Alix Goss is executive director of the Pennsylvania eHealth Partnership Authority, which works to improve healthcare delivery and outcomes across the state via the secure exchange of electronic health data. The authority announced late last month that it would provide at least $10 million in onboarding grants to help connect practices and hospitals to its Pennsylvania Patient & Provider Network HIE.
How does the Authority work with physician practices?
The Authority’s certified participants provide services directly to providers, including physician practices. Providers and other end-users of electronic health information exchange (eHIE) connect to private-sector health information organizations (HIOs), who then connect to the Authority’s PA Patient & Provider Network (P3N).
Why did the Authority decide the time was right to announce additional funding to help connect providers to the P3N?
Programs that help HIOs to connect providers to the P3N will help to incentivize both the providers and the HIOs to join P3N and accelerate the build towards a critical mass of participation. However, Authority grant programs are predicated on the Authority’s ability to identify funding from private-sector donors, other agencies, and/or federal sources. The current announcement is based on proposed funding from CMS. Awards to the HIOs are contingent on actual awards by CMS. One of the challenges with the previous grant opportunities was the compressed performance period. We are announcing the grant in advance of the actual award to give us a head start on accepting and processing applications from the HIOs, so as to afford the HIOs the maximum possible time to perform the work of connecting providers to their networks using the grant funds.
Where are Pennsylvania’s physician practices in terms of connectivity to P3N and other HIEs within the state?
Measuring connections by physician practices is more complicated than it might seem. While some practices are connecting to the P3N via direct connections with HIOs, many more may be connected by virtue of their participation in integrated delivery networks (IDNs) anchored by a hospital system that is connected. In the past, not all HIOs have collected information about these subsidiary connections. We are working with the HIOs to develop measurement techniques and practices that will provide the Authority with consistent information across the various network participants. We anticipate this data will be available in early 2016.
Does the Authority have any measurable goals when it comes to connecting physician practices to the P3N?
Our goals for calendar year 2015 involved getting the HIOs connected to the P3N. We anticipate that all four existing HIOs currently operating in the Commonwealth will be connected by December or, at the latest, in early 2016, with any other HIOs that emerge in the coming years to join as soon as practical. We anticipate working aggressively to accelerate hospital connections to the P3N-participating HIOs at least through September 2016, with a stretch goal of connecting at least 90 percent of the facilities that are eligible under proposed Authority grant programs (approximately 125 facilities). Currently, about 27 percent of these eligible facilities are affiliated with a HIO. Also in 2016, we will work with the HIOs and their connected facilities to better understand affiliations between other facilities and physician offices with the grant-eligible facilities, which will in turn allow us to set goals and focus outreach efforts for connections with those who are not affiliated.
How have you seen physician practice adoption of P3N increase and impact patient outcomes since it was launched?
As noted above, and due to the nature of our partnership with the private-sector HIOs in advancing eHIE in Pennsylvania, the Authority does not yet have concrete information regarding growth in physician practice participation in the HIOs. The HIOs will be obligated to provide this information to the Authority only once they are connected to the network. Part of our strategic plans calls for the Authority to undertake surveys of the facilities and physician practices after they are connected to the HIOs, and then the P3N, to gather evidence of changes in patient outcomes deriving from eHIE. We anticipate the first of these surveys in mid- to late 2016, with results published towards the end of the year. In the meantime, the Authority continues to facilitate efforts across the HIOs and with input from other stakeholders to help ensure that the network we are mutually building is focused on supporting improved quality of care and better patient outcomes.
Bonus question: As Meaningful Use winds down, how do you foresee HIE increasing in relevance when it comes to creating true interoperability amongst providers?
A major advantage of the public-private partnership that is the basis of the P3N is that the HIOs are not merely building capabilities to satisfy Meaningful Use requirements, but rather building networks that deliver broader value-added services to providers. Likewise, features of the P3N go beyond minimal Meaningful Use requirements to ensure that the P3N has long-term relevance. For example, the design of the public health gateway, a single point of connection to enable reporting from providers to a variety of government agencies and registries, has long-term efficiency advantages both to the Commonwealth government (thus saving taxpayer money) and to the private-sector organizations who contribute data to these important public health initiatives.
While it is true that the EHR Incentive Program and Meaningful Use have accelerated adoption of both EHR and eHIE technology, the opportunities that these technologies have made possible (i.e. better coordination and transitions of care) are foundational to emerging population health-based care reform models such as accountable care organizations and patient-centered medical homes. The momentum behind these cost-saving and quality improvement efforts, and the commitment to them by national leaders such as CMS now seems quite likely to outlast Meaningful Use. While not certain, this seems to bode well for not only the continued relevance of eHIE, but the continued evolution of eHIE as an integral part of 21st century standards of care and support for precision medicine.