HIE 2.0 hones in on 'clinical network management'

The future of health information exchanges (HIEs) will be “clinical network management,” according to a 2013 HIE market report by Chilmark Research.

As the market for HIE services slows its growth — now growing in the high single digits — and consolidates, 2013 is set to be the year when most HIEs realize they need to focus on supporting care coordination, or clinical network management, Chilmark said.

Clinical network management could also be thought of as HIE 2.0, according to Chilmark researchers, with HIEs having robust use of query-based exchange; cross-venue medication reconciliation; automated clinical quality reporting to public agencies, Medicare and other insurers; virtually managed care plans; and population health analytics.

By Chilmark’s reading of the HIE 0.5 to 2.0 spectrum, only six vendors have passed HIE 1.0 on the way to HIE 2.0.

All of those vendors, if they’re looking for “the missing pieces,” as Chilmark researchers wrote, should think of HIE and care coordination through a play on a real estate industry adage: “Analytics, analytics, analytics.”

With meaningful use driving interoperability and new payment models emphasizing care teams, HIEs — or EMR-enabled HIE, in the case of the CommonWell EMR company alliance — will be used for organizations to manage care coordination.

Healthcare organizations “are not actuaries but they need actuarial skills,” the researchers wrote in a presentation.

On the analytics front, payers and providers could improve and expand, the report noted. Payers’ claims data, for instance, is “not well-leveraged,” while a lot of provider HIE use-cases have been limited to messaging.

Among the signs of the migration to HIE 2.0, Chilmark noted that query-based transactions are slowly increasing, estimated at most as being 10 percent of all HIE transactions. Query-based HIE, where providers basically search for patient records from other providers, will “be extensively used in cross-enterprise care plans where data access needs could be unpredictable,” the report said.

The Cambridge, Mass.-based research and advisory firm managed by John Moore, also noted that the market is now being driven by private-sector purchasing by hospitals and payers, after HIE state programs were infused with some federal funding in 2009.

The regulatory and political landscape has left some complicated policies for HIE nationwide, likely for the long-term the report said. National patient identifiers “will not happen,” the researchers wrote, noting the need, amid that absence, for regional, multi-organization master patient indexes.