Quality Health Network HIE - Best Practices

QHN is a not-for-profit community partnership, established to support the adoption of health information technology, provide health information exchange (HIE) services and promote innovative uses of electronic health information for improved healthcare outcomes. We try to link the information about people such that providers of services can do a better job. We are really interested in connecting service providers to the needs of individuals. Our organization is not just about technology, it’s about the relationships we build, it’s about people and processes and workflows.

We are trying to do a better job of data collection and distribution as well as aggregation and normalization in order to provide relevant and meaningful information to our stakeholders at an appropriate time. There’s far too much data and not enough information. Doctors are drowning in data and what they are interested in is information. We do a variety of things to filter and to customize what we push to the physicians based on the individual physicians practice and preference.

Using health IT leads to benefits by facilitating creating value designed for specific stakeholders.  

Best Practices

• Filtering -  With routing and mapping we are able to filter the information using Mirth Connect which is an interface engine software. On top of the exchange of patient data we are also able to do really high level filtering which is really unique.
• Physician input -  Physicians dominate our board and direct what we do. We could not figure out why the longitudinal health records that we created were not being used more frequently. The physicians  then helped us to understand that we did not have the right information in there. They said “we can always go to a hospital or a lab to see lab tests and radiology reports and discharge summaries, but what we cannot see is the progress notes that an ambulatory physician wrote two weeks ago while the patient was in the hospital”.
• Utilizing progress notes - QHN began doing progress notes which basically tells the patient’s story as opposed to plain discrete data. Most of the CCDs don’t have the progress notes in them. We have been engaged in collecting them using very special interfaces and working willing EHR vendors who would export those notes to us.
• Pushing the data - This makes it easier for providers to receive the information they seek. The concept of ‘push’ is based on the premise that we really want to understand when an exceptional event has occurred, notify the relevant people that the exceptional event has occurred and may need additional scrutiny, and then either provide the data directly to the providers who need to know about it or give them the ability to query that specific information. We observed that there was a dramatic difference between the number of ED acute stay admits and discharges that we were collecting verses the  number of times we were actually able to inform the physician that their patient showed up in the ED. So we began a process that we call “Subscription” which allows us to push this information to the primary care doctors who are subscribed to the HIE so that the doc knows that the patient has been admitted into the ED. We are not depending on the registrar to ask who their primary care doc. We can also send this to case management for Medicare and Medicaid patients who do not have primary care doctors.
• Watch out for vendor consolidation -  We are attracted to smaller very nimble vendors because they are able to meet the needs of our participants. What happens all too often is that these small nimble organizations get bought up by larger ossified bureaucracies and the cost typically goes up and the nimbleness goes down. This is a problem for our industry. Size does not necessarily equate to success. We not only have to have sufficient revenue streams to sustain our operations but we have to accumulate sufficient revenue to have capital available to replace platform components when the vendor situation has changed and caused us consternation. Many of the people in our space do not fund depreciation of their platforms; they do not plan to have to swap it. In addition to consolidation of the industry there will be an ongoing cost to conversions.
• Price adjustment - Try to tie subscription rates to lives covered, that is per member per month, as opposed to one price regardless of size. This will be a much more structed methodology of providing for smaller scale participants and permits the ability to grow revenues over time as the scale increases.

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