by Chris Daily, Vice President of Solution Engineering
I was skimming the HIE Watch newsletter recently, and one of the headlines caught my eye. The article, One of Stage 2's Trickiest Tasks, was lamenting about the difficulty for providers to meet the 12th measure of the 16 core measures that are required to attest to Meaningful Use Stage 2 (MU2). The measure, often referred to as Transitions of Care (ToC), is defined as: provide a summary of care record for each transition of care or referral. Ironically, Direct secure messaging is intended to be easy to implement; In reality, it has been difficult. The three most significant problems are the lack of Direct email addresses, the variability of Direct secure messaging configurations, and the size of the Continuity of Care Documents (CCDs).
Hospitals thought that contracting with a Health Information Service Provider (HISP) would address their ToC needs. Unfortunately, hospitals discovered that the providers they wanted to transfer patients to did not have Direct email addresses. This is reminiscent of the early days of telephones. If the person you wanted to call didn’t have a telephone number, you couldn’t call them.
ONC and CMS are supporting several configurations of Direct secure messaging. While the choices are primarily XDR/SOAP and SMTP/SMIME, EMR vendors and HISPs are using different configurations. Below are the variations we have encountered in the first 5 months.
· XDR/SOAP – major EMR vendor
· XDR/SOAP with SAML – major EMR vendor
· XDR/SOAP with text – major EMR vendor
· SMTP/SMIME – major HISP vendor
· SMTP/SMIME with XDM – major HISP vendor
The uncertainty surrounding the required CCD content caused most EMR vendors to include the kitchen sink in their CCD. As an example, the average CCD size for our first customer was 30 printed pages, which is more than 60 pages on a computer screen. Some of the CCDs were over 100 printed pages. While this meets MU requirements, it has questionable value for the receiving provider.
At the Indiana Health Information Exchange (IHIE), we created an innovative solution to help our members meet the 12th measure (ToC). To address the lack of Direct email addresses, we assigned a Direct email address to every provider in our provider directory (over 25,000). We accommodated most of the Direct secure messaging configurations because EMR vendors and HISPs were unwilling to conform to a single configuration. And we consulted with sending providers to reduce the content of the CCD. Most importantly, we leveraged 10 years of experience with care transitions and our clinical results delivery infrastructure, which combined support millions of transactions daily.
As of this post, more than 40 Indiana hospitals are sending over a thousand CCDs daily for MU2 ToC. As far as we know, this is the largest HIE-based MU2 ToC service in the country. Based on our early success, 30 more hospitals are in our implementation queue. Our initial reports shows that we are delivering over 80% of the qualified transitions to support ToC for our customers, much higher than the 10% minimum requirement.
Our ToC solution is a great example of a partnership between a HIE and its members solving a problem in a unique way.
Thanks for coming in today.