Driving Health Information Exchange via Medical Record Retrieval

One of the most antiquated and inefficient processes in healthcare today is medical record retrieval — or, as it is affectionately known in the industry, “chart chasing.” Health plans depend on this outdated method to retrieve and abstract clinical data from healthcare providers’ records in order to support a wide range of auditing and quality reporting programs, including HEDIS reporting.

(For the uninitiated, HEDIS (Healthcare Effectiveness Data and Information Set) is a performance measurement tool that is coordinated and administered by NCQA (National Committee for Quality Assurance) and used by Centers for Medicare & Medicaid Services (CMS) for monitoring the performance of managed care organizations.) 

Current Medical Record Retrieval Methods

Today, medical records requests are generally sent to providers via the ubiquitous fax machine, and the request includes a member list, the relevant quality measures and a description of the “minimum necessary” information needed in order to abstract the necessary data from the records. The data needed is then collected through various methods including: fax, mail, on-site visits for more voluminous requests, and in some cases remote electronic health record (EHR) system access or other forms of secure electronic data interchange (EDI).

Under the Health Information Portability and Accountability Act (HIPAA) Privacy Rule, data collection for HEDIS is permitted, and the release of this information requires no special patient consent or authorization. However, it is subject to the “minimum necessary” rule to support healthcare operations, and thus leads to increased administrative burden for providers and payers, whose staffs need to engage in what is often at least in part a manual process of abstracting the minimum necessary data from the EHR.

Rethinking Medical Record Retrieval

One of the greatest challenges facing healthcare is the need to share health data more effectively. (Chart chasing is just one example of the many inefficient processes in play.) Better sharing of health data across the healthcare continuum improves care coordination, care quality, and patient safety. It also promotes a more efficient delivery of services that reduces redundant procedures and tests. This has clinical value and — in the emerging world of value-based reimbursement — economic value as well. Medical record retrieval in today’s environment not only supports utilization management, quality improvement and care management functions; it can also be leveraged to support patients and payers in collaborations with providers around shared decisionmaking. All parties benefit from the sharing of fuller information.

In order to survive and thrive, healthcare organizations must look beyond traditional legacy health IT vendors and adopt truly patient-centered platforms that emphasize the sharing of data into a universal patient data layer that is independent of any one provider and payer organization.

Sharing data in this manner and for all of these reasons is far more efficient than traditional chart chasing and its attendant extra steps of abstracting the “minimum necessary” data and getting data out of one system and into another. Using a universal patient data layer to support payer, provider and patient needs can streamline operations and enable better care.

Enter Flow Health

At Flow Health, we partner with health plans to electronically retrieve necessary electronic health records to support HEDIS and other quality reporting. However, what sets us apart is how we aggregate this data and make it available to the connected care team. We’ve partnered with one of the largest payers in the nation and are using HEDIS medical record retrievals as a driver for clinical data exchange. Instead of a simple point-to-point solution, we take a medical record request and give the provider organization an opportunity to join the Flow Health Network, where they agree to share their clinical data (there is no set-up fee, no EHR integration fee or ongoing cost to participate), and in return, they get access to data from other members of the care team and the health plan. We use automated tools to abstract the minimum necessary information to share with the health plan, but the entire health record is available to the connected care team and the patient. This has proven to be a powerful driver of provider adoption of meaningful data exchange.

This is just one example of how payers have the unique leverage to drive the transformational change necessary to make the transition to value-based care work well for providers and improve the overall patient experience.

The aggregated data is now available to support all health plan operations, including risk adjustment, and barriers are removed for providers to access clinical data from providers across the community.

When everyone’s playing off of the same sheet music, the end result is far more harmonious.

Thank you for taking the time to learn about Flow Health. Flow Health is presenting at HIMSS 2016 Venture+ forum. We invite you to see all of our #HIMSS16 posts. If you would like to know more about Flow Health and how we can help your organization succeed, please contact us today at sales@flowhealth.com.

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