- A recent study found connecting to an HIE can assist in overcoming information gaps in patient care and improve care coordination for end-stage renal disease (ESRD) patients in need of ongoing dialysis.
A collaborative effort between Quality Insights Mid-Atlantic Renal Coalition (MARC) and Fresenius Medical Center launched in 2016, the study marked the first effort by a large dialysis organization in the United States to establish a connection to a health information exchange (HIE).
“Many present with multiple chronic conditions that require a number of prescribed medications, treatment plans, and lab tests from multiple sources,” wrote authors Amber Paulus, RN and Nancy Armistead, MPA. “Dialysis providers are challenged by incomplete transfer of pertinent clinical data from patient hospitalizations, impeding safe care transitions.”
Twenty outpatient hemodialysis facilities part of Fresenius Medical in Maryland were chosen to connect to instate HIE Chesapeake Regional Information System for our Patients (CRISP).
“Sharing clinical information through a health information exchange (HIE) offers a systems-minded solution to overcome the information gap between outpatient dialysis providers and hospitals,” wrote authors.
Reducing the likelihood of unintended health consequences occurring during transitions of care is especially necessary for ESRD patients.
According to researchers, the ESRD patient population experiences a re-hospitalization rate of 34.6 percent—twice the rate for Medicare beneficiaries without the disease, which stands at 15.3 percent.
“The disproportionate readmission rates of ESRD patients calls into question the communication and care coordination occurring as patients return to outpatient dialysis facilities from acute hospitalization,” noted authors.
Researchers outlined the process of implementing an HIE connection for other ESRD facilities to emulate in an effort to improve care coordination and patient outcomes for patients in need of ongoing care management in outpatient settings.
“The result of this project has laid the foundation to develop and implement HIE-enabled interventions to improve ESRD population health,” they wrote.
Implementing the HIE connection took approximately twelve months.
First, Fresenius handled the legal and compliance tasks necessary to implement the health information exchange connection.
“Fresenius legal and compliance team reviewed the HIE participation agreement, modified the notice of privacy practices language for dialysis facilities participating in the project to include information about the HIE, and finally, developed an opt-out process by which patients could request to be removed from the data exchange,” authors stated.
Next, the medical center reviewed the health IT available to exchange health data between dialysis facilities and the CRISP HIE. The medical center had the appropriate infrastructure but needed to make adjustments to fully integrate the HIE.
“The Fresenius IT team started by developing a patient panel for each dialysis facility for upload to the HIE platform using direct secure messaging,” they wrote.
“The patient panel methodology has remained in place while the Fresenius technical team collaborates with the HIE team to establish an encrypted virtual private network (VPN) for the HL7 messages via an ADT feed (i.e. admissions, discharges, and transfers),” authors continued.
After successfully enabling the connection, the medical center began its onboarding and clinical integration process.
Ultimately, researchers reported the HIE connection resulted in positive outcomes for participating patients and providers, yielding improvements in both patient care and operational efficiencies.
“Increasing data transparency among providers is key as the importance of value-based care efforts mature,” they wrote. “Obtaining blood culture results collected in a hospital via an HIE is one example of effective application of an HIE that could improve the fragmented care coordination for the continuation of treatment in an outpatient dialysis setting.”