Lathe Bigler serves as Emdeon's senior director of clinical services for the pharmacy services division. He has more than 15 years of experience in healthcare and information technology. He recently spoke with ComputerTalk's Will Lockwood about the latest efforts to improve the availability of patients' health and medication information across the healthcare continuum.

CT: Lathe, tell us about the ongoing efforts around improving clinical connectivity in general, and at Emdeon in particular.

Bigler: The concept of Clinical Exchange is not a new one by any means. Healthcare providers have been trying to figure out the best and most cost-effective way to exchange clinical information for years. However, the migration of care has played a large part in our vision of Clinical Exchange. This means that what used to be done at a hospital is now done at a clinic, procedures performed at a clinic are now performed in a doctor's office, and what had been done in the doctor's office is now being done in a retail pharmacy. A lot of this really comes down to technology and the ability patients have to receive care from different providers within their communities, including their trusted local pharmacy.

Some examples are an outpatient surgery that used to be an OR procedure, or disease care that was done at clinics or physician offices, and immunizations and flu shots that are done at a pharmacy today. This creates not only an opportunity, but a need for providers to exchange clinical information. A patient may have specialists, a GP, a hospital, a payer, and pharmacists that all need to talk. They all need to be able to exchange information, to access records to ensure that the patient is safe, that the patient isn't prescribed drugs that will actually damage his health. So what we've done at Emdeon is take a look at all the different segments that we connect to directly, which is pretty much every segment in healthcare. We start at the financial end and extend all the way to clinical information. We connect to more EMR channel partners and payers than anyone, and we connect to the majority of pharmacies. So that puts us in a unique position to exchange information from one platform or one service to the next.

CT: Achieving clinical connectivity and continuity is critical for pharmacy. What are some of the steps being taken to make this happen?

Bigler: Recently, one area that's showing a lot of promise is a government initiative to exchange information locally by funding HIEs, which are health information exchanges. Every state has at least one, and most have multiple. We recently started working with a state that has over 40 HIEs. Some of those are private and some are government run, but all are receiving some sort of funding for their efforts.

CT: There are 40 HIEs in one state? That almost seems like a problem in itself.

Bigler: Right. Our first thought was that you need an HIE to exchange with HIEs. But we then realized that the HIEs are not the actual owners of data. They just need the ability to access it. So the types of partners that HIEs and hospital systems are looking for are those that do have access to data, either because they own it or because they have consent to release it. As we dove into this world of exchanging clinical information, it became clear that our vast network and the breadth of our connectivity could provide a central access point for HIEs. This would eliminate the need for all the separate HIEs to go out and establish relationships with numerous data sources.

CT: One question that comes up about HIEs is where the funding comes from to run them. Federal funding may get them started, but what's the long-term financial model that's going to support HIEs and other methods of clinical exchange?

Bigler: I think that the first question is whether an HIE is a sustainable model. In today's form, some may say it is not a sustainable model. Most of the funding is coming from the government, and that will eventually run dry. I think a lot are trying to figure out whether there are membership programs through which providers gain access. Or is there a model of being a hybrid of an HIE and an independent physician association [IPA], that will allow a gateway to exchange information from one physician or hospital to the next? Are the hospitals going to realize as they adopt and purchase specialists and doctors offices that it will make more sense to build in an HIE infrastructure for clinical exchange instead of making them all adopt the same EMR system just so they can talk? I think there are going to be a lot of different opportunities for healthcare companies to adopt technology that makes sense more from a network standpoint rather than just standardizing on the same software user interface. That's always been the struggle in the past: these four doctors use the same EMR and they can talk to each other, but another four use different EMRs and they can't.

The solution needs to exchange information across different platforms, maybe by using the cloud or a software-as-a-service model. There are different options. What's valuable about the HIE initiative is that it really gets everyone thinking about the ability to share information across different platforms across a geographic area and even across state lines.

CT: What will happen in the pharmacy? What's the potential for generating new revenue out of connectivity and clinical exchange?

Bigler: This goes back to the point that HIEs are looking for more data. Pharmacies hold a large record of patient medication information. This data passes through Emdeon's network, but we don't own the rights to that data. The pharmacy has to allow us to exchange this information. So if a pharmacy is willing to allow us to deliver a medication history and provide reconciliation services to a hospital, for example, revenue is generated by providing the data. We have a shared revenue model with every pharmacy that participates in this exchange.

CT: Ultimately, this data is the patient's, of course, but for clinical purposes it's appropriate for the pharmacies to make this available to other healthcare providers.

Bigler: That's correct. And let's be clear, neither we or our pharmacy partners are in the business of selling what is ultimately the patient's data. What we are selling is access to the data to improve clinical decision support at the point of care. A hospital system may be required by law to do medication reconciliation on admission; we provide a delivery method to ensure they see this record based upon the patient's consent.

CT: So this is a way to create continuity of care, which can be a huge factor in avoiding adverse medication events and improving outcomes. Effective clinical exchange should provide significant benefits.

Bigler: No question. The hospital readmission rate is directly associated with medication errors, and these are directly associated with lack of knowledge. Caregivers are not going to knowingly endanger patients. But they can, if they don't know any better. Providing more information at the point of care, which is information Emdeon has access to through the consent of its pharmacy partners, makes all the difference in the world.

CT: What are some of the ways you can ensure there's a comprehensive view?

Bigler: When you look at the records we have access to, you can see that there's a risk of duplication. A lot of the frustration that physicians have with medication history reviews is that today they just get a mess of data. If someone does a request on a specific patient, some organizations just regurgitate whatever they have and dump it in the physician's lap. Then they have to spend a great deal of time sifting through. We've taken it a step further. We focus on a clean record that deduplicates multiple records for a single patient and takes out the information that's not necessary or is invalid. Unfortunately, there is no one organization that has a complete record of all patient medication histories. What we're trying to do is develop a process that takes claims data, cash data, and Medicaid data, for example, so that we have access to the data to create a useful report once it's been cleaned up.

CT: What information could flow to the pharmacist?

Bigler: One thing would be lab results. As a pharmacist is consulting with a patient, it will be very useful to be able to retrieve these results, as well as a full medication history for all the pharmacies a patient may be using. The best case will allow for exchange in both directions.

Another rapidly expanding area of information flow to the pharmacy starts with electronic prescribing. As we all know, e-prescribing establishes a connectivity platform between physicians and pharmacists that simplifies collaboration to enhance patient safety. It can also reduce paperwork and thus improve the associated efficiencies and accuracies that may flow from electronic notes. And new technologies are designed to add transparency to drug pricing during the e-prescribing process, allowing clinicians to search for cheaper alternatives at the patient's request. But beyond these well-known advantages, technology developers are responding to healthcare's emerging drivers, including interoperability and patient-centered care models, by integrating new capabilities into existing e-prescribing platforms that allow for greater information exchange.

CT: What's been the reaction from pharmacists?