Virginia HIE Helps Providers Improve Patient Management

Health information exchange technology helps reduce wait times for follow-up care after ED visits.

A certified community behavioral health clinic in Richmond, Virginia, is benefitting from a real-time statewide health information network that lets clinicians track their patients' emergency room visits.

Powering this data feed is Virginia Health Information (VHI), a private 501(c)3 organization in existence since 1993, which recently implemented a layer of technology to speed the flow of patient admission, discharge, and transfer information between different healthcare organizations around the state.

This enables allows care teams at Richmond Behavioral Health Authority (RBHA) to identify their patients presenting at other points of care, enabling rapid response for behavioral health crises and other urgent matters and connecting them to RBHA's case management services for longer-term support, tailored to their unique needs.

VHI Chief Executive Officer Kyle Russell is basically the second leader of the organization, starting as a data analyst working on an all-payer claims database in 2013. Back then, received claims information lagged could be six or nine months behind, but since its primary use was in research and setting health policy, that kind of lag was acceptable.

In 2019, by an act of the legislature, VHI became the health information exchange for the commonwealth of Virginia. Real-time reporting, such as vaccinations, became imperative.

Now, "the biggest program by far within the health information exchange is the Emergency Department Care Coordination Program (EDCC)," Russell says.

VHI became the vehicle through which clinicians could determine whether a patient had been in any of 10 different clinics or emergency rooms in the past six months, for instance.

RBHA's BeWell, part of its certified community behavior health clinic, began eight years ago with funding from the state and the Substance Abuse and Mental Health Services Administration (SAMHSA), a program of the US Health and Human Services Department, and has served more than 3,000 people since then. RBHA serves a population of uninsured Medicaid patients, providing case management, psychiatry, primary care, group counseling, all over one roof, according to Sara Hilleary, program manager for RBHA's integrated care clinic.

By August 2020, RBHA, which also serves as the community services board for the city of Richmond and surrounding areas, was poised to begin using the new, more real-time information. Rates of domestic violence and suicidal ideation had spiked as the COVID-19 pandemic raged. RBHA received additional SAMHSA funding to connect its systems to VHI's and begin tracking its patients as they presented to clinics and emergency departments in Virginia.

Part of what powers the actionable health information exchanged is when emergency clinicians enter specific ICD-10 codes into each patient's record. Specific ones, such as a code indicating the patient has engaged in self-harm, alerts programs such as RBHA to initiate follow-up outreach to patients. Additional data points, such as missed appointments, can be correlated to ED visits and the ICD-10 codes to paint a more complete picture of patients at risk.

EDCC is also able to generate reports to track ED utilization by various time periods such as one week, a month, or six months, Hilleary says.

Although state and federal grants help maintain the operation of VHI, the information exchange also must rely upon support of health systems who participate in its network.

EDCC was brought into being by mandate of the Virginia state assembly in 2018. Although every health system in the state must connect to EDCC, "we have to operate like a business that either has to provide value to the state of or value to a private entity to make it all work," Russell says. "For most entities, it doesn't cost them anything."

RBHA did not sign on right away, but was an early adopter of EDCC, Russell says.

The care coordination software powering the EDCC is provided by PointClickCare.

"We get e-mail alerts, and then we are able to reach out to hospitals, if individuals are still there, or we are able to reach out to the individuals themselves and see if they need either to get reconnected with services or collaborate with them or their current care providers if there are any other needs," says Jillian Olson, an RBHA care coordinator.

The sudden statewide activation of EDCC posed its own challenges to VHI.

"You have this mass avalanche of connectivity that comes in with the mandate," Russell says. "You're going from zero to like a really big system in six months, but then after that, it's a trickle, because it's voluntary," with variation in what the attached providers do with the exchanged information. RBHA excels at doing a lot with it, he adds.

The pandemic complicated this next growth phase of EDCC, Russell says.

"With COVID, [ER] utilization went down," he says. "So how do you know how it's really doing?"

But over time, EDCC data shows that by implementing a care coordination program such as that in place at RBHA, ED utilization consistently drops 20% to 40%, Russell says.

And the care coordination platform also decreases wait times for patients requiring post-ED follow-up care at RBHA, Hilleary says.

As for other health systems that haven't yet tapped the potential of EDCC, Russell says many eyes are on the state to see how various players are participating.

"The health plans notice," he says. "RBHA is like this rock star contributor. If someone [else] is connected and doesn't do anything with it, what does it take to also get them to become strong, active users? That's where the real value-add change happens."

Part of that is being driven by informal regional collaboratives, such as one in the Tidewater region of Virginia, sharing best HIPAA-compliant data sharing practices among hospitals, health plans, freestanding and ambulatory practices.

"We don't have to push that," Russell says. "They're taking ownership of it themselves. We're looking at doing something like it in the Piedmont area" of Virginia as well.