Bridging Medicine’s Electronic Gap
Thursday, December 08, 2011
According to the Centers for Medicare and Medicaid Services, 20% of seniors have five or more chronic conditions for which these patients visit an average of 13 separate providers and receive an average of 50 prescriptions. Given this statistic, how can the 13th physician safely and effectively treat a patient without the benefit of any prior medical information? As an industry leader, MedVirginia has proven itself adept at solving that riddle with its health information exchange (HIE) systems.
Photo: Steven Gravely, J.D., M.H.A., and Erin Whaley, J.D., M.A.
The concept of HIE is the electronic transmission of medical information, including diagnoses, laboratory and imaging results, and medications that historically were communicated in person or by courier, fax or phone. Most physicians and hospitals have invested in electronic medical record systems. However, as Michael Matthews, CEO of MedVirginia, explains the value of HIE as a tool emerges in providing a comprehensive picture of a patient’s health.
With the launch of MedVirginia Solution in 2006, the company established the HIE model, a patient-centric chart clearly detailing all information pertaining to a patient’s health from multiple providers. It also developed the first HIE to connect with the Veterans Affairs hospital network and Department of Defense military hospitals.
Affecting patient care through electronic communication via online or cloud host systems can introduce patient privacy and data security concerns. Both data suppliers and receivers of MedVirginia’s HIE operate under strict agreements in accordance with HIPAA and other legal requirements.
“In 2011, we are seeing that participating in HIE activities is becoming a standard of care,” says Steven Gravely, J.D., M.H.A., partner and leader of the Health Care Practice Group at Troutman Sanders, LLP. “By designing legal agreements, procedures and policies to ensure electronic personal health information is transacted appropriately, we give the physicians and patients faith in the HIE system.”
Realizing the Impact
MedVirginia also achieved an HIE first with the Social Security Administration (SSA), dramatically reducing the eligibility determination process of disability benefits in two Richmond area communities.
The traditional determination process requires claimants to complete a paper form specifying their disability and every provider seen for that condition or injury. The SSA then sends postal requests to each provider for copies of patients’ medical records — a cumbersome step in the process as requests can often go unanswered for months. When the information is received, an SSA clerk must create a report to be reviewed by a claims examiner who makes a determination. The average process for an individual claim takes approximately four months.
MedVirginia’s HIE eliminates almost every manual aspect of that process. If a provider listed by a claimant participates in the company’s database, the SSA will send an electronic request to MedVirginia on behalf of the claimant’s case. Within 60 seconds, MedVirginia will return a full report of the individual’s medical information. The SSA then submits the data to its internal algorithm. If the data includes one or more combinations that match pre-set decision rules, a claims examiner can make a determination on the spot.
While MedVirginia is expanding its HIE in a partnership with Centra Health, the SSA is replicating the model in 15 other communities nationwide.
“It is time for us to move past viewing HIE as a big science project,” says Matthews. “The technology is available today, it works today and we have a track record of success today.”
To learn more about Troutman Sanders’ Health Care Team, visit www.troumansanders.com/health_care. To learn more about MedVirginia visit www.medvirginia.net.
MD News Special Issue 2011, Richmond/Tri-Cities