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The 2016 Healthcare Informatics Innovator Awards: Co-Third-Place Winner—Indiana Health Information Exchange

February 2, 2016
by Rajiv Leventhal
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A replicable model in a thorny HIE landscape

Healthcare leaders will generally agree that the electronic exchange of health information is critical to improving the quality and efficiency of the nation’s struggling healthcare infrastructure, one in which costs rise faster than inflation. But for most patient care organizations, effective health information exchange (HIE) remains quite challenging. 

In Indiana, however, the Indiana Health Information Exchange (IHIE) is building a model that has potential to blaze the trail for other HIEs across the U.S. In 2004, IHIE was launched to help lower Indiana’s staggering healthcare expenses and improve the state’s consistent poor rankings in leading health indicators. In the years since its inception, IHIE has continuously been working to flip that script, first, through its DOCS4DOCS (D4D) Service, a clinical messaging application in which more than 25,000 providers in over 6,000 locations throughout Indiana receive clinical results as the ordering physician.

IHIE officials say that the D4D Service is the backbone for the delivery of three million monthly clinical visit summaries and 17 million monthly clinical results to healthcare providers in Indiana. Launched 11 years ago by IHIE, the D4D Service served to standardize the way patient information was presented and streamlined, and how this information was received across an entire community and state. When messages come in, IHIE does a provider lookup for which providers are supposed to get those clinical results, says Keith Kelley, vice president of solution delivery at IHIE. “We do that lookup, and then look at the physician’s delivery preference. All 25,000 physicians have given us a preference of how they want to get results—workflow is very important to them. Then we deliver that result to the physician in the way they want to receive it,” Kelley says.

For providers, this service proves especially beneficial for the transitions of care requirement in the Centers for Medicare & Medicaid Services’ (CMS) meaningful use program, which mandates that eligible professionals electronically transmit summary care records for transitions of care and referrals. While most of the country was attempting to do this task with Direct secure messaging, there were issues with Direct, including email messages that didn’t fit the workflow of physicians, as well as many physicians not having Direct email addresses, Kelley says.

“We were able to leverage D4D and the delivery preference, so we built a solution where the sending organization sent us the CCD [Continuity of Care Document] to get to the next provider of care. We did the physician lookup, looked at the delivery preference, and delivered the CCD the same way they get their other results such as labs and radiology reports,” Kelley says, noting that now, IHIE is also set up to send a CCD to any Veterans Affairs (VA) facility in the country—inpatient or outpatient. Further, today, IHIE is the largest provider of transition of care summaries in the U.S.; by mid-2015, IHIE delivered more than 1.2 million CCDs for over 56 hospitals and their providers, its officials note. Kelley adds that the service has a “FedEx effect, in that it’s all about getting the result delivered within 30 minutes quickly, accurately, and securely.”

As such, at the Indianapolis-based Community Health Network, providers connected to IHIE no longer have to wait hours, days, or weeks to get information they have requested from other facilities, says Christina Grindle, network provider medical informatics consultant and network IHIE operations analyst at Community. Grindle is in charge of onboarding new providers to IHIE, as well getting a feel of what providers like and dislike about the HIE. “One of the things that we have found is that doing Direct is laborious on both our part and the other connector that we’re trying to connect to,” Grindle says. “Practices often don’t have the ability or the right people to view the Direct connection. IHIE makes it easy.”

When the D4D service was started, IHIE had five large Indianapolis based health systems sign up for it, which gave it the critical mass needed 11 years ago to get the service going and make it viable, Kelley says. “What we see in other parts of country is that they try to start a clinical messaging service or transitions of care service with one or two senders, but you really need that critical mass to get going,” he says. Now, though, because electronic health records (EHRs) are better at delivering results, the value proposition isn’t as much on getting the message delivered, but about workflow, EHR integration, and how it’s delivered, Kelley says. “We have evolved to meet that changing demand,” he says.

To this end, IHIE recently launched its latest enhancement to deliver information contained in the D4D system directly to providers’ EHR systems. In fact, as of December 2015, more than 4,000 providers on 28 different EHR systems are now participating in this service. One such collaboration in December between IHIE and Indianapolis-based St. Vincent Medical Group (SVMG), a member of Ascension, allows the more than 900 SVMG physicians to receive patient information and results via integration with the organization’s athenahealth EHR system, Kelley says.