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Solving a State's Interop Challenge, Differently

Analysis  |  By smace@healthleadersmedia.com  
   August 16, 2016

How the South Carolina Medical Association and the Medical Association of Georgia plan to leverage the health information exchange built by the state of Kansas.

State health information exchanges continue to fall short of their potential to make exchanging medical records more like a utility and less like a computer science problem.

Despite recent HIE discord in neighboring Missouri, Kansas's HIE has not only thrived, it is exporting the technology to other states, notably Georgia and most recently South Carolina.


Feuding HIEs Pit Cerner vs. Epic Loyalists in Missouri


Most interestingly, the move, both in Kansas and in Georgia and South Carolina, is spearheaded by medical associations.

The original Kansas HIE formed after the passage of the American Recovery and Reinvestment Act in 2009 through a partnership between the Kansas Medical Society and the Kansas Hospital Association.

KaMMCO Health Solutions, which operates the Kansas HIE and is supplying technology to providers in Georgia and South Carolina and potentially in other states as well.

And in an added twist, KaMMCO Health Solutions itself is a subsidiary of the Kansas Medical Mutual Insurance company (KaMMCO), a provider of medical malpractice insurance.

Laura McCrary is senior vice president of KaMMCO Health Solutions. Malpractice insurance companies aren't typically thought of as technology innovators, but in this case, McCrary says more and more malpractice insurers understand the importance of providers being able to have good quality complete medical information at the point of care.

"A significant number of the medical malpractice claims filed against KaMMCO insureds are due to poor transitions of care, so the information that the doctor needed did not get to the doctor in a timely manner, or the information was incomplete, or the patient did not receive the information they needed," she says.

In South Carolina, the 6,000-physician South Carolina Medical Association (SCMA) will deploy a suite of KaMMCO Health Solutions technology, the same technology powering the Kansas HIE, this fall. [In Georgia, the Medical Association of Georgia will deploy it before the end of the summer.]

Gregory Tarasidis MD is a practicing ear, nose, and throat doctor based in Greenwood, SC who was SCMA's physician leader on the project and a past president of the SCMA.

He was president in 2010 "when all of the EMR mandates came out and we worked on all that and we all instituted it, and we all worked towards that goal with the hope and the dream that I would have this great ability to transmit data back and forth and I would be able to take care of my patients much better," Tarasidis says.

'Nice Statewide Interoperability'
"Well that didn't really turn out to be, as you well know. In Kansas, the dominoes fell correctly, and they've really got a nice system that is up and running that allows them to have nice statewide interoperability."

In addition, Tarasidis admired the way Kansas physicians could check on patients' progress in getting their hemoglobin A1C checked and other lab work "and get true real-time data analytics out of it, not later in the stage when the claim comes through for the charge" he says.

Earlier efforts in South Carolina, including its own HIE, have fallen short of this. "Part of that was [that] at the time it was hard to get providers and stakeholders to basically commit to a project that wasn't built," Tarasidis says.

Kansas, he says, "has the system, the software, the subcontractors, the server farms, everything we need. So we don't have to reinvent that at all."

Tarasidis chooses his words carefully when asked about the South Carolina Health Information Exchange (SCHIEx), which he helped organize in 2010.

"It was a state entity, and recently became a private entity. Our goal is work with them, not to compete. I would say this. [The partnership between SCMA and KaMMCO] is going to fill the role that we hoped would be bigger with SCHIEx, but we didn't get there."

The fact that the Kansas HIE is led by physicians and providers is a factor, he adds.

Of course, even the KaMMCO infrastructure is built on a variety of technology provided by vendors including ICA, Diameter Health, No More Clipboard, and BluePrint Healthcare IT: Care Navigator. KaMMCO supplies some components itself, including a help desk, project management, integration engineers, and dashboards.

As 2017 approaches, and with it the advanced reporting and value-oriented goals of MIPS and MACRA, look for more medical associations around the country to look for affordable alternatives to the interoperability and HIE offerings available to them currently.

What South Carolina is doing may be an early indicator.

KaMMCO charges $100 per month per physician for its connectivity suite, including the analytics mentioned above. "We think that is a nominal fee, and the goal here, of course, is to spread it broadly. And the more people who participate, the more opportunities we have to reduce the overall cost," McCrary says.

Now that government is on the verge of "moving the cheese," truly changing the payment incentive away from fee-for-service, it may be the perfect time for such offerings to scale up at an affordable cost.

Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.

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