As Comagine Health moves forward following our recent merger of HealthInsight and Qualis Health, we bring a variety of skills, talents and business lines together. How will we capitalize on the new capabilities and become an even stronger and more capable organization? That’s a question that’s just now coming into focus. One of Comagine Health’s more interesting and unique business lines is managing the state of Nevada’s only health information exchange, HealtHIE Nevada. HealtHIE Nevada is a private not-for-profit organization that contracts with Comagine Health to operate and staff the HIE.
The primary function of all HIEs is to build a network between providers’ electronic health record (EHR) systems and offer master data management (MDM) services to participant organizations. They aggregate data from numerous sources, manage interfaces, index that data, measure its quality, store it and make it available for providers, payers, public health and other organizations to make informed clinical decisions. Advanced HIEs also get into technologies like terminology normalization or natural language processing to make data even more effective for analytics. The goals are to improve transitions of care, support public health reporting, reduce costs and improve health care quality. By providing a single source of clinical data statewide, we support population health management and quality improvement.
Over my first 15 months here at Comagine Health, I’ve become more familiar with our work as a Medicare Quality Innovation Network Quality Improvement Organization (QIN-QIO). As the Center for Medicare & Medicaid Services (CMS) begins to look at additional data beyond claims to meet their goals, this is where one of the biggest opportunities presents itself for our work with the HIE. HIEs already collect much of the real-time clinical data that is needed for quality reporting, and they are experts at collecting data from HIEs despite a lack of standards. A single clinical data interface from an HIE could result in collecting data from hundreds of providers. Before joining Comagine Health, I was the chief technology officer for the HIE in Vermont. We developed data-sharing capabilities with both our patient-centered medical home (PCMH) and our accountable care organization (ACO) to provide real-time clinical data for their quality improvement efforts. While these organizations are not QIOs, the data they needed was the same type of clinical data that CMS is looking for to manage quality improvement projects.
As we move into our next phase of contracts, I believe we are uniquely positioned to provide real-time clinical data from HealtHIE Nevada and other state and regional HIEs to augment claims and provide new insights and capabilities for CMS.
Shylettra, I agree that a QI project can be helpful in improving vaccination rates. I'm interested in knowing if there's a way to have the system that collects data talk to other systems so that if a child is seen by another clinic or somewhere else in the same state that the information can be shared electronically? I wonder if a QI project to coordinate providers within a region would help increase vaccinations?
I think coordination with providers would help to improve rates, but I also think that using published data to address the underlying reasons why parents choose not to vaccinate their children could improve rates even more. A study done by McKee & Bohannon (2016) explored reasons why parents chose not to vaccinate their children. The main concerns were: religious reasons, personal beliefs, safety concerns, and a desire for more information from their healthcare providers. We, as healthcare providers, can address the latter two concerns by staying fully informed about vaccines (ingredients, side effects, facts about their efficacy) and being open to discussion with parents about their concerns. The study found that parents desire to have open conversations with their child's healthcare provider "without feeling judged or attacked". We can do more to improve vaccination rates by doing our own research, providing better education, and not criticizing parents who have questions about vaccines.
Using data to make improvements in quality
Data that points directly to patient care issues is what really drives the evidenced-based science that leads to change. Most clinicians accept such data especially when it is used to evaluate their patient's outcomes while receiving the care they prescribe. As a soon to be nurse practitioner I would look forward to utilizing technology to help me provide high quality care at the lowest cost to the patient. In a study by Harder et al, 2018 (Quality Improvement to Immunization Coverage in Primary Care Measured in Medical Record and Population-Based Registry Data) they evaluated how effective QI projects really are that focus on improving immunizations rates by utilizing a data registry to validate immunizations rates for children vaccinated in the primary care setting. Vaccines are a great example of a low cost high quality service that primary care clinics can offer, and this study found that QI projects did lead to successfully improving immunizations rates in the clinic setting with a data registry to back-up their results. From this study clinicians can conclude that implementing a QI project that focuses on improving vaccinations rates will be helpful, and that having a data registry to collect the rates is a worthwhile investment for their community if one is not already in place.