CCOs Braced to Deal with Information-Sharing Hurdles

The technical, cultural, and regulatory challenges to sharing patient records and standardizing clinical data across systems don’t appear to be undermining providers’ excitement about the opportunity that CCOs present for improving health
The Lund Report

Sept. 24, 2014 -- Technology-based information sharing and data gathering will be key tools for Oregon’s newly minted coordinated care organizations (CCOs) as they work to improve the health of the state’s vulnerable population while reducing costs.

Anticipating the challenges of information sharing, representatives of the partners who make up Health Share Oregon—Portland area’s largest CCO—formed a technology committee that meets several times a month to discuss the road ahead.

Included on the group’s agenda are two of the big issues: How to deal with the technical inter-operability issues among partners using different electronic health record systems (EHR), and how to start reporting CCO data to the state on a common matrix?

Healthcare data challenges are nothing new. But CCOs’ reliance on technology to meet state goals has made providers’ discussion of data sharing more urgent, focused and intentional.

Using technology in the context of the CCO mission is like “taking a can opener to my EHR and using it in really novel, transformative ways,” said Legacy Health’s senior vice president and chief information officer John Kenagy.

The potential for realizing savings from coordinated care as physical, mental, and dental service providers begin to openly share patient information with one another is real and could bolster the health of their patients, say Health Share of Oregon providers.

CCO partners say increased availability of data will also help them better understand the demographics of the people they serve. “We want clinical intelligence, the ability to look at data across populations, time and facilities,” said Kenagy. “How well are all of the diabetics being cared for by Health Share Oregon?”

Broader data of this sort will yield larger disease and behavioral trends so that providers can tailor prevention and treatment programs -- a move facilitated by the new, more flexible Medicaid funds from the federal government.

Kenagy sees the CCO model of combining health information exchange with clinical intelligence as the means to making health reform an operational reality, not just a pipedream.

But sharing information among health plans isn’t something that comes naturally to provider institutions, especially in a highly competitive healthcare market like Portland’s. The good news is that the very existence of CCOs, which require partner organizations (some of whom are former competitors) to share information for the greater good of the CCO and its patients, is forcing openness where there wasn’t much before.

“People share a common vision,” said Cindy Becker, director of health, housing and human services for Clackamas County, which with Multnomah and Washington counties and six hospital systems, make up Health Share of Oregon. “They appear to be leaving their organizational hat at the door and are looking at the whole. That hasn’t been done before.”

One positive byproduct of having partner health plans around the same table is the sharing of best practices, according to Becker, who has already seen this occur.

This cultural change, she said, is creating an environment conducive to getting people and groups on board with the technology changes needed to coordinate patient care.

Indeed, the common goal among CCO partners of improving health while lowering costs will be a needed spur to overcome the current barriers to free exchange of patient records and system data among disparate organizations.

Providers say the technical hurdles won’t be as hard to clear as the cultural bars but are thorny nonetheless.

Electronic health records are the main currency of information exchange that CCO providers will use to coordinate patient care. In rural areas, transmitting medical records electronically is especially crucial because of the large distances between small providers and hospitals, according to AllCare’s chief medical officer Dr. Lyle Jackson, based in southern Oregon. Connecting the players on the same system is a big challenge for AllCare, which serves 23,000 Oregon Health Plan members.

In Portland, where Health Share of Oregon has a population eight times that large and many more partners, not all the systems use the same EHR software. Many use Epic but rely on different versions or use a proprietary system. Another hole that needs patching: mental health providers are typically less likely than their physical health counterparts to even use an EHR system.

EHR systems can also be costly. A large health plan with money invested in one system won’t readily ditch it for another. And without national inter-operability standards, reconfiguring different data systems to interact with one another will take time and effort.

Then there’s what Cindy Becker calls “a big deal”--regulatory requirements for patient privacy. “The federal laws can’t be understated” as a barrier to information sharing, she said. The tendency among providers to err on the side of caution when interpreting federal confidentiality laws such as HIPAA, she noted, will create tension between the mandate of CCOs to share information and the need to protect patient privacy.

As well, gaining patients’ consent to share sensitive medical records is not a sure thing. “Just because we have the technology today doesn’t mean we’ll get the permission and consent today,” added Becker.

Surmounting the challenges to information sharing will not happen overnight. No one pretends to have the answers--the real work has just begun. But optimism abounds. “There’s excitement about this being the time and place to do something really unique,” said Kenagy.

Image for this story by Peter Hosey (CC BY 2.0) via Wikimedia Commons.

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"Many use Epic but rely on different versions or use a proprietary system." Privacy is paramount, but the federal government doesn't seem interested in regulating the over-reach by private interests. You see, the "proprietary" nature of private companies means guarding "trade secrets." That is true with health care, with education and with prisons, the repository for a very sick society. Electronic medical records and super-charged data-mining undermine the intent of the Health Insurance Portability and Accountability and Family Educational Rights and Privacy Acts. (HIPAA and FERPA) We live in a facebook world and a National Security State that blends corporate and government interests without considering basic human rights. Congress lies in a perpetual lame duck state, beholden to the money in politics. Kris Alman MD