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Where Health Information Exchange Fits in Care Management

"We have to be able to have a feedback system that says maybe our pathway is or isn't working for a population. If it isn't, we need to allow them the discretion to adapt and give us that feedback."

- Many health information exchanges nationally facing challenges in proving their value to healthcare organizations and providers — some had experienced success, others failure — but the complexity of value-based care could provide in an opportunity for these networks to demonstrate their usefulness.

HIE in value-based care, population health management

In an EHRIntelligence.com feature earlier this week, Christiana Care Health System CIO and Senior Vice President Innovation and Strategic Development Randy Gaboriault, MS, addressed the health IT needs of his organization as it focuses its resources on population health management.

EHR technology and add-ons are not the only forms of health IT Gaboriault identified as central to effective value-based care. Health information exchange is another.

The health system spanning Pennsylvania, New Jersey, and Delaware relies on statewide HIEs to help move patient health data between providers and EHR technologies. That isn't to say that HIE alternatives are not a viable means of achieving the same end.

"Maybe that is just a condition of our environment," he says. "I can appreciate if you were in a different market configuration where the largest provider may serve as the anchor for the HIE."

According to Gaboriault, the aims of population health management require a multitude of technological functionalities not easily stood up by health systems:

There are a whole bunch of components you need to build in addition to being able to move that data. You have to be able to build that longitudinal capability. You have to be able to demonstrate some component of an analytic function to be able to look at that population, figure out who's in it, and then organize them in a way where you can move them in to cohorts and manage them accordingly. Whether you do that through a registry approach or some other model, you have to build that.

Complementary to these provider-facing capabilities are those necessary for communicating with patients.

For its part, Christiana Care Health System finds itself in the process of designing and expanding its intelligent care management platform called Christiana Care Link. Critical to the success of this platform is the ability of care managers interact with health data and interact with patients across the continuum of care.

"Those are the guardian angels paying attention to the longitudinal experience, activity, and outcome," Gaboriault maintains. "They sit above everything and do that intelligent care management — make sure the right things are happening, the right triggers are moving at the right time — so that patient who is in our care moves through the care pathway or targeted health outcome objective."

For Gaboriault, the continuum of care is becoming far more complex as population health management must account for both sickness and wellness and the role of patient as consumer. As a result, a provider must account for multiple dimensions in the patient experience.

"That can span everything from the person who is in the back of the ambulance with crushing chest pain who needs his life saved to the person who has self-directed and is receiving care from the organization," he adds.

As complexity increases so too do the array of health IT necessary addressing it. It is the latter where HIE comes into play at Christiana Care Health System.

"We envision this modular capability to build different programs to serve those different unique needs for different cohorts of patients based on all these other exogenous factors," says Gaboriault. "Then you need to marry all that back into your clinical EHR platform to move the information and back into the HIE."

The role of HIE, however, isn't limited to an individual patient encounter. It likewise has a role to play in gathering feedback from providers to better inform future care decisions.

"They are the generals on the front lines. We have to be able to have a feedback system that says maybe our pathway is or isn't working for a population. If it isn't, we need to allow them the discretion to adapt and give us that feedback," concludes Gaboriault.

The lack of one-size-fits-all solution to value-based care means many technologies will be in play and moving information between them essential to having a complete picture of a patient's health. HIEs may very well be able to bridge that gap for providers.

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