Meaningful-Use Policies for Multi-System Health Information Exchanges: The Beacon Community of the Inland Northwest (BCIN)

The Centers for Medicare & Medicaid Services wish to institute meaningful-use (MU) policies that advance the ability of electronic health records (EHR) to improve the quality, efficiency and safety of health services. Following that precedent, Inland Northwest Health Services (INHS) aims to increase MU in care coordination for people with Type-2 diabetes in the Spokane Hospital Referral Region (HRR) by improving an existing health information exchange (HIE) among participating multi-site health systems, clinics, providers, and other organizations. By improving the MU framework in two-way, real-time EHR care coordination through HIE, INHS seeks to increase receipt of diabetes-related preventive health services; reduce diabetes-related emergency and inpatient utilization and costs; and improve provider access to diabetes information. The study employs a clustered-trial design with clusters of approximately 50 patients drawn from 5 Beacon provider facilities and 50 provider facilities from outside the Beacon region. Participants consist of 250 adult patients seeking Type-2 diabetes-related care from a Beacon ambulatory care provider and compared to outcomes of approximately 2,500 matched comparison group patients. Initial baseline data pre-BCIN indicate that Type-2 diabetic adult patients who received preventive care from a BCIN-affiliated provider had outpatient paid claims of $1,960 and $30,979 for diabetes-related hospital care in 2010. Subsequent data collection will reveal the impact of the BCIN program on costs and utilization of health services. Preliminary information from the BCIN implementation suggests that urban and rural regions are implementing large-scale care coordination successfully by leveraging two-way real-time HIE. The use of HIE is expected to assist providers in providing high-quality care coordination that meets meaningful-use expectations tied to reimbursement. Meaningful-use policies and care coordination through HIE offer potential improvements in health services in quality, efficiency, and patient safety.