Health Current, Arizona’s Health Information Exchange or HIE
Dr. Karst at Horizon Health & Wellness remembers when his staff was first able to avoid a needle stick for a frequent, elderly patient of the clinic because of their connection to Arizona’s statewide health information exchange or HIE, Health Current. The staff knew very well both the patient and the difficulty of drawing blood from her, but with a few clicks, they were able to access the results of blood work done in the hospital a few days earlier, avoiding the need for a blood draw. While there was time and money saved, the real value was more personal.
Dr. Karst and Horizon Health & Wellness care for a broad range of patients, including many seriously mentally ill (SMI) patients, and the management of these patients and other high-needs patients has changed significantly since they connected to Health Current. Horizon was initially set up to receive Alerts, real-time notifications of hospital admissions, discharges or transfers (ADTs) on a list of patients they “subscribe to” through the HIE. When any individual on their subscribed list lands in or is discharged from a hospital, they receive an immediate Alert. This service had an immediate impact, according to Karst. “I was shocked to learn how many of our patients were spending so much time in hospitals, and we knew that we had to do something about it,” he said.
Horizon and many other Health Current participants who care for SMI patients have reported that receiving Alerts on SMI patients has changed how they manage these patients, including adding more weekend clinic hours, encouraging walk-in visits, and even picking up SMI patients at the hospital.
Health Current began to offer Alerts in 2015, but the growth in information available to provide Alerts came after the Arizona Health Care Cost Containment System (AHCCCS) began in 2016 to provide incentives or differential payments to large hospitals for connecting and sending ADTs to Health Current. This contributed to a rapid growth in participation in the HIE, from 244 organizations in 2016, to 347 in 2017 to nearly 500 organizations by June 2018. As the number of HIE participants has grown, so have the sources and amount of data in the HIE. Today Health Current receives data from more than 100 data sources that now include 95 percent of the data from all Arizona hospital inpatient and emergency admissions.
Most importantly, this data is being accessed and used. There are two primary ways that Health Current provides data – through Alerts and through access to the HIE Portal. An Alert provides notification of an event such as an ADT or an abnormal lab result. Participants can also access data through the portal, such as information on a patient labs, diagnostic tests or clinical notes. Participants pull reports (called continuity of care documents or CCDs) such as discharge summaries from the HIE portal. Many participants also use the Direct secure email service of the HIE that allows them to share messages and documents with other participants. Today over 250 HIE participants are set up to receive Alerts and nearly 350 have access to the HIE portal. Already in the first five months of 2018, Health Current has delivered more than 13.5 million Alerts to Health Current participants.
A few examples illustrate how Health Current is working with HIE participants to improve care and quality. At Mountain View Pediatrics in Flagstaff, the largest pediatric practice in northern Arizona, they have built Alerts into their practice workflow and receive Alerts on all patients discharged from the hospital. Where they used to receive an occasional call about a patient being discharged, these Alerts now serve as a “security blanket,” allowing them to schedule follow-up and then use the HIE portal to access a discharge summary when needed. At El Rio Health, the largest federally qualified health center in southern Arizona, they have taken these Alerts a step further. El Rio has 28 care coordinators spread across multiple facilities, managing 16,000 patients who account for up to 60 hospital discharges and 100 emergency department visits daily. Health Current Alerts have allowed El Rio to not only reassign staff that used to call hospitals every day to find El Rio patients, they have also worked with Health Current to develop “enhanced alerts” that are sorted by facility and provide more detail that enables a seamless care coordination plan for discharged El Rio patients. These enhanced alerts deliver more meaningful machine-readable data that integrates with El Rio’s electronic health record (EHR) system and has become a dependable part of daily workflow.
The growing success in how HIE data is being used and the need for improved care coordination in value-based healthcare were the impetus behind the recent move by AHCCCS to increase the differential payments and expand eligibility for participation in the program beginning October 1, 2018. Recently, Health Current worked closely with the Arizona Hospital and Healthcare Association (AzHHA) to reach out to AzHHA members who are not yet Health Current participants and eligible for the expanded differential payment program. This outreach has expanded participation in Arizona’s HIE and is increasing the data that is available for participants to access and share.
Today Health Current has clinical data on more than 8.5 million unique patients, and continued growth of data sharing through Health Current will improve care, increase quality and lower costs for all Arizona patients.
For more information on Health Current, visit www.healthcurrent.org. To learn more about participation in Health Current, please contact Beth Scully, Senior Manager of Recruitment at firstname.lastname@example.org.