NwHIN at the SSA and VA
A pair of use cases exhibit exactly how NwHIN Exchange has progressed thus far. At the VA it’s sharing patient records among not only multiple VA hospitals but also non-military and private providers, while the Social Security Administration has focused on reducing the time it takes to determine disability claims.

One of the NwHIN-Exchange goals is to enable smoother transitions of care between federal health departments such as the DoD or VA and the private counterparts that provide well more than 50 percent of a military veteran’s care, particularly when it comes to seeing specialists.

A veteran might spend the winter in Florida and the summer in Rhode Island, for instance, seeking care at VA hospitals in both states, as well as episodic care at an emergency room or other private provider.

[Q&A: S&I's Fridsma on NwHIN enabling the Amazon, eBay or Facebook of health data.]

“In those instances it makes perfect sense for us to be able to query the private provider and get a packet of foundational clinical information so that enhances our clinicians knowledge about what the veteran had happen to them in the private sector,” Cromwell explains (pictured at right). “And when our veteran goes to an episodic visit in the private sector it makes sense that those clinicians would be able to pull what we know about them, so it’s enhancing the quality of care for veterans. That’s the big win for all of us here.”

At the Social Security Administration, meanwhile, sharing data via NwHIN-Exchange has cut disability determination in some instances from 84 days to 45 days, Yeager says, with 10 percent of claims filled in one to two days.

“One story the chairman of my board told me is about how they heard from a fellow that he was going to be going on disability and 10 days later he received the first payment,” recounts Cheryl Stephens, president and CEO of the Community Health Information Collaborative (CHIC), in Duluth, Minn. “It’s an extraordinary thing to hear those actual real-life events occurring in your own world, not just in another situation.”

That was just one instance. Echoing Yeager, Stephens said that NwHIN-Exchange reduced disability determinations “easily in half,” across the four sites it has been submitting data to SSA via their EHRs.

What’s more, NwHIN-Exchange enables the state of Minnesota to even have such contracts with SSA and the VA, the latter to pilot VLER. “We have a VA clinic that has always been forlornly sitting on its own because nobody could share data with it,” Stephens says of the Duluth area. “Now we’re piloting with it and that exchange is going to begin.”

The implementation of NwHIN specifications enable that kind of connectivity. “The VA and DoD utilize the Connect gateway as their transport,” Thompson adds. “Private partners use other transport software but federal partners are using the Connect Gateway.”

Stephens considers the three most significant aspects of CHIC’s participation to be those contracts with federal partners that truly affect the exchange of patient data, having an HIE based upon federal standards, “so nobody can say ‘We don’t want to connect with you because you’re weird,’” both of which contribute to CHIC having become the HIE folks can turn to because they know it’s keeping abreast with federal standards and guidelines.

[See also: DoD, VA and 18 million patients are 'a force that can move markets'.]

Adding to that list of benefits, MedVirginia CEO Michael Matthews points to “tremendous value for, first and foremost, the patients.” Then on the business side, both Matthews and Yeager mentioned a surprising revenue impact for Bon Secours Richmond Health System that, in it’s work with the SSA was able to eliminate some $2 million annually in uncompensated care by recognizing where patients qualified for Medicare or Medicaid.

Participating in NwHIN-Exchange also enabled Marshfield Clinic to automate its release of information workflow to the SSA, says Melissa Owens, interoperability development manager at Marshfield Clinic.

“We were able to move from theoretical discussions on the applications of new interoperability standards to actually putting them into practice in a production setting,” Owens explains. “The incorporation of SNOMED, RxNorm and LOINC terminologies was the largest component of the project for us.”