Perficient Healtchare Solutions Blog


Posts Tagged ‘Health Information Exchanges’

Top Technology Trends in Healthcare – May 2013

The healthcare IT field is rapidly developing and changing. Emerging technology and updated regulations put pressure on healthcare providers and health plans to stay ahead of the curve. Perficient creates a monthly list that explores some of the current topics and issues in health IT. This list examines the most talked about issues and technologies that are currently affecting the industry.

HCBlog Top5 Trends

Patient Engagement and e-Patients

The term “patient engagement” is on the tip of the healthcare industry’s tongue these days. We can only end the long-running trend of low patient engagement, along with the dangerously high cost of care, by shifting to true patient engagement that holds the patient experience, and the power of the resulting data, at forefront of healthcare business strategy. The healthcare industry is shifting emphasis to the patient, caused not only by government mandates but also by a shift in consumer expectations inspired by other industries that have permeated healthcare.

Healthcare Payment Reform

It is a common opinion that our healthcare system does not provide good value for the care received. Incentives for hospitals are not properly matched with delivering the best possible care at an affordable rate. In response, healthcare payment reform models have been created. Bundled payments reimburse healthcare providers based on the expected cost of a group of services delivered, instead of payment for each treatment provided. Hospital value based purchasing tie reimbursement to the quality of care delivered based on clinical results and patient satisfaction.

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HIMSS 2013: An Interview with ePatient Dave

Earlier this month at the HIMSS 2013 Conference, Perficient’s Liza Sisler spoke with Dave deBronkart, better known as ePatient Dave. Dave and Liza discuss the unique roles of health, care and medication in engaged healthcare and the idea that the patient is the key to bringing all three aspects together in order to provide better health outcomes. He also talked about the role of useful digital tools to help engage patients and interoperable systems allow data to be shared and presented in a useful manner, providing better, safer care. Dave talks about the idea that patient’s healthcare data should follow them as complete and correct data at the point of care is critical to provide effective, safe health care. Lastly, @ePatientDave tells the story of Dr. Eric Topol utilizing a mobile health tool, AliveCor, to diagnose a woman on his flight home from HIMSS and the impact of mhealth tools.

When Patients Engage, Outcomes are Better

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BI, Portal and Interoperability: Perficient’s Hot Topics at HIMSS

My colleague, Taylor Rhyne, recently wrote a blog post about Perficient’s upcoming presence at the HIMSS 2013 Conference. With the show quickly approaching next week, Perficient has announced plans to exhibit and highlight solutions in Business Intelligence and Analytics, Portals and Connected Health, and Interoperability and Integration in this news release.

Perficient experts will be on hand in Booth #1555 to discuss key focus areas top of mind for healthcare organizations – business intelligence and analyticssocial and collaboration, and integration and interoperability. Specifically, visitors to the booth can learn how, through its partnerships with leading technology innovators – IBMMicrosoft and Oracle – Perficient drives faster, more cost effective healthcare technology solutions for its clients.

Additionally, Perficient’s Martin Sizemore will lead the “Patient Engagement: Transforming the Healthcare Experience” TweetUp, which will be held Wednesday, March 6, from 11 a.m. to 12 p.m. in the Social Media Center in Lobby G.  The #epatient TweetUp will focus on how providers are designing secure and engaging patient portals for access to records, and how the world of social media is shaping patient expectations around caregiver interaction.

To further address the patient engagement topic, Perficient has released a new white paper, “Patient 360: The Complete View of Patient Engagement,” in conjunction with the HIMSS 2013 conference. This white paper will discuss how healthcare organizations can end the long-running trend of low patient engagement, along with the dangerously high cost of care, by shifting to true patient engagement that holds the patient experience, and the power of the resulting data, at the forefront of healthcare business strategy.

To read Taylor’s full post, click here. To learn more about Perficient’s healthcare technology experience and our presence at HIMSS 2013, visit

Looking forward to seeing you next week!

Webinar: ACO=HIE+Analytics: Enabling Population Health Management

Healthcare organizations are challenged with collaboration and coordination of patient care while struggling with many aspects of payment and quality. The shift from a traditional fee-for-service model to the ACO has many physicians worrying about a return to capitation versus risk and cost sharing. The key is managing the health of a fixed population of people, generally on a regional basis. In order to manage population health, extensive data analysis is required – not retrospective reporting but predictive, trend projecting.

Join Martin Sizemore, principal in Perficient’s healthcare business group, as we look at ACO, HIE and the role advanced analytics plays in the delivery of population health management. Learn how your organization can tie all of the pieces together to be successful in meeting ACO goals and provide vision for the healthcare IT architecture.

In this session we will:

  • Explore the types of accountable care organizations
  • Take a look at the changing role of the health information exchange
  • Examine the advanced analytics necessary for population health management
  • Review practical technologies from Oracle to support key elements of this value chain

To register for the webinar, click here.

ACO = HIE + Analytics: Enabling Population Health Management

February 21, 2013

11:00 am CST


Top 5 Technology Trends in Healthcare – January 2013

The healthcare IT field is rapidly developing and changing. Emerging technology and updated regulations put pressure on healthcare providers and health plans to stay ahead of the curve. Perficient creates a monthly list that explores some of the current topics and issues in health IT. This list examines the most talked about issues and technologies that are currently affecting the industry.

HCBlog Top5

EHR/Meaningful Use Stage 2

Meaningful Use is a set of standards that ensures Electronic Health Record systems are being used meaningfully, in order to improve the quality of care. Stage 2 of meaningful use has a primary theme of interoperability between EHR systems and engaging patients in their own care.

Population Health Management

PHM is a concept that includes the healthiest and the sickest individuals by improving the overall health of high- and low risk patients by addressing personal health behaviors that may contribute to health through care, communication and education.  PHM places an emphasis on primary care to provide preventative, acute and chronic illness care, which is coupled with efforts to educate patients and encourage behavior and lifestyle changes.

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Top 5 Technology Trends in Healthcare – December 2012

The healthcare IT field is rapidly developing and changing. Emerging technology and updated regulations put pressure on healthcare providers and health plans to stay ahead of the curve. Perficient creates a monthly list that explores some of the current topics and issues in health IT. This list examines the most talked about issues and technologies that are currently affecting the industry.

HCBlog Top5


Having social networking access to providers, via secure portals, patients have the ability to be more engaged in their care and make better decisions about the care they receive. Portals provide near instantaneous access to patient and clinical information, streamline core business processes, referrals and claims, and improve communications with patients/members, physicians, administrators and partners. Meaningful Use Stage 2 requirements are helping to spur the growth of portals.

Hospital Readmissions

Hospital readmission is a growing problem within our health system.  Many patients discharged from an inpatient stay find themselves back in the hospital within 30 days. Some of these readmissions are considered avoidable and as signs of poor care and coordination. Predictive analytics are able to help healthcare organizations manage clinical issues in a timely manner and analyze statistical data to identify potentially preventable conditions. Healthcare business intelligence can provide organizations the ability to use their data to improve quality of care, increase financial efficiency and operational effectiveness, conduct innovative research and satisfy regulatory requirements

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Oracle Open World 2012: The Healthcare Edition

This week Perficient Healthcare will be heading to Oracle Open World in San Francisco.  If you’re in town for the event, then please feel free to stop by to geek out with the Perficient crew on the latest in Health IT.  What will we be talking about?

Accountable Care = HIE + Analytics

In order for healthcare organizations to comply with evolving governance and compliance regulations, and combine and exchange clinical and cost information through a comprehensive delivery model, Health Information Exchange (HIE) must be a part of the overall conversation for population health in Accountable Care.  Healthcare organizations can further accelerate compliance to ACO quality reporting requirements by using Business Intelligence and Analytics tools to enhance clinical decision support, performance bench marketing, and persona based dashboards that unlock the medical value of electronic information.  Not only have we seen some great Oracle HIE tools, in the form of Oracle Health Information Exchange, we all know that robust analytics are an imperative toward harnessing the big data that is population health.

Connected Health

I’ll specifically be speaking on the topic of Connected Health and the ePatient at the event.  I’ll be discussing the correct technology decisions a healthcare organization needs to make to harness the growing movement of ePatients in Healthcare Consumerism.  Key points include:

  • Provide instant access to patient and clinical information through Healthcare Portals
  • Enable instantaneous access to patient and clinical information using Mobile Health applications
  • Transmit medical images, video and audio for Telehealth diagnosis and treatment plans
  • Allow patients to exchange information and discuss health conditions with healthcare providers using Social Media

Look forward to seeing you at the event!

Health Information Exchange: Where are we today?

Health Information Exchange (HIE) is “the development of secure health information exchange between healthcare providers…in order to improve the continuity and quality of care for patients.”[1] According to a recent research study, 71 percent of U.S. hospitals intend to purchase a HIE solution, with 25% intending to purchase it within a 7-to-12 month period.[2] States across the country are setting up HIEs in which providers and ACOs can participate to better integrate their health information.

Idaho, through IHDE (Idaho Health Data Exchange), has helped groups like Primary Health Medical Group (PHMG) access patient information such as admission and discharge summaries, as well as physical and lab test results, better understand its patients’ medical history before diagnosing and implementing treatment. As a result, PHMG is preparing a multi-phase approach to its participation in which the intended end result is the statewide availability of the 200,000 patients it sees annually.[3]

The Kansas Health Information Exchange (KHIE) was intended to be a government HIE but evolved into a public-private share entity with private funding from the Kansas Hospital Association and the Kansas Medical Society. Now its operations are being handed over to the state completely, with leadership citing cost issues. As a private, independent entity, KHIE’s staffing costs were as high as $400,000 a year. As a government entity, however, its staffing costs are expected to fall to $54,000 a year. The board is hoping this will force the government to “have some skin in the game,” thereby giving more attention to the providers whose participation will ultimately benefit the patient.[4]

Michigan Health Connect (MHC), Michigan’s largest health information exchange, recently teamed up with Greenway Medical Technologies to provide Michigan providers and physicians real-time access to clinical data leading to more than 900,000 results per month. The partnership is geared toward ambulatory practices and clinics, and will include 54 member MHC member hospitals and more than 4,000 physicians across the state.[5]

Other states, like Montana, Colorado, and Florida, are also contracting with physicians to participate and share patient information with each other. However, which HIE solution is the best at the state level? Further, do we need HIE solutions to be operable only at the state level? Or should we be strategizing toward a solution that will eventually tie all state patient data into a national health information exchange? The Office of the National Coordinator for Health Information Technology is currently working with federal agencies, local and state governments, health information exchange organizations, and other entities to develop standards and policies at the national level. This group is formerly known as the NHIN (National Health Information Network) Cooperative and expected 35 participants in this network by the end of 2011. As of March 2012, it had 27.[6]

The Marriage of ACOs and Technology

ACOs are paving the way for a healthcare payment model that is based on quality and efficiency instead of volume.  They were created as a response to health reform initiatives that focus on improving patient safety, quality of care and affordability.  As the name suggests, ACOs are institutions that collectively share the risks associated with improving outcomes and patient satisfaction.  ACOs seek to make these improvements by improving the coordination of care amongst nurses, physicians, practitioners, hospitals and health care providers.

The goals of ACOs are to successfully provide three foundational elements:

  1. Continuum of Care:  These organizations rely heavily on the transfer of data to and from different institutions and areas of care to meet its objectives.
  2. Minimal Capacity Constraints:  ACOs must be able to provide care when care is needed, without pushing out care and threatening outcomes.  The constant ability to meet demands requires a delicate balance between efficiency and excess.
  3. Patient Centeredness:  Ability to engage and promote patients to take part in their care through the use of educational materials, patient monitoring, telemedicine or gamification.

To meet each of these characteristics, organizations will put forth substantial efforts and will rely heavily on technology for help.

Role of Technology

Solutions provided by Health Information Technology (HIT) are critical to the ACO delivery of care model, because it is the solution to integrating disparate data from multiple locations and care givers.  By investing in electronic medical records (EMRs), enterprise data warehouses (EDW) and health information exchanges (HIEs), data can and will be used to overcome the cost and quality healthcare hurdle.

An ACO must have an advanced HIT infrastructure to appropriately manage the entire population and connect with their members using tradition and alternative methods of communication.  As a result, we can expect ACOs to lead the way to healthcare solutions and serve as examples of what technology can do for healthcare.

Protecting patient data

As our healthcare systems become increasing connected and interdependent, protecting the privacy and integrity of patient data is critical. As health information exchanges (HIE), regional HIEs (RHIE) and health information service providers (HISP) become more prevalent, the importance of following best practices implementing security for the exchanging of data with external partners should be a key objective. Public Key Infrastructure, or PKI, is the technology used to ensure that healthcare data is protected while being transported between partners over the Internet.

Following are the three functions provided by PKI encryption/decryption services for the secure exchange of health care data:

  1. Encryption/decryption of the document being exchanged – This is the encryption of actual data being exchanged. This could include a Word document, txt note, HL7 message or JPG.
  2. Encryption/decryption of the transport – The transport is essentially the pipe that the data is sent over. This is the layer that would contain login information, cookies and other environment information that would otherwise be exposed if the transport were not secure.
  3. Verification that data received was not altered in transit – The sender of the document will generate what is called a ‘hash’ that will be included within the encrypted document that provides verification that the document was not altered.

PKI is the technology that provides the security foundation for internet-based services such as online banking and shopping. Prior to the adoption of PKI, most EDI transactions were sent through a value added network (VAN). In the “old days” before the internet, there were dial up connections where partners would exchange X12 EDI data with each other through a VAN intermediary. As the internet came of age and security technology and practices evolved, the VANs faded away much like the vinyl record and partners began connecting directly over the internet.

All of this is based around the PKI “trust” model. If Alice wants to exchange electronic documents with Bob, both parties need to establish their identities with a third party called a certificate authority, or CA. This third party CA establishes that both Alice and Bob are who they claim to be. In addition, Alice and Bob trust the CA so that by abstraction, they trust each other. Now when Alice sends a document to Bob, she also includes the credentials of her CA along with her credentials. Bob’s system will verify the validity of both Alice’s and the CA’s credentials to determine that the document was in fact sent by Alice.

When Alice sends a document to Bob, she will first generate a “hash” that is mathematically linked to the document being sent. The document and hash are encrypted and sent via an encrypted transport to Bob over the internet. When Bob receives the document and hash he will decrypt the document then evaluate the hash and verify that it matches the document received. If he hash calculated by Bob and the one provided with the document sent by Alice match then the document has not been altered.

To deliver the encrypted document from Alice to Bob there are many different mechanisms that could be used. For instance, the encrypted file could be sent via secure FTP, secure HTP or over a VPN connection. The important aspect here is that the encrypted data, when transmitted over the internet, must be sent over an encrypted transport. Each of the transports referenced above provide for encryption of the data transport. This protects any secure information that the sender may provide that is required by the receiver for authentication and authorization of access to the remote system such as password, user names and IDs.

The three key PKI elements required for enabling secure healthcare data exchange over the internet are described above and should provide a basic understanding of the core principles around PKI. While this is a high level description of encryption/decryption, a basic understanding of these components is important. If any one of these three components is omitted the security and integrity of the healthcare data being protected could be jeopardized. It can be very easy in today’s fast paced technology-driven environment to be lulled into a false sense of security by implementing a technical solution that fails to address the complete scope of the necessary requirements. At a minimum, the risks of excluding a necessary component should be understood so that the appropriate business decision can be made.

To HIE or Not To HIE… that is the question payers are pondering

First, I want to point you to a two-part recent post:

Some great stuff posted by the prolific Mr. Rao before heading out to HIMMS12.  But I’ll get back to that…

So, to HIE or not to HIE?

HIEs continue to struggle with sustainability – between 18 and 24 (depending on the source) out of 255 HIEs have achieved sustainability. Though this number is increasing, it still represents a small percentage of HIEs.  While there may be some argument as to viability of HIEs, I believe there is the general agreement that HIEs at some level (enterprise, regional, state-wide) are key to facilitating, at least initially, electronic information sharing among healthcare providers.  So, why is sustainability such an albatross to HIE success?

According to a recent article in Government Health IT, there are essentially 5 key roadblocks that HIEs continue to face:

  • Data sharing
  • Patient consent
  • Standards
  • Complexity
  • Competition

Some great topics for future discussions.

A Healthcare IT News article argues that this can really be boiled down to the following:  the cost and the slow pace associated with integration of disparate data sources.

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Does the U.S. need a Federal Law to Protect PHI and encourage HIEs?

Requirements regarding the electronic transfer of personal health information differs from state to state. Some have suggested that the Federal government needs to establish guidelines for health information exchanges.

Health information exchanges (HIEs) are technology solutions that address healthcare issues by aggregating massive amounts of data and allowing multiple entities have access to the data for research and quality purposes. HIEs can be thought of as technology systems that permit the transfer of electronic personal health information (PHI) between organizations within a region or a system. For example, an HIE may be set up between hospitals and public health departments to transmit data regarding diseases. This information can be used to determine if a certain substance such as contaminated water or poor air quality is harming specific populations. Because patient information is protected by HIPAA, HIEs are necessary to securely transfer electronic PHI.
HIEs are an important part of establishing partnerships throughout a community. They empower public health departments and hospital networks by providing a method for each to manage health-related programs and provide the necessary related services. According to the latest eHealth Initiative report, HIEs improve the quality of care and reduce healthcare costs by securely transmitting PHI (AHIMA 2011).

To date there are two types of HIEs; “Opt-out” and “Opt-in”. An opt-out HIE network allows a patient’s PHI to be exchanged through the network unless the patient formally requests their PHI not be part of the HIE. The opt-out approach dominates HIEs because it is easy to set up, has lower administrative burdens, and historically there are higher levels of participation – making an opt-out version better poised to serve communities by providing a more robust set of data.

Despite the noted advantages, opt-out HIEs are threatened by state legislation regarding how health information data is transferred. PHI such as genetic information, HIV status, abortion history, mental and behavioral health issue data is considered highly personal and therefore more heavily protected in some states. Therefore, this type of information poises an issue for HIEs that span across state lines. Some have suggested that this information should be automatically excluded from the exchange. However, in doing so the value of the HIE is substantially depleted.

An opt-in HIE network requires affirmative authorization from a patient before their PHI can be exchanged. An opt-in network has received less favor amongst organizations implementing HIEs because of the increased effort required to achieve patient participation. Gayle Harrell, a former Florida state legislator claimed, “We have a very distinct right to privacy that’s not only guaranteed in our Constitution, but has been upheld in our courts. And there’s nothing more private than your healthcare information.” If we agree with Ms. Harrell, then the debate about which type of HIE is best is clearly opt-out models.

An opt-in model offers a way to overcome the legal shortcomings of opt-out models by allowing patients to select which PHI will be available for exchange and to what extent. However, participation levels are historically lower and physicians are required to contact each patient before their information can be included in the HIE – a feat which may take years.

Each HIE model comes with its own unique advantages and limitations. However, since the electronic transfer of PHI is determined at the state level, each member of an HIE operating across state lines must determine how the laws of each state impact the type of HIE established –  and, eventually we must determine if the healthcare industry would be better served with federal legislation outlining how and what PHI should be transferred.

Want to learn more?  Register for our upcoming HIE webinar and you will be entered to win one of two Perficient client badges to the February HIMSS Conference in Las Vegas!