Entries in HIE (2)


Look to Payers for Innovation in Health Information

So much attention has been focused on the adoption of EHRs by provider organizations—largely because of ARRA HITECH funding—that one could be led to believe that most health IT advances are occurring on the clinical side of healthcare.  In reality, the business side has been quicker to adopt IT systems that add efficiency to the workflow of the participants. Practice management software and revenue cycle management solutions are two examples.

However, the exchange of data between stakeholder groups remains the stumbling block in improving the efficiency of our healthcare system.  On the provider side, it has been evident from the start that one of the most “meaningful” uses of a patient’s electronic record is the ability to make the information available where, when and to whom it is needed.  But, the pathway to meaningful health information exchange (HIE) is a bumpy one—not just because of technical issues, rather because of the regional nature of healthcare laws and regulations that has led to a very fragmented healthcare market.  I overheard someone from a hospital system in Florida at HIMSS say that a Florida-wide exchange may be a good thing, but it doesn’t solve his real problem of the snowbirds who come to Florida in winter but whose primary healthcare providers are in the Northeast. 

But once again, payers are leading the way in “meaningful” exchange of patient data between providers and payers.  The infrastructure created for revenue cycle management applications—eligibility checks, claims submissions, etc.—already exists, so why not build upon it?

In March, I attended the grand opening of NaviNet’s new headquarters in Boston.  I knew that NaviNet provided a communications platform for payers to exchange information with providers and that they were actively expanding their portfolio of services, so I wanted to know more about them.  I left that evening thinking that NaviNet’s existing platform that already connects 470,000 physicians in 128,000 offices to a growing number of large health care plans could be leveraged for exchanging clinical data. 

This week I had a follow-on conversation with Kimberly Labow, Chief Marketing Officer at NaviNet.  Kim confirmed that NaviNet recognizes the opportunity to leverage their existing network to become a single point of contact for business and clinical communications. 

At this point, NaviNet has already expanded to offer practice management and EMR applications to provider clients and has recently launched a mobile eprescribing application in Florida in conjunction with Aetna.  It’s interesting to note that Availity is also part of this strategic partnership because they were working with Aetna and Prematics prior to NaviNet’s involvement.  NaviNet subsequently acquired Prematics, which led to this multi-factorial “coopetition”.  [Note: Aetna has recently acquired Medicity, a health information exchange vendor, which makes the level of coopetition even more multi-dimensional.] However, this level of cooperation is not an anomaly; I see it is a sign of things to come as our healthcare system undergoes periods of consolidation within and across stakeholder groups. 

Given the existing structure of our healthcare system, the payer segment— unlike the providers—has clear incentives to use information to increase efficiency in business and clinical areas.  Payers recognize the benefits of working with patients to encourage more healthful behavior and are taking an active role in creating care plans and follow-on communication with patients.   At the recent Patient-Centered Computing and eHealth: Transforming Healthcare Quality course, Blackford Middleton suggested that in an alternate future, if providers don’t respond to the challenges of adopting health IT and learning how to use and analyze data, they will be disrupted and the insurers will become our healthcare coaches. 

I doubt that many patients, physicians or hospital groups want health insurance plans to become the primary source of health advice and care management.  However, we are moving toward a more integrated payer-provider model with ACOs and we have witnessed the success of integrated delivery networks like Kaiser Permanente. Convergence is occurring from all directions: providers are merging with physician groups, providers are consolidating, payers are consolidating, and payers are also diversifying into healthcare delivery.  A recent Wall St. Journal article described the payer diversification efforts as including: “acquisitions and partnerships that will allow the [health insurers] to employ doctors directly, delivery health information technologies, and participate in new hospital-doctor groups known and accountable-care organizations”. 

With alliances and acquisitions occurring within and across stakeholder lines, it is becoming a challenge to coordinate standards efforts and for analysts like me to try to diagram an industry that’s in flux.

NaviNet is trying to make a contribution toward coordinating efforts with the Unified Patient Information Management (UPIM) platform they are supporting. For my part, I rely on variations of the convergence diagram below that I created some time ago, which attempts to illustrate the clinical information market in an EHR-centric world. The initial version had payers outside of the inner circle. After writing this post, I think it’s time for another updated illustration that more closely aligns providers and payers!


Clinical Information Flows in an EHR-Centric World


Patient-Centered Computing and eHealth 

In early May, I had the opportunity to attend the Harvard Medical School CME course, Patient Centered Computing and eHealth: Transforming Healthcare Quality. The 2 1/2 day course is directed by  Blackford Middleton,MD, MPH, MSc Corporate Director Clinical Informatics Research and Development Partners HealthCare and co-directed by Patricia C.Dykes, DNSc, MA, RN Senior Nurse Scientist Nursing Research Program Director Center for Nursing Excellence Brigham and Women’s Hospital.  The outstanding faculty of experts included Brent James, Paul Tang, Patti Brennan, John Halamka, Fabienne Bourgeois, Josh Seidman, Victor Strecher, Judy Murphy, and many others.  The full list of the faculty and their affiliations is included on the site linked to above.   I served as the “official tweeter” for the course and want to share with my readers some of the highlights of this practical course designed for the physicians who are responsible for adopting EHRs and applying health IT in “meaningful” ways to improve healthcare quality.

The full transcript can be found at:  For smaller doses, you can read the daily summaries here:

Day 1 Summary

Day 2 Summary

Day 3 Summary

The course included workshops, panel discussions and plenary presentations. To give a taste of the topics covered and insights shared, I’m posting a few outtakes from the Twitter stream for #PCeHealth11 below:



 Brent James opening keynote sobering view of healthcare crisis but making case of HIT as one key factor for positive change

Clinicians are poor at “rate estimation” and need technology tools to support decision making - James 


Brent James — more important to standardize care than anything else to control costs and improve quality. Great opening talk!


Sobko: 25% of Medicare recipients had a complication during care transition within 30 days post-discharge


Sobko on care transition: setting goals helps engage patients with care plans; also teach them when there is a red-flag.



Vic #Strecher #UMich to achieve behavior change don’t always need Health Coach, often eHeatlh tools sufficient, or combo 


Common theme for engaging #patients : establish a mission or goal to drive behavior change. Tools alone aren’t sufficient.


#MU incentives have to be aligned so that efficiency gains aren’t viewed as income reduction by some: @jhalamka.


#NHIN isn’t a “thing”; it’s a set of data usage agreements and standards: @jhalamka #HIE


Micky Tripathi: think of #HIE as a verb, the act of exchanging information. 


Common theme here: secure provider-patient communication saves time b/c it replaces phone calls that typically take more time.


Recap from @bfm for day 1: healthcare system is in crisis (Brent James) & has severely negative effect on US financial health.


Need to train physicians to be effective knowledge managers; simply too much to know everything. @bfm #KM #CDS #pcehealth11


Paul Tang keynote: cannot change issues like obesity one person at a time. Change must be community-driven.


Jon Wald—biggest driver of usage of patient journals in study: marketing of the patient portal by the practice. #PHR


“Any doctor who can be replaced by a computer deserves to be replaced.” -Dr Warner Slack


Who sponsors #PHRs? 50% health insurers; 25% providers. J. Wald,


Not much focus on #patient-reported data yet in #EHRs; Wald calls it “patient-entered data” or P-E-D. #PHR


BI-like dashboards w/ trend data in #EHRs help provide early warning signs to physicians. #analytics


Too many facts to remember & the right information is often not available at point of need. #CDS #EBM #POC @bfm


Referral is weak link in continuum of care: Zuccotti’s team developed clinical referral management system. Patient role was key.


Jonathan Teich def of #CDS: makes the right thing to do the easy thing to do. #EBM


Teich refers to #AHRQ’s eRecommendations project: #CDS


Cool: @jjseidman describing new program #pophealth: Open-sourced qual measures prog. #CDS #MU


AF4Q works with #ONC #REC (regional ext. centers) to help them w/ #quality measures; also trying to harmonize the many meaures.



Alt. future: If providers don’t respond to challenges they will be disrupted & insurers & payers will become coaches @bfm


#ARRA #HITECH: the $27B tail wagging the $2.5T dog (Paul Tang). #HCR


#EHR and #CDS adoption isn’t so much a function of fear of techology; rather physicians need to be convinced of added value. @bfm


#ACOs will shine light on importance of handoffs btwn providers & reduce missed communication. Luke Sato


Powerful keynote by Brent James: “Today’s problems are nearly always yesterday’s solutions.” #EBM