The Advantage of Physicians and Hospitals to Connect to an HIE in Order to Achieve Meaningful Use to Obtain Stimulus Funding

By: Linn Foster Freedman

On July 16, 2009, the Office of the National Coordinator for Health Information (ONC) Health IP Policy Committee voted on recommendations from workgroups, including a matrix of the qualifications that define “meaningful use” of health information technology (HIT) in order for providers to obtain incentive payments from stimulus funds. The incentive payments will begin in 2011 and be paid through 2016, with penalties commencing in 2017 if providers have not achieved “meaningful use” of an electronic medical record (EMR) by that time.

In order to qualify for the first year incentive payment in 2011, (up to $18,000 per physician), an eligible provider must meet the established 2011 measures that correspond with the HIT Policy Committee Health Outcomes Policy Priority Objectives. One of the policy priorities is to improve care coordination with the goal to “exchange meaningful clinical information among professional health care team.” The defined Objective to meet this goal is the “capability to exchange key clinical information” and the corresponding measure is the ability to show that the provider has the “implemented ability to exchange health information with an external clinical entity” such as labs, care summary and medication lists. Click here to view the matrix accepted by the HIT Policy Committee.

This means that in order to receive the full amount of stimulus funding for the adoption of an EMR, not only does a provider need to have an EMR system in place, but the provider cannot be utilizing the EMR as a standalone system or in a silo. The provider must be able to exchange information with other providers outside of the provider’s office or group practice. One of the ways to achieve this measure is for a provider to connect to a health information exchange (HIE).

Nixon Peabody represents several Regional Health Information Organizations (RHIO), including the Rhode Island Quality Institute (RIQI). RIQI is a collaboration of the top leadership of health care stakeholders working together to transform the health care system in Rhode Island. RIQI is the state designated RHIO for the State of Rhode Island and Rhode Island was one of five states in the country to obtain an AHRQ grant to develop and implement a statewide HIE. Rhode Island’s HIE, currentcare is presently in development and RIQI has been recognized nationally for its efforts in e-prescribing and as a leader in its efforts to achieve a statewide HIE.

Our guest contributor this week is Laura Adams, President and CEO of RIQI, board member of the National eHealth Collaborative (NeHC) and a faculty member of the Institute for Healthcare Improvement (IHI). Laura is a nationally recognized expert in quality and health information technology and a leader in public policy and has testified before Congress on multiple occasions. Here is her view of the advantage for providers to link to an HIE in order to achieve the “meaningful use” requirement of a demonstrated ability to exchange health information with external clinical entities.

Laura, what is your view of what hospitals and physicians will need to demonstrate as an "implemented ability to exchange health information with external clinical entities," and the impact of this requirement for Health Information Exchanges such as currentcare and Regional Health Information Organizations like the Rhode Island Quality Institute?

“Hospitals, physicians and consumers will be best served in the short and long run if the requirement to demonstrate an "implemented ability to exchange health information with external clinical entities" is broadly interpreted. While some hospitals and physicians may be exploring the minimum they can do—perhaps connecting to a single lab or a local hospital and still meet the requirement--to do so would miss the point and disadvantage themselves in the future. The goal is to improve health by better coordinating care, which means connecting to multiple entities. The good news is that hospitals and physicians can position themselves to do this without the burden and cost of multiple interfaces—if they take advantage of local health information exchanges.

For HIEs and RHIOs, the meaningful use requirements are a tremendous boon, if they understand how to leverage them to provide even greater value. The requirements raised awareness of health information exchange among physicians and hospitals in an unprecedented fashion. HIEs/RHIOs have a real opportunity to offer more immediate economic and clinical value to providers in a tangible way that may have been less apparent before. If HIEs/RHIOs communicate their value in “meaningful use” terms and explore offering other services, such as helping the small to medium size practices and hospitals with their data extraction and meeting reporting requirements, they can embed themselves in the fabric of the new infrastructure more deeply than they thought possible. Sustainability suddenly got a little easier.”

RHIOs and HIEs are in different stages of development and implementation all over the country. The inclusion of separate stimulus funding for HIEs and Regional Health Extension Centers will no doubt have a positive impact on their ability to thrive and assist the federal government with the stated objective of implementing a National Health Information Network to improve quality of care to patients. Connecting to RHIOs and HIEs gives providers the ability to achieve meaningful use in a cost effective way, and to improve the quality of care provided to their patients.