Episode 22: The Need for Health Information Exchanges

Health Information Exchanges, or HIE’s, have only existed as a business concept for a decade, but they are already solving many issues related to sharing private health information between providers. Brian Mack, marketing manager for Great Lakes Health Connect, and a former HIMSS social media ambassador, provides a “state of the state” overview of HIE’s. He dives into how medical practices benefit from the solutions that HIE’s can provide, including what to remember about recent mergers and acquisitions.

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Full Transcript

Announcer: It’s time to think differently about healthcare, but how do we keep up? The days of yesterday’s medicine are long gone, and we’re left trying to figure out where to go from here. With all the talk about politics and technology, it can be easy to forget that healthcare is still all about humans and many of those humans have unbelievable stories to tell. Here, we leave the policy debates to the other guys and focus instead on the people and ideas that are changing the way we address our health. It’s time to navigate the new landscape of healthcare together and here’s some amazing stories along the way. Ready for a breath of fresh air? It’s time for your paradigm shift.

Michael: Welcome to the “Paradigm Shift of Healthcare” and thank you for listening. I’m Michael Roberts here today with co-hosts Jared Johnson and Scott Zeitzer. On today’s episode, we’re talking to Brian Mack, Marketing Manager for Great Lakes Health Connect, the leading provider of networked health information services in Michigan and beyond. Hey, Brian, and thank you for coming on the show.

Brian: Hey, guys, thanks for having me. It’s my pleasure.

Michael: So cool to get to talk to you in person. We’ve had some chances to connect on Twitter and interact, and as we got to learn more about what you’re doing, I reached out to Jared and said, “Hey, do you know this guy? I’d love to get him on the show.” And so, as we started looking into some of the specifics of the work that you do, it seems like a really great opportunity for you to kind of educate me and as well as everybody else that may not be as familiar with health information exchanges, with HIEs. As Jared put this, like maybe we could kind of talk about the state of the states as far as it goes like a 10,000 foot view of what HIEs are, how they work, and what they’re doing today.

Brian: Sure. Happy to do that, you bet. Firstly, I guess, it’s the act of sharing health information is something that long predates the information age, right? It’s that, you know, there’s probably some caveman doctor pounding on a log somewhere trying to get some information to some other caveman doctor at some point. It really goes back that far. The concept that we know of as health information exchange today really came into being after the passage of the high tech act in 2009 and then quickly followed by the Affordable Care Act in 2010, and so as a verb health information exchange describes the process of being able to seamlessly and securely share patient’s personal health information in a way that is accessible to healthcare providers, to patients themselves, and really to any other party that has, you know, sort of what we call TPO needs, so treatment, payment, or operations kind of need for that level of insight into a patient’s healthcare life.

In a nutshell, that’s what we think of as health information exchange. And it really kind of takes a significant step forward from what had really been the standard for practice for years and years and years, which was really about phones and faxes and that we counted a good day to know that we are turning off fax machines in provider offices. If we’re getting that done, we’re getting something done well.

As a verb, health information exchange describes the process of being able to seamlessly and securely share patient’s personal health information in a way that is accessible to healthcare providers, to patients themselves, and really to any other party that has TPO needs: treatment, payment, or operations kind of need for that level of insight into a patient’s healthcare life.

Brian Mack

Scott: I couldn’t agree more about the faxes. I’m still amazed that there’s any communication at all coming from a doctor’s office via fax.

Brian: It’s mind boggling to me.

Scott: Yeah, I agree.

Michael: And we work with a lot of medical practices that, you know, in ortho and spine and neuro and it’s funny now getting to see, we have to put the fax number in the header much less often than what we used to.

Scott: Thanks for saying it. Yes, it’s true.

Michael: That’s also always like a sign of success for us. But relating it down to that particular group, you know, what is it that medical practices need to know about HIEs? What is it that, and maybe even thinking about like things like privacy concerns, all that kind of stuff. How does all that play together?

Brian: We talked about what health information exchange means as a verb, as a noun, health information exchange organizations like Great Lakes Health Connect where I work, we sort of sit in the midst of the healthcare delivery ecosystem and most of that is in a given region. They are technically different from state to state, but those organizations, our purpose, our reason for existence is to facilitate the flow of that electronic health information.

The HITECH Act mandated that providers transition away from paper-based records and move into EMRs, into electronic medical records systems. And, as we all know, that created this whole new market and ecosystem opportunity. The challenge there was that those EMR systems were really not designed to talk to each other. They were really, you know, fairly siloed and there was a lot of proprietary systemization in each of those competitive entities that limited their ability to communicate.

And so, that’s how health information exchange organizations kind of come into the picture. As far as what that means for medical practices, I suspect that at this point here we are pushing on 2020, that most medical practices are probably somewhat familiar with health information exchange as a concept. But, interestingly, the degree of sophistication in health information exchange varies broadly from state to state. And with that, the services and solutions that might be available to our medical practice vary as well.

So, when health information exchange is appropriately incorporated into a medical practice workflow, access to that shared health information can significantly enhance the delivery, their quality, the outcomes of care as well as, you know, reducing repetitive, you know, treatments and testing that would reduce cost overall. And so, when I’m talking to medical practices or giving them some advice about what they should be thinking in terms of, I would first advise practices to familiarize themselves with the HIE services that are available in their own geographic areas and to try to gain some understanding of the types of the information that might be available through their local HIE. And from that point they can determine how that might best be leveraged and incorporate it into their own operations.

When I’m talking to medical practices… I would first advise practices to familiarize themselves with the HIE services that are available in their own geographic areas and to try to gain some understanding of the types of the information that might be available through their local HIE.

Brian Mack

Scott: Yeah. I know, you know, for me personally, I’ve always, Brian, been amazed at how many times I need to provide my first name, last name, and date of birth. Getting beyond like whether I have, you know, a specific dangerous allergy, what medications I’m on, etc., you know, I kind of walk through like from a practice perspective how…You’re saying like, “Hey, reach out to that local HIE.” What would be the things that you think a practice, when they reached out, what kind of things should they be looking for informationally-wise and then from an information perspective, and then, how does that benefit the practice?

Brian: So, there are lots of requirements that are already on the books that most practices are having to find some way to meet, right? There are lots of requirements built into meaningful use a few years ago for example, that require practices to be able to send immunization records up to their state, up to their public health departments, those kinds of things. And so, the win in terms of making that connection through the HIE is pretty quick and pretty obvious and it checks that box. Those requirements are still enforced, you still have to be able to do those things. Those are the really basic simple things.

Some of the more advanced things that we are able to do in health information exchange today from a practice perspective are things like, you know, really basic admissions discharge and transfer notifications. So, prior to my getting into health information technology,  I spent years in long-term and post-acute care working in admissions, and I can tell you that the number one most frequent call that I would get was from primary care physicians who had just had a patient discharged from a post-acute care stay and as they were on their way out the door, the discharge planner would hand them the ream of paper that covered the course of treatment that they had just received in rehabilitation with the expectation that that ream of paper was going to go from the patient to their primary care doc so that the primary care knew what had just happened.

Unfortunately, statistically speaking, that happens less than 50% of the time, right? The primary care doc doesn’t get the paper. And so, what would then end up happening is that some administrator or office manager at the practice level is calling me saying, “We need you to fax this record because this patient has just dropped into a black hole and they had heart surgery two weeks ago and we need to know what’s been going on.” And so, it’s that kind of thing that, you know, fundamentally, healthcare providers are in the business and are missionally driven to provide the best possible care and deliver the best possible outcomes to their patients that is possible. And so, what health information exchange does, the value that we deliver to them in that particular case is one that just kind of greases the wheels, that takes out the middleman and it removes a whole lot of the efforts and obstacle that is involved in phoning and faxing and delivering reams of paper and all of those different things to allow the practice to focus more specifically on delivering the absolute best care that they can. The bottom line, that’s really the value that we deliver.

Scott: Yeah. It makes a lot of sense. I mean, so you guys just must have lots and lots of fax machines so that you could send faxes between all the different practices, I’m sure.

Brian: Exactly right. We have a room full of fax machines.

Scott: Best and fastest faxes. But that kind of takes me to another part before I start talking about value to the patient. But do you guys work with the EMRs like Epics of the world, etc, in terms of getting that data in and out of systems?

Brian: Yeah, we absolutely do. And so, and again, it’s different from organization to organization and state to state, but here at Great Lakes Health Connect here in Michigan, we are effectively EMR agnostic. So, we translate information, we pull that in, even though there are those proprietary overlays that sit on top of an Epic, or a Cerner, or a Greenway, or whatever the system happens to be. Most of the code, particularly for acute and ambulatory care, so hospitals and doctor’s offices, is written in one language and that language is called HL7.

And so, we can break the…we can kind of cut through the proprietary layer, get down to the base code, pull that apart, translate it, and then redistribute it to wherever it needs to be in the language that it needs to be understood in. And we do that, no exaggeration, more than a billion times a year in a matter of seconds per transaction, and in a whole variety of ways depending on how a specific provider needs to get that information, and what specific information they’re looking for. So, it gets a little bit more complex when you start talking about long-term care and behavioral health because the base codes are written in different languages but we do that stuff too. It’s just an additional level of complexity.

Scott: Yeah. And, you know, and so, if patients are listening to this, I wanted to kind of ask like, hey, how does this benefit the patient? But before I even do that, how do you guys stay HIPAA compliant and handle the privacy concerns? Because it’s a tremendous amount of obviously critical data, but data that everyone may not want, you know, to have out there.

Brian: Yeah, absolutely true. And I will tell you that privacy and security is a very, very high priority for us here at GLHC. We have a privacy department and a privacy officer and she reports directly to the CEO and we have monitors built up in the system so that all of the information that is flowing back and forth is being monitored on a regular basis. And we’re talking about, as I said, like millions and billions of bits and bytes. It’s virtually impossible to eyeball every single one, but there are triggers built in the system that are monitored on a regular basis and certain behaviors that can be flagged so that if we see something that is happening inappropriately, we can report that back to the people who need to know so they can do that. So, as an example, let’s say this person is a nurse in a long-term care setting and so they’re dealing with geriatric patients and their daughter sprains their ankle and so they want to go in and pull up their daughter’s record and figure out what’s going on.

In a situation like that, the profile of the individual accessing the information would indicate that this is somebody who doesn’t work in a pediatric environment, they work in a geriatric environment. And so, this could potentially be an inappropriate access of that data and it would automatically be flagged and then that information would be reported to the provider organizations involved and then they would go through their own escalation process, and depending on what that specific event is, there are different escalation steps that our privacy and security folks take. I will tell you very straightforwardly that I don’t know a lot of the detail, and the reason for that is because they want that private and secure.

Scott: They don’t want you to have all the details, right?

Brian: That’s exactly right.

Scott: So, as a patient in the State of Michigan, would a patient basically walk in from one doctor’s office to the other and have a different set of expectations regarding what kind of information they need to provide?

I bring this up because I went to my GP’s office, like I switched GP’s about a year ago, general practitioners, and I can’t tell you how many times I had to write my name on every single piece of paper and then how many times I refused to provide my social security number on these pieces of paper because I’m like, “Guys, no, you know, you’ll get it one time from me. You’ll get it verbally, and that’s it, and do your job.”

I think people don’t realize like when you talk about the level of privacy that is being looked at and reviewed right now relative to filling out my name and social security number 14 times on 14 different pieces of paper, it really is good. But getting back to this like expectation level for patients, do Michiganders, you know, enjoy some better level of having to not fill out their name and social security number as much when they’re going from doc to doc?

Brian: Sometimes, it’s just the…I mean, the easy answer is that it depends, right? And the reason for that is because sometimes, depending on who those docs are and what the specifics of the information that they need to have is, that might be different. The specific information that a cardiologist needs is going to be radically different than the information that a podiatrist needs, right?

So, I can tell you, in one instance, we have one of the largest closed network referral systems in the country running in Michigan today, and that’s a solution that GLHC offers to our network. And that system is set up to allow the provider the opportunity to pick the information that they need to see to have a successful referral. And then you can have a PCP who is sending out that referral to a specialty doc and they can make sure that that information has been populated before the patient arrives for their appointment. That circumvents the need for the clipboard on the way in the door, right?

Scott: Yeah.

Brian: And there are…

Scott: Fantastic. Yeah.

Brian: And other instances of that doing that. No, that’s okay. There’s, you know, that stuff, there are lots of sort of variations on that theme as well.

Scott: Yeah. You know, if you think about it, PCP, by the way, for patients out there, that’s primary care provider. From my perspective that to me is almost like the holy grail of, you know, you’re walking into…and you talk about a podiatrist and a cardiovascular specialist, the cardiovascular person might’ve put them on some sort of blood thinner, there’s a variety that are out there, and the podiatrist still needs to know that if they’re doing any type of surgery, etc. And, you know, I talk to some patients where they don’t know what they’re taking, what the dosage they’re taking, and then I’ll talk to my mom who tells me that she’s taking a red pill and then I have to get on the phone and ask the podiatrist what’s the red pill? And always good. But that’s the kind of stuff where not only is it easier to walk from place to place, but it could essentially be life-saving, you know?

Brian: Absolutely true. Yeah. Well, so, I’ll give you a for instance, you know, here in Michigan, I live in Grand Rapids, especially at different times of the year people will go up into Northern Michigan, either in the summertime or the wintertime for vacation, and there’s lots of recreation up there. Let’s say somebody lives here in Grand Rapids and they go up to Traverse City and the, I don’t know, they run a snowmobile into a tree or they have an allergic reaction to something and they end up in the ED in Traverse City. Now, the largest, more than one, but the largest health system in Traverse City for an example is a customer of Great Lakes Health Connect and all of the major health systems here in Grand Rapids are customers of Great Lakes Health Connect. And so, that ED physician will know, when that patient comes through the door, because this information will be available to them through their EMR discreetly.

They would have that patient’s entire longitudinal record at their fingertips. They would know what…it would give them a basis for understanding what may have caused that allergic reaction or would let them know upfront that, okay, if this person has a broken limb, they’re on a blood thinner and so we need to make sure that we are accounting for that in the treatment plan, and not only that, but through the course of that event, that information would be put back into the system which would then be available in real-time to that patient’s primary care physician back in Grand Rapids so that when that individual returned home they could go to follow-up and their doctor would know exactly what they experienced while they were away. That’s the level of value that we are able to deliver in terms of improving the quality of care and the experience that a patient can have at the point of care.

Scott: Yes. It’s just amazing. I know that, you know, we do a lot of application development, like we do a lot of work for individual practices, but we also do work with pharma and medtech and one of the companies with which we work basically collects the data, they scrub it clean so that it’s not associated with any specific patient, and then they supply that data to Watson, the IBM supercomputer. Is that something you guys are looking into in terms of trying to get a better idea about how to better take care of people, etc? Is a lot of that information being scrubbed and maybe trying to get some sort of overview? Especially, you know, I think of a lot of cases where public health studies, you know, they find like, you know, X number of nurses over a 20-year period to go on a particular diet, etc. I see so much potential there, as well. Do you guys look into that?

Brian: Yeah, we absolutely are. And I will say that the, you know, health information exchange, generally speaking, you can even, you can go out to the ONC website for example, and the definitions that they have for health information exchange are fairly rudimentary. And so, this particular act used to be thought of as sort of basic sending and receiving of testing information or even in a slightly more advanced way, query and retrieve, in other words, a doctor could actually ask the question, do you have this information? Then get it sent back to them. And those fundamental building blocks will always sort of be a part of what we do, that’s the blocking and tackling of basic health information exchange, but the potential to dramatically impact, just as you were saying, Scott, the potential to dramatically impact the way that health information can inform and enhance care delivery is happening all the time as we speak. Just as you mentioned.

The potential to dramatically impact the way that health information can inform and enhance care delivery is happening all the time as we speak.

Brian Mack

We here at GLHC have begun doing some deep dive analysis on this ocean of data that we help manage, and it is anonymized, but it will help us better understand and better be able to respond to public health crises and those needs and chronic disease state management. That information is helping us deal with a whole range, a whole variety of different things, with social determinants of health needs.

For example, we have members who are now part of the network that are not what you would think of as a traditional healthcare provider. They are community-based organizations. They’re food pantries, and transportation providers, and housing organizations, and these companies are plugged in because we know now as we move, as the pendulum shifts from this volume to value emphasis on healthcare delivery, we know that sometimes you got to get to a root cause and sometimes people’s nutrition needs are at the core of what is driving their healthcare concern.

And so, we are able to drill into those social determinants of health and connect resources to the network that can then be referred out to, either from a primary care physician or from an emergency room or whatever the case may be, and really build what we call here a connected care community. That’s really the goal of what we’re trying to do. Take the entire continuum and get us closer so that we can be communicating more effectively on behalf of the patients we serve.

Scott: Yeah. That’s just absolutely fantastic.

Jared: Yeah, and I’m glad, Brian, you can, at the end of the day, really draw that line to the mission and the purpose of that connected health community that you were just describing. And I’m sure some of the recent news, as far as mergers and acquisitions, that have happened across the country have probably played a part in that because, at the end of the day, you’re going to have to be able to draw that line from now the fact that structures have changed for several NCs including Great Lakes Health Connect. That’s my understanding, a merger with Michigan Health Information Network. Do you want to tell us about that integration and kind of what that means for the healthcare, like the healthcare landscape in Michigan and really, I’m sure it’s setting some precedents around the country too.

Brian: You know, just in terms of, just to sort of frame the conversation a little bit, in terms of mergers and acquisitions in general, a report came out a while back, and I’m sorry I forget the specific source, but basically it highlighted some of the failures that had occurred in health information exchanges around the country where they had to struggle and some had closed in some states, and then they also made the observation that the total number of health information exchange organizations across the country was declining over time and that they were indicating a trend that the number of organizations was getting smaller. And then based on that information, the conclusion that they came to was that health information exchange as a concept was failing and I can you that nothing could be further from the truth. In fact, we are doing more business and having a larger impact today than we’ve ever had before.

And the affiliation that we’re headed into with my and the Michigan Health Information Network is only going to make that larger. And, you know, when you think about it, health information exchange as a business concept has only been around for 10 years, and think about what has been accomplished in that very short period of time. People will often talk about why is it that health information exchange or health information doesn’t move the same way, say for example as financial information moves, that you can go to an ATM on one side of the country and get cash out from your home bank on the other side of the country in a couple of seconds. But people don’t fully appreciate that it took 60 years to develop the ATM system that we have today. We’re about 10 years in and we are light years ahead of where we were 10 years ago.

And so, if we’ve learned nothing about this transformational journey that we’ve been on, that healthcare is in the midst of from volume to value, it’s a consolidation as a fact of life, right? We see it in healthcare systems, we continue to see consolidation. The landscape has changed, the regulatory environment has changed, and organizations are coming together and joining forces because they are stronger together than they are apart. And that’s really what GLHC and MiHIN are in the midst of, and so I’m glad you asked that. Yeah. Late last summer, our CEO here at Great Lakes Health Connect and the executive director of the state-designated entity, which is called the Michigan Health Information Network. They came together to have a conversation about how our two organizations could best position for the impending changes that were going to come along with the Tesco final rule.

And so, you know, Tesco is the new federal interoperability series of regulations that is basically building a federal infrastructure to help drive interoperability on a national scale. And that is going to have very specific implications for every regional health information exchange organization. And by extension, every healthcare provider organization in the country. And our two leaders came together and said, we really need to be positioned to address this and we’ve worked as collaborative organizations here in Michigan for years. As a matter of fact, there are no two organizations that spend more time working with electronic health information in Michigan than GLHC and MiHIN. And over the course of that conversation, it just became obvious that, combined, our strength and capacity to serve people in Michigan was greater as a united front than it was as two separate organizations.

Over the last 10 years, we have basically had very similar missions, and that is to better facilitate the transmission of health information to improve the quality of care across the state and really beyond because now we’ve started to move outside of the state’s borders, but we were on separate tracks doing that. So, MiHIN’s primary focus was really on the governmental side of things. They were the state-designated entity, they were the front door to the state. They deal a lot with state and federal government, Medicare and Medicaid, as well as some of the larger payer organizations in the State of Michigan.

And they were really focused on building infrastructure and building the network across the state that would allow that information to flow. And meanwhile, during that same time, my organization, GLHC, was really focused on what we call the last mile. It was focused on being in the doctor’s office, being in each individual hospital, drilling down consultatively into their workflow, understanding how they were using that information and what they needed to have at the point of care and then finding that solution and connecting it to this infrastructure that MiHIN had created. Now, as a combined organization, we’re going to be able to do both of those things without any disconnect at all, and that is going to do nothing but improve the quality of care delivery for providers, for payers as well in driving down those costs. But ultimately for patients, this is a huge win. It’s exciting stuff and it’s going to be a big benefit for everyone here in the state.

Jared: Thanks, Brian. I appreciate going into detail on that, because I know that’s an important piece.

Brian: You bet.

Michael: Brian, we’ve obviously got like a ton more questions that we could ask you around this space. It was just an interesting show, we need to wrap up. But, I think what’s really interesting for some of the different audiences that we speak to, you know, for practices in particular, there’s been so much conversation around the struggle at getting at this information and obviously this is going to differ by state to state, but, just the fact that there are people solving this problem is very encouraging. Like, we can get away from fax machines for good eventually. Yeah. Which is a win for everybody, but, it is very encouraging to see that this is coming. It’s maybe not evenly distributed, but it’s definitely on its way. So, thank you so much for your time today, Brian. I really appreciate it.

Brian: Oh, it’s my pleasure, guys. Thanks for having me. And, you know, if I can leave you and your listeners with something, it would be to say that health information exchange organizations across the country are in the business to be problem solvers for our partners and for those providing care. And so, I would encourage folks, you know, don’t listen to the naysayers. Reach out to your local health information exchange and ask how we can help and we would be more than glad to help achieve provider’s quadruple aim goals. That’s what we’re here for. I appreciate the time, guys.

Michael: Thank you, Brian. Have a good one.

Scott: Have a great day.

Brian: And thank you too.

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