Winter 2010 - University of Utah - School of Medicine

CHIE and APD
Two of the new tools with which Utah leads
By Robert Huefner, Professor Emeritus,
University of Utah, former Governor
Scott M. Matheson Presidential Endowed
Chair in Health Policy and Management
S
peaker Clark concludes his article
by pointing out two keys to (i.e.,
tools of) reform: the Clinical Health
Information Exchange (cHIE) and the All
Payer Database (APD). Both are at the
frontier of today’s information technology
(IT). Both are likely to be slow or
problematic in development nationally
because, when starting from scratch, they
require substantial time for development
and payoff. Both must build upon coordination,
and if possible cooperation,
among the full range of health care providers.
Finally, in Utah, both tools have
special opportunities because they build
upon the state’s leadership in IT, because
of success in cooperative endeavors, because
both public and private entities
already are well along the road to payoff,
and because of the exceptional – even
unique – support given these tools by
Utah’s legislative and executive leadership.
The cHIE expands upon UHIN
(Utah Health Information Network;
http://www.uhin.org/) originally developed
to route medical billings to insurers.
UHIN, operational for 16 years and a
national model of success, is highly reliable
and efficient. It now transmits 200
million transactions each year, at a frac-
tion of the time and the cost of the
processes it replaced.
4
With legislative encouragement and
financing, UHIN’s development of cHIE
is creating a system expected to improve
the quality of our care and to further
reduce its costs. It will offer an electronic
network that may be used, with a patient’s
approval, for immediate access – by authorized
physicians, hospitals, and other
health care providers throughout Utah
– to view the patient’s previous medical
history, tests, scans, and treatments.
In 2009, cHIE was implemented in
pilot regions, such as Moab and Green
River. Previously, lab tests performed in
the Moab hospital were printed and then
picked up by local providers, commonly
by the staffs of physician clinics driving
to the hospital three times a week, or
by hospital staff delivering the reports.
With cHIE the results are transmitted
electronically, less expensively and immediately.
Care for accident victims near
Green River can save more lives and limbs
because records of allergies, current medications,
and chronic conditions will arrive
at the hospital even before the patient.
Throughout the region, persons served by
a primary care physician, a specialist, and
a hospital miles apart can avoid the delays
and costs of repeated tests and scans.
Utah’s APD expands one of the nation’s
most respected and experienced
databases of health care treatments. In
the early 1990s, the Utah Health Data
Committee (http://health.utah.gov/hda/
HDC/overview.php), was established with
legislative authorizations, mandates, and
financing. The Committee began with a
hospital discharge database that it subsequently
expanded to collect information
such as prescriptions and emergency room
encounters. These data are used to compare
providers and time-trends for the
use, costs, and outcomes of medical
encounters.
In 2008, again because of legislated
mandates and with legislated financing,
the Committee initiated the APD, an
exceptionally complete collection of information
about treatments and the expenditures
for them. The comprehensiveness
of Utah’s APD is likely to make Utah the
first state to analyze and report total expenditures
for “episodes of care” (EOC).
An EOC for an acute condition such as
a hernia includes the complete course of
care, from diagnosis through treatments
and final follow-up care. For a chronic
condition such as diabetes it includes all
treatments for that condition during a
given year. The APD will better inform
providers, patients, and policy makers of
the costs of care, the variation in these
costs, and the comparison of costs across
providers and over time. It establishes data
and perspective that are the foundations
for shifting reimbursement to total costs
rather than for specific procedures and
providers. This builds incentives for hospitals,
physicians, and other providers to
manage, together, the total costs of care.
Finally, the APD provides a rich database
to research variations in costs, means to
reduce variation, and relationships between
processes, costs, and quality of care.
Data software for the APD went on
line the middle of 2009. Standards and
expectations of data submittal were explored
and then adopted. Data for 2007,
2008, and the first quarter of 2009 began
to be submitted last fall. An initial pilot
analysis is currently being conducted using
15 million medical claims and 19
million pharmacy claims from 960,000
Utahns. It is anticipated that preliminary
reporting will be available prior to the
2010 legislative session. The first public
reports are expected in early 2010.
The cHIE and APD require state-ofthe-art
technology. They also require tested,
as well as new, protections of privacy.
Although on both counts Utah is one of
the most experienced states, much care
is required because the tools involve new
purposes and procedures. Those directing
the programs face the need to apply
the skill and take the time necessary for
responsible, as well as timely, development
of these powerful tools.
The power and progress of these
two tools could not have been achieved
without the skills and commitments of
the staffs involved. Much is also owed
to the remarkable cooperation in Utah
of hospitals, insurers, physicians, and
others providing the data. Finally, Utah’s
legislative initiatives and financing
have been essential.