Background
In recent years, different stakeholder associations and civic/state leaders have worked to advance clinical information sharing in the city of Chicago and/or the state. These efforts have been in the service of attempting to establish and maintain a health information exchange (HIE) capable of ingesting, standardizing, and making available clinical information pertaining to patients to the different parties when needed. A number of different forces have historically conspired against these efforts and in every case, the initiatives have failed.
While there is currently no related health information exchange in the state or city, there is a proven model in Chicago (and other states across the country) that is capable of sharing basic, but important information regarding a patients clinical or social pathways. An Admission/Discharge and Transfer (ADT) system that is connected to a provider’s electronic medical record (EMR) is able to record and notify authorized parties when a particular patient has been admitted, discharged, or transferred to or from any facility connected to the core ADT system. These alerts can be useful to providers or payers with an interest in ensuring patients are receiving clinically appropriate care from providers or social support services who may be better positioned to address underlying needs.
Several key stakeholders throughout the state have expressed an interest in examining the merits of establishing a statewide ADT system. The Health Care Council of Chicago (HC3) in partnership with the Medicaid Transformation Project (MTP) believe there is a unique opportunity to assess the propensity of the community and policy makers to reach a consensus that would result in a statewide funding, adoption, and implementation of an ADT system that could be leveraged as a utility by all providers and social entities.
Hypothesis
As Illinois looks to continue improving the efficiency of its health system and organizing resources in a way that promote improved outcomes, lower cost, and higher health capital in communities, there are key advantages to improved information sharing. While establishing an HIE throughout the state may be politically challenging, enabling an ADT system that can be leveraged by different stakeholders in different ways is increasingly appealing.
We propose organizing a taskforce to explore whether such an effort is tenable. If so, then this taskforce would be charged with fashioning the key guiding principles of such an effort (key decision parameters are listed below) and determining the pathway for successful technology selection and implementation statewide.
Key Considerations
There are a myriad of considerations that should be explored by any parties collaborating to advance this initiative. Notable areas include:
What is the overall objective of implementing an ADT system and who benefits?
What are the parameters for ensuring patient safety and privacy?
Who should be responsible for underwriting the initial implementation and ongoing maintenance fees associated with the technology and what should be the financial expectations on the state?
Where is the technology housed and who is the party that maintains it?
What are the specific capabilities required by any contracted technology company? Should deference be placed to local community technologists that have established similar systems (such as Alliance Chicago or Medical Home Network)?
Should the state adopt a position of integrating provider and payer information systems with a central ADT platform compulsory?
Can this be designed in a way to promote subsequent platforms or models of information sharing within the provider community? For example, could this effort support the future functional expansion that would reflect an HIE?
Participants and Initial Timeline
The following organizations have committed to participating in an initial roundtable discussion on September 13, 2019 to determine general viability and to establish the parameters that would be associated with ongoing collaboration:
Advocate Aurora
AllianceChicago
Cook County Health
Drinker Biddle and Reath
Erie Family Health Centers
Illinois Health and Hospital Association (IHA)
Illinois Primary Health Care Association (IPHCA)