HIE: Promoting Quality Care, Efficient Growth, and Improved Functionality

HIEs promise transformation in the way medical professionals and patients swap records.

By Kevin B. Shields, CPC, CPC-H, CPC-P, CCS, CCS-P, RCC, CCP-P

Health Information Exchanges (HIEs)—and their larger counterparts, regional health information organizations (RHIOs)—allow payer, provider, and patient to retrieve, view, and enter information on conditions, encounters, payments, etc. This vital data exchange with increased security and robust viability is a health IT dream.

HIEs are focused on building and maintaining electronic information architecture. The design of these electronic record “warehouses” allows users (patients) and participants (hospitals, providers, and payers) various access and control over patient medical record content.

Immediate Access

An insurance company must request copies of a medical record when reviewing treatment necessity. Very soon, access to that same record may be available as soon as the provider completes, enters, and authenticates the note. If this same visit requires consultation elsewhere, little or no paperwork would be required for the consultant to access a comprehensive patient history.

For patients, transferring records easily, maintaining a personal health transcript, and granting access improves the customer service experience. For providers and hospitals, HIEs solve workflow and broken information trail problems; clinical benefits result from care delivery and continuity. Payers must find opportunities to connect fragmented patient data and draw upon a full range of clinical opinions.

The revenue cycle also gains from HIE’s mediation of health data needs by driving down the moving information costs between one another, permitting quicker turnaround times with denial management, claims submission, and payment. Automation allows re-routing staff time from return on investment (ROI) and claims submission to other areas in the revenue cycle. HIEs empower patients to readily participate in the revenue cycle process and encourage practices to excel in collection efforts.

Opportunities Abound

In the framework of HIEs, coders will likely see duties take place in real time. Revenue cycle functions will move forward, making us pioneers in this process. In that leadership role, coders become responsible for developing HIEs’ usefulness in mining data and querying for information in that network system. This role will encourage coders to become data quality experts for their employers. Others’ roles, including QA management, and quality control, will emerge.

Ideally, HIEs would permit end users to tap into embedded knowledge resources and share clinical, coding, and billing related tools, information, and products. This host of information would improve daily coding processes and allow smaller practices to access resources that might otherwise be off limits due to expense.

Staff in coding areas, especially, will become experts on key points of the HIE adoption. Foremost, our understanding of sharing information related to billing will give us a strong foothold over the HIE. Our current understanding of medical records easily translates into working the HIE as a research tool for the practice—not only on coding-related issues, but in sharing patient data or information within our organizations. Coders should also have a keen understanding of HIE privacy and security issues in the ever-changing health care business.

HIEs also promise to make strides in the accuracy of diagnostic coding for provider-based services. With clinical laboratory results and documentation available shortly after completion of a test, coders may be able to use the information to capture more specific codes for claims. Insurers, similarly, could easily trace the provider’s purpose of ordering additional services related to lab test results.

A Promising Future

Realistically, HIEs cannot mend all the woes of our health care system; however, the less time spent volleying redundant tasks and more time spent establishing patient care is a step in the right direction. At the base of an HIE is a fundamental electronic health record for each participating entity. Linking to an HIE can easily remove the human error in facilities exchanging patient information. Finally, HIE promotes quality improvement by scattering reviews to all aspects of health care, rather than limiting the scope to immediate view.

As more providers and insurers use the interchange system, it will become necessary for their counterparts to participate in order to maintain existing business relationships. With coders embracing this technology and comprehending the mushrooming effect in practicality, HIEs can proliferate locally. By making ourselves available to help refine HIE projects, even as volunteers, we give voice to our unique industry knowledge and ensure continued validation as stakeholders in HIEs.

Streamlining health information knocks out existing barriers between patient, payer, and provider. In acknowledging the patient as our consumer, we cultivate the way we exchange health records and as a result upgrade their care.

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