Heeding calls from customers for more services, health information exchanges are finding ways to add value to their data aggregation. For instance, New York City-based Healthix has started sending “smart alerts” triggered by changes in diagnoses or lab values.
Healthix, a regional health information organization (RHIO), provides services in metro New York City to millions of patients and thousands of providers from hospitals, physician practices, home health agencies, nursing homes and managed care organizations. In a recent webinar, Tom Moore, the RHIO’s senior vice president of innovation, described how smart alerts work.
Like most HIEs, Healthix has been offering clinical event notifications for a while. These are the admission, discharge and transfer (ADT) feeds it gets from thousands of participants at 7,000 different facilities. Through SHIN-NY, the statewide RHIO network, Healthix also pulls in data from other organizations from across the state. “We have a repository on 17 million patients,” he said.” That data is used by a clinical alert engine to generate alerts that go out to providers triggered by healthcare transactions or encounters, including those involving the New York City jail.
Clinicians can choose to receive the smart alert messages in several different modes: as an HL7 message sent to the EHR; through a clinical message center on Healthix’s portal; or as a secure e-mail using the Direct protocol. The majority use HL7 messages, he said.
Healthix customers get a lot of mileage out of these standard alerts triggered by encounters,” Moore said, “but we are leaving it up to them to make something useful out of that.” Healthix is now being smart about sending the alerts as well. “What we have learned from talking to participants over the years is that there is more we can do,” he added. “There are more interesting things happening with their patients outside their organizations they want us to help them understand — not just about transitions, but something that requires looking across the clinical record and determining something of significance has happened with this patient that they wouldn’t know about because it happened outside their organization.” Healthix is sitting in the right spot to pull that data together.
Here are some of the examples he gave of smart alerts:
• Changing diagnosis. A patient might have a diagnosis of COPD. “If we then got a new diagnosis that the patient had congestive heart failure or something that is not COPD, that would trigger an alert,” he said.
• Significant change in lab value: If hemoglobin A1C lab value changes significantly or hits an abnormal threshold, that could trigger an alert.
• Patients who visit ED frequently: More than three visits in 90 days or more than one visit in a 72-hour period can trigger alerting.
• Chronic disease area: If a patient with HIV has a viral load that is above normal, that will trigger an alert. In a clinic setting, you would want to know if the patient's viral load is out of control and if they are getting primary care anywhere else, he said.
Healthix also is working on predictive analytics offerings, Moore said. All of these alerts are enhancing care coordination efforts in New York City. “We also work with participants to help support their population health initiatives,” he said. “Recently we have gotten involved in exchange with social service agencies, which is a key growth area.”
