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HealthShare Exchange: Pushing the Envelope on HIE in Southeastern Pennsylvania

June 2, 2014
by Mark Hagland
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Martin Lupinetti is bringing numerous organizations together in southeastern Pennsylvania around HIE

At HealthShare Exchange of Southeastern Pennsylvania, executive director Martin Lupinetti has been leading the advance of a health information exchange (HIE) that is bringing numerous parties together to share clinical data in order to improve patient care.  HealthShare Exchange (HSX) was incorporated in May 2012, and its board and bylaws were put into place in January 2013. By December 2013, the University of Pennsylvania Health System (Penn Medicine) and Crozer-Keystone Health System had begun to share test data; and by February 2014, HSC announced the beginning of data exchange.

By that point, Penn Medicine had directly and securely sent a patient-care clinical summary (in this case, a clinical care document, or CCD), from the office of UPHS internist Susan Day, M.D., to the office of internist Karen S. Scoles, M.D., of Crozer-Keystone Health System.  With HSX facilitating the exchange, the Crozer practice also sent a test CCD electronically over the new platform. 

What’s more, 37 health systems in southeast Pennsylvania have signed a letter of commitment documenting their desire to participate in HSX. Of those, between eight and 12, including Penn Medicine, Crozer-Keystone, and Children’s Hospital of Philadelphia (CHOP), have been involved in the testing of data-sharing. Lupinetti and his colleagues have been working with the Boston-based Alere Accountable Care Solutions, which has been providing the technology solution for the initiative.

And this is a very important, densely populated area in the Northeast; indeed, the five-county region that HSX is servicing represents  32 percent of all healthcare consumers and 36 percent of all hospital discharges in Pennsylvania.

In April, HCI Editor-in-Chief Mark Hagland spoke with Lupinetti about the progress of HSX’s work.

At that time, CHOP was scheduled to be moved into live production (following Penn and Crozer-Keystone) this month (May), soon to be followed by several other patient care organizations.

Below are excerpts from Hagland’s interview last month with Lupinetti.

At this point in time, which organizations are live in terms of sharing data?

Penn and Crozer, and CHOP has tested successfully, and we hope to move CHOP into production this month [April].

Martin Lupinetti

And then after that?

Grand View Hospital, Doylestown Hospital, Main Line Health, and Einstein Healthcare Network will be the next wave. We’re hoping to cycle through as many health systems as we can this year, but those are the ones we’re in active conversation with right now. Some kicked off in February, some in March, with testing. After the April go-live at CHOP, we’re hoping to bring those other organizations online in May and June.

What are some of the key types of data you’re focused on exchanging at first?

The two use cases we’ve focused on are really addressing the readmit challenge in this region. Surprisingly, there’s no dominant health system; they all have a slice of the pie. And there was a recognition early on that the health systems needed a better way to support one another and manage patients once they’ve been discharged from EDs. So the first use case is the discharge information use case. It’s different from a summary, because it happens sooner than a discharge summary would typically happen. We can send it out within 20 hours, whereas the discharge summary typically takes 28, 36, or 72 hours—or sometimes never. We’re sending this to the PCP, the specialist, and the care manager. And what’s interesting about this endeavor is that we have health plans that are part of this as well, and they’re not only contributing financially to making HSX possible, but are also providing data for the exchange and are receiving data as well.

Which health plans are involved?

Independence Blue Cross, AmeriHealth Caritas, and Health Partners, to start. It’s a very unusual model. I’ve not heard of it happening elsewhere in this kind of context. And again, for our opening act, it’s addressing this readmit issue. The plans are going through their development effort right now to be able to support the routing intelligence part of the use case. So they’re helping to manage the patient-PCP relationship closely; and conversely, we’re letting the plans know that their members are being discharged from EDs. And as a result, they will feed us the patient’s PCP, the specialist, and the care manager, all of whom will be made aware that their patient was just discharged from one of the member hospital EDs.

Are you also going to look at hospital discharge data?

We are going to look at that, but this was the first thing we wanted to put in play, because the health systems all recognized the readmit charges and penalties this could help reduce, and wanted to manage that in the region.

How many discharge information messages have been sent so far?

Right now, our focus is just to get the technology ready for connecting the exchange. And the health plans are preparing now to be able to provide that routing intelligence. So that will all come together in a go-live scenario in the latter half of this year. There are a lot of moving parts to make this happen; all are components of our business plan.

How many electronic medical record systems are involved?