HINs are only beginning to tap vast potential
January 1, 1998 5 minutes read
HINs are only beginning to tap vast potential
Emerging technologies will drive more changes
Although health information networks (HINs) have been around for several years, they’re still only in their infancy in terms of potential uses and benefits for the health care industry as a whole and the managed care industry in particular, according to Jeff Miller, partner in Deloitte & Touche Consulting Group in Atlanta.
Speaking at the American Association of Health Plans’ Information Management and Technology conference and exposition in Atlanta in November, Miller offered a revealing assessment of HINs as they exist now, and more importantly, how they can be improved to provide an efficient exchange of health information among the many parties involved in health care.
Like everyone who must have access to patient health data as part of their jobs whether they are doctors, nurses, coders, billers, or insurance companies the purpose of gathering and storing that information is to turn raw data into useful information for treating patients, obtaining insurance reimbursements, or conducting research. But thus far, Miller said, HINs haven’t lived up to their potential because development projects in general tend to take on too much, trying to be all things to all users at once rather than creating HINs piece by piece.
"Anyone who tries to tackle everything is really looking for a hard time," he said. "It’s the elephant problem. Instead, we should take small bites."
A more effective way to create and manage HINs is to think about the structural organization of the data ahead of time, he advised. There are several ways to organize the information contained in a HIN:
r By information type.
By starting with one type of information, a solid foundation can be built, he said. That means organizing the information into clinical, administrative, and financial information, for example.
r By data life cycle.
This means organizing according to how the information will be used. "The sole purpose could be to support operational transactions that occur," he explains. Other purposes include use of the information as a research tool.
r User-based.
Under this scenario, the data would be organized and accessible according to who needs it. "What are the sets of data the clinician needs? What are the sets of data the patient needs?" Those are questions that can be asked when setting up the structure of an information network, Miller says.
r Business process.
This scenario would organize the information according to business segment within the organization, such as administrative management, medical management, and utilization management. "Begin to focus on how to benefit that set of users," Miller said.
r Organizational.
This looks at the use of information from a big picture standpoint. Information would be organized by its developer so that a health care provider-based HIN could be efficiently connected to a payer-based HIN, and so on.
Miller explained there are several converging forces throughout the health care industry that are driving the popularity of HINs. These will not go away any time soon.
The biggest factor driving the need for information networks is the transformation the entire health care field has experience over the last decade or so, "the consolidation into larger integrated delivery systems," Miller noted. This creates a greater need for exchange of information for several reasons:
1. Larger health care providers.
This growth has created a need to develop more formalized channels for obtaining health information. "It’s one thing to walk down the hallway and pull a chart out when you’re a small town doctor. It’s different when you’re going cross-country to get that information," Miller said.
2. Growth across the continuum of care.
As health care providers integrate their lines of business across the continuum of care, participants need to be able to access a larger portion of that bigger health care system. From the provider and the managed care standpoint, "You don’t want to treat [patients] on an episode-by-episode basis," Miller said. "As we continue to move to a continuum-based environment, where do I get the data to manage that process? The answer is networks," Miller said.
3. Health care consumerism.
Health care has moved away from the idea of the patient as passive participant in the treatment process. Patients are now taking an active role in their care. This "raising of accountability" means that patients, more than ever before, need access to information about health care that they can use to make decisions along with their physicians about their course of treatment. Consumers, too, are now part of the health information network equation.
Miller said that the ideal HINs for health plans include the ability to provide information about the following processes:
r administration, including information about claims filing, claims status, and payment;
r account management, meaning the health plan’s interaction with employers;
r medical management, involving disease management, case management, utilization management, pre-certification, and pre-authorization information;
r consumers, including allowing health plan members access to claim status, provider directories, and patient education information.
Where do we go from here?
Even as HINs are evolving, several new technologies are emerging which will have an enormous impact on how health care is delivered, Miller predicted.
Not surprisingly, the Internet is emerging as a means of communicating information both within health care organizations and externally to consumers whether this means patients accessing medical information or health plan members accessing claims information.
Using World Wide Web-based technology, the Internet can act as a "glue to combine existing information systems" in hospitals, Miller said. And because of its flexibility, the Internet will allow users of health information to create new applications to improve the way health care is delivered, Miller said.
Mobile computing is another technology that will have a profound impact on the way health information is gathered and stored for common use. Laptops, wireless technology, and electronic tablets are enabling health care providers to gather clinical information at bedside and store it immediately on information networks. Kiosk service centers are enabling patients to access health care and insurance plan information at the touch of a button. Interactive, Web-based television will allow unprecedented access between patient and health care provider.
One remaining concern with HINs is security, Miller said, adding that encryption of information on a computer network is far more secure than many paper medical record departments. Looking ahead, Miller said that authentication will enable users of health information to verify who is sending the information and what it says. And technology will continue to offer new and innovative ways to secure and verify health information on networks, he added.
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