DRAFT: This module has unpublished changes.

The Emergency Department Information Exchange in Oregon

 

Hannah Hohendorf

 

Assignment Date: October 17, 2016

 

Health Information Exchanges (HIE) have become a large part of the national movement toward accountable healthcare. The aim of developing an HIE is to reduce costly mistakes in ordering and prescriptions, hospital readmissions, and emergency room visits by having transparency in the value of healthcare being provided and sharing information among providers who may not have communicated previously. One state that has achieved success in working to improve communication among providers and other care coordinators is Oregon. Through the Emergency Department Information Exchange (EDIE), healthcare providers across Oregon have been working toward decreasing repeat emergency department (ED) visits by capturing data across health systems and investigating patient needs that are not being addressed outside of the ED. This system has benefits to healthcare delivery overall, but there are barriers to the implementation of this program which will be discussed below.

 

The Oregon Health Authority (OHA) has a robust healthcare transformation program including initiatives that are developed to fulfill their triple aim of improving patient experience, improving population health in Oregon, and decreasing the cost of care (Oregon Health Authority and Health Information Technology Oversight Council, 2010). One of these initiatives, EDIE, shares patient information from the ED “including date/location, demographics, insurance information, diagnosis, known medications, allergies, known care providers, care guidelines, discharge notes, summary of care, and up to 24 months of historical information” (Oregon Health Leadership Council, 2014c, p.1) across multiple health systems. If a patient has been to an ED five or more times within one month, visited three or more EDs within the last two months, or has a special care algorithm, a notification is sent from the EDIE system to all of the associated providers for that patient giving the updated status from the current ED visit (Oregon Health Leadership Council, 2014a). This information exchange is done in an effort to capture those patients who are being inadequately served and who may need more resources to become engaged in their care.

 

One barrier to the development of the EDIE system is the diverse electronic health records (EHR) used within the different health systems, for-profit and non-profit, across Oregon. In order to share this information, software must be developed that can pull the necessary information from these different EHRs, and push it back out to providers and payers in a standardized and time-efficient manner. In order to do this, each of the EHRs must be studied and software made to efficiently perform the information exchange. According to the Collective Medical Technologies website, “CMT works with your Information Technology department to get EDIE up-and-running in a standard implementation in just a few weeks” (Collective Medical Technologies, 2016a). Also, the company claims to be able to connect EDIE to any electronic health record.

 

Another barrier to implementing the EDIE program is the security requirements for the software which must follow the Health Insurance Portability and Accountability Act (HIPAA) and other federal, state, and local laws. Patient privacy and information security must be addressed to remain compliant with regulations and when attempting to secure buy-in among providers and patients. There must be built-in exceptions to data exchange that protect certain patients that are victims of violence or require increased security with regards to their location and condition. Additionally, information that is exchanged should not hinder the ability for a patient to access quality care due to a specific disease process or negatively impact their well-being (such as holding their job or home). That is why some information requires specific patient consent in order to share among providers and the notifications that are sent must be encrypted to prevent information breaches. According to the Collective Medical Technologies website, when treatment has been established between a provider, or organization, and a patient, and there is data to back-up the encounter, then HIPAA allows EDIE to share information with those entities that have a relationship with the patient (Collective Medical Technologies, 2016b).

 

Despite these barriers, the EDIE system in Oregon has been a success. According to the EDIE Hospital Adoption Update, 100% of Oregon hospitals have gone through legal review and signed a letter of intent to Collective Medical Technologies, the developer of EDIE, and 93% of Oregon hospitals are receiving notifications from the EDIE program (2015). Those hospitals that are using EDIE have reported that the system helps to cut down of duplication of ordering and services, gives insight into the healthcare providers associated with each patient, allows for more collaboration between payers and providers, and cross-discipline discussion of cases to determine the best treatment course for the patient (Oregon Health Leadership Council, 2016, p. 4). Furthermore, due to the success of the EDIE program, another program called PreManage has been added to the initiative in order to facilitate health information exchange from inpatient care areas.

 

The choice of the program EDIE was made after looking at the success of the state of Washington to decrease ED visits. In 2013, it was estimated that Washington had saved “$33.6 million as a result of EDIE and other best practices” (Oregon Health Leadership Council, 2014b, p. 8). From Washington to Oregon, a successful health information exchange has expanded and serves as one example of a health information exchange that has taken hold and is improving the care of patients regardless of the hospital they visit. With improving technology and increased provider and payer buy-in, there may soon be a system that can traverse the entire country aiding in the study of population health and saving money by cutting out wasteful rework.

 

References 

Collective Medical Technologies. (2016a). This is EDIE. Retrieved from http://collectivemedicaltech.com/what-we-do-2/edie-option-2/.

 

Collective Medical Technologies. (2016b). Privacy and Security. Retrieved from http://collectivemedicaltech.com/privacy-security/.

 

EDIE Hospital Adoption Update. (2015). Retrieved from http://www.orhealthleadershipcouncil.org/wp-content/uploads/EDIEImplementationUpdate-ExecutiveSummary-Apr-2015-WebVersion.pdf.

 

Oregon Health Authority and Health Information Technology Oversight Council. (2010, August 23). Health Information Exchange: A Strategic Plan for Oregon. Retrieved from https://www.oregon.gov/oha/OHPR/HITOC/documents/sandopplans201008/hiestrategicplanor.pdf.

 

Oregon Health Leadership Council. (2014a). Emergency Department Information Exchange Press Release Talking Points. Retrieved from http://www.orhealthleadershipcouncil.org/our-current-initiatives/emergency-department-information-exchange-edie.

 

Oregon Health Leadership Council. (2014b). Emergency Department and Inpatient Admission/Discharge Notification Across the State of Oregon Business Plan. Retrieved from http://www.orhealthleadershipcouncil.org/wp-content/uploads/EDIE-Plus-PreManage-Business-Plan-OHLC-Final-Version.pdf.

 

Oregon Health Leadership Council. (2014c). Frequently Asked Questions About the Emergency Department Information Exchange (EDIE) Plus Project. Retrieved from http://www.orhealthleadershipcouncil.org/our-current-initiatives/emergency-department-information-exchange-edie.

 

Oregon Health Leadership Council. (2016). Oregon Health Leadership Council Progress Report-June 2016. Retrieved from http://www.orhealthleadershipcouncil.org/wp-content/uploads/Progress-Report-July-2016.pdf.

 

Policy Paper-Healthcare Transformation in Oregon.pdf

DRAFT: This module has unpublished changes.