful use for both ambulatory and acute, wild fires in Arizona and have I mentioned ACOs? We’re also seeing new and strange bedfellows coming around. Insurance companies are getting into the HIE and connectivity business, Quest has an ‘open connectivity strategy’ with Medplus and an EHR 360.

But on the other hand, I don’t think I’ve ever been so optimistic, too! All and all, the hospital and reference markets are doing very well.

If you look at the laboratory market in its entirety, 22% is the national, Lab Corp and Quest. They are organized. They seem to be everywhere telling their and your clients they can connect to an EHR in two weeks for practically free. But here is a surprising statistic; 54% of the lab market is hospitals, the rest is reference specialty labs and 5% POL. But the nationals at 22% are not nearly as big as what I would have guessed and, here is the kicker, they are not growing organically, it’s thru acquisition! Hospital labs are growing organically, so something is going right! Here is another statistic I picked up from an insurance company presentation. People in their 20s and 30s use on average two lab tests a year! People in their 50s, 60s and 70s use over eight! The sea is going to rise as all of us young baby boomers get a tad older.

But there is competition and change, and where there is change, there is opportunity. Let’s take the EHR market for a moment. It’s expected to grow from a 20-80% adoption rate in just a few years. Seventy percent of all EHR data is lab! Seventy to eighty of diagnosis are in part based on laboratory data! So what good is an EHR without the very valuable services the laboratory service market provides? Docs want the data in there, the EHRs want the data, insurance companies want the data and so does the government and, of course you know, it is in part tied to the subsidies.

So in our own analysis, we have determined that a physician on average trades with 2.8 laboratory service providers each and many have more than this. Physicians will want this data electronically, including orders and, if they don’t get it, they may decide to go elsewhere. So here is the opportunity and the threat. Without a strategy and connectivity, your clients might go elsewhere to get it, but with a strategy you can secure, clients who might otherwise leave and you may be able to expand you market share (organic growth) from those labs that are not so well prepared. As an aside, there are there are around 375 to 400 different EHRs out there and we haven’t seen a consolidation yet, we actually are meeting new ones still.

Okay, here is the crass commercial. At Halfpenny, we connect to EHRs, to approximately 128 different EHRs today. We provide this connectivity day in day out and are good at it. We are ‘the’ strategy for some organizations and others we augment or are a backup to existing IT initiatives. We also push results to hand held devices, now orders too, and provide LOINC mapping. Okay, I am done. Anyway, my encouragement is to develop a strategy if you don’t have one and or you might consider a backup position too … and if interested, we’d love to talk with you.

 

Back to the Past with a New Exploding Market

What is the most closed hospital information system (HIS) system available today? Who are open vendors? Sunquest, Cerner, McKesson. Do they have a proprietary integration engine? No, they partner with vendor neutral solutions. Will they coexist with competitors solutions, or allow the hospital to make best in class and best in service choices without penalty?

Historically, open systems architecture and service philosophy has been the topic of many tradeshow seminars, not to mention the promise of most vendors in the HIS market today. It wasn’t always that way. Why? Their constituency wanted the ability to choose specific solutions that best fit their departmental or enterprise needs without bias.

It is a rare hospital that buys all of its IT from a single supplier. Many will argue that a single supplier just does not exist that can competently supply all. Therefore, their clients want a fundamental ability to simply choose and an ability to interoperate without bias. Popular terminology then and now includes ‘best in class,’ ‘best in suite,’ ‘best in service’ or ‘open architecture.’ Can you imagine all the hundreds of vendors trying to work out how to integrate with each other? This is just one of the reason HL7 gained adoption.

Users wanted their systems to work together efficiently, with full functionality and without the penalty of high costs of proprietary integration. From this desire or requirement, open tools were developed to promote this concept of open systems, called integration engines. These engines currently sit in the middle between systems to transfer data allowing all systems equal access and could even conformed to specific formatting requirements. They work very well within this environment and nearly all hospitals have one. They are the clinical, administrative, and ADT information highway within a hospital, and they are open to all applications capable of connectivity.

These engine vendors, not surprisingly, were and are NOT owned by the major HIS vendors. Why? It would be a clear and loud conflict of interest. Would a major HIS vendor be incented to invest in connectivity to its competitors? Absolutely not! An engine vendor that is vendor neutral is very incented; in fact, that is how they make money. It is fundamental to their value. So, many forward-thinking HIS vendors partnered with engine vendors, like McKesson, who used ITC or DataGate for example.

So what is happening now? It is sort of ‘Back to the Past!’ There is a new exploding market, with nearly 400 different ambulatory EHR vendors and growing. Market adoption is going from 20 to 80% in the near term future, an astounding rush to connect with suppliers of clinical information. So the value and promise of an EHR is gained, not to mention stimulus money, but the vendor tactics are as old as the hills!

It seems every vendor with a bias, or ax to grind, wants to control/own the information highway. EHR vendors are developing HIEs that work well with their EHRs but not with others. Big surprise, insurance companies are buying HIE companies. Now this is scary and service providers for laboratory are also trying to own the highway to the physicians EHR. How open are they going to be if they allow another laboratory service provider to play on their highway they lose money? It is fundamental.

But who loses the most? The physician receives one choice free and clear, however, the other choices, if available at all, will come at a penalty, of time, money availability or choice. To trade with other service providers, they will be strapped with multiple point-to-point interfaces that, when evaluated individually, may be cost prohibitive or the expense of operating on multiple highways, which is actually a lot harder than it sounds.

Even though the service providers, out of the goodness of their hearts, are offering to put their proprietary infrastructure in place, it may not be worth it. It reminds me of a Trojans bearing gifts. Don’t be fooled. A service provider who is recommending an open solution is listening and taking a broader view of the market. Look for suppliers who are promoting open systems architecture and mean it.

 

What is the Right Connectivity Strategy for My Outreach Program

and how about them U of A Wildcats; I think they have a real chance this year in the NCAA!

Let’s review the environment. In many areas of the country, the penetration rate of physician of EHR/EMRs will drive from a lowly 20% to nearly 80%. This adoption rate is fundamental to the changes necessary to drive more effective and efficient healthcare. But let’s also be honest, too; it is also driven by funding from good old Uncle Sam. These physicians and physician groups will also want to comply with meaningful use criteria to qualify for stimulus funding to underwrite their costs of entering the new electronic medical record and health record era.

Meaningful use criteria, as many already know, in stage one, two and three begin and then accelerate sophisticated use of these systems. Early stages mandate the storage of discrete data like lab which comprises nearly 80 to 90% of the potential data within an EMR. Let also not be modest; laboratory diagnostic data represents probably the largest data source for diagnostic efforts of physicians. No bias here! Later stages mandate Order Entry so drug-to-dug, drug-to-disease interactions can be checked, and – drum roll, please – laboratory ordering which eliminates errors, reduces manual data entry, (there is a solid ROI behind clean orders and getting paid, but that’s another blog) and promoting quality and efficiency across the spectrum of care.

It only makes sense. Reality check number one; there are at least 375 different EMRs out there that we know about. We are learning about new ones on the pace of a couple per month. It is the Wild West, and it sort of feels like a there is a stampede coming over the hill doesn’t it?

If you are one of the 75% of hospitals laboratories in America with an outreach program or are a reference lab, you could be facing this stamped and that’s actually not the worse part. The worst part is they are all DOCTORS!!!!! (By the way, I hope our Chief Medical Information Officer does not read this blog, but I couldn’t help throwing that analogy in. You should see him when he is mad; he turns all sort of funny shades of red and purple! Anyway…) So, you are facing the stampede and wondering what’s the right strategy. Okay, let’s start with the options.

Option 1. My IT department controls an Interface Engine. Why can’t I just connect my orders and results to it, and let them connect to all the different EMR’s? Sounds simple, right?

Here are a couple questions to ask yourself.  Does your IT department have a lot of extra time on their hands? Have they already completed the ICD9 to ICD10 and 4010 to 5010 conversions? Are they prepared to handle the stampede? Can they deal with 375 different EMR systems? Are they good with doctors?

Option 2. I could use the physician access system/portal vendor I am currently doing business with! Sounds good, doesn’t it? If you are using one of them, they probably already have some connections out there. You have used them for quite some time. You like them or maybe not.

Okay, here are a couple questions to ask yourself. Are they prepared to handle the stampede? Can they scale to the demand you have and all of their other customer’s needs, too? Is EMR connectivity a sideline or are they really in this business with both feet? How is there service now? What might it be like when things get really crazy?

Option 3. Use the local HIE. This one usually comes from corporate. “We don’t want you wasting time building interfaces to EMR’s, because we have that covered with this here strategic relationship with the state’s HIE!”

Okay, you have got my pattern figured out. Here are some questions to ask yourself. Who is faster at building interfaces to my clients’ EMR, the HIE or my competitor? Can you afford to wait? Does the HIE initiative take care of the special requirements and workflow of lab order and result processing? How are the specimens going to be received? Will I be able to get paid with the information they are sending? How will MRN, Event, Episode or Account Numbers be associated with the order when transmitted to the LIS? Will the physician be presented with ask-at-order-entry-questions? Will an ABN get printed, signed and will the transaction contain an indicator of same? Is the HIE technology biased in any way that might prevent it from interfacing really well to all my customers EMRs?

(Note to reader: some HIE technology vendors are also EMR vendors and may not play nice with other EMRs or heavily influenced by your competitor. You get the picture. Their goals may not coincide with your goals to protect and grow your business.  At the worst case, you might want your own strategy in place or at least a backup!)

Option 4. Find a vendor who does this for a living: just this.

Big Finish – I hope you find the rather weak attempts at humor and analogy not too distracting. There is merit within each option and other’s I haven’t mentioned, but I pick on each pretty hard for a purpose. There is a are large demand for connectivity now and we expect it to grow.  Your strategy and options deserve careful consideration and potentially a multifaceted approach. If you already have a strategy, great, what’s your back up plan? If you don’t have a strategy, it’s probably time to start the process.  I welcome any and all comments, thoughts, concerns as long as they are positive and constructive, for the rest I’d like to introduce you to our CMIO; he’d love to hear from you!!!!!

(Note to reader: Our CMIO, Dr. Gai, is actually an incredibly smart, nice, and visionary individual. His face doesn’t turn red when he gets mad either. I’ve never actually seen him mad, and I enjoy his company. I just made all this up to see if he would read my blog!)