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Large Area, Small Population and Lots of Connected Providers for North Dakota’s HIE

April 13, 2015
by Gabriel Perna
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In a state with a population of less than one million and an area that’s nearly 71,000 sq miles large, one HIE is proving that bringing people together in this environment is no problem at all. 
The North Dakota Health  Information Network (NDHIN), the statewide health information exchange (HIE), has brought 690,000 people into its clinical data repository out of a total of 720,000 people in the state. More impressively, Charles D. Peterson, technology and operations manager at NDHIN, said to Healthcare Informatics Senior Editor Gabriel Perna at the 2015 Healthcare Information and Management Systems Society (HIMSS) Conference in Chicago, that only a few years back, they had zero unique patients.
Now every major hospital in the North Dakota area, most of the smaller ones, and numerous other provider organizations are connecting through NDHIN’s Direct service. This has allowed the HIE to expand through other services and create a long-term plan for sustainability.  
“Things are going well,” said Peterson, stating the obvious. 
It wasn’t always this successful. After three years of planning through steering and advisory committees, Peterson said the HIE began operations in 2009 with an unnamed vendor. While the state at the time had gone from one of the lowest rates of electronic health record (EHR) system adoption in the country to one of the highest, the HIE didn’t work out as well. By 2013, the organization turned to Orion Health (based in New Zealand) and its fortunes changed. 
On top of changing products, NDHIN received a good deal of luck thanks to an in-state legislative requirement. “One of the big reasons that many of the small practices across the state have adopted Direct is because Medicaid function within the state has mandated that anyone using electronic claims submittals, needs to use Direct,” Peterson said. 
While connecting providers through Direct secure messaging was the first goal, per requirements around meaningful use, it isn’t the only service NDHIN offers its participants. Since it’s Direct secure messaging service is on a web-based portal, the HIE can build different apps within the portal and distribute to its participants. 
One example is it’s created a PACS (picture archiving and communication system) viewer to allow for image exchange. It’s also helped providers with syndromic surveillance and electronic lab reporting meaningful use requirements through offerings within the HIE. “We’ve created an advanced directive repository in the clinical portal. So either providers are uploading advance directives or patients can upload their own through the patient portal,” said Peterson.   
These services will allow NDHIN to move forward without funding from the Health Information Technology for Economic and Clinical Health (HITECH) Act (North Dakota received slightly more than $5 million) and the matching funds it received from the State of North Dakota. The HIE is looking at having participants pay for the HIE, based on their net patient revenue. While this means bigger hospitals would pay more, he said they see the value. “The [bigger hospitals] see value in getting non-Epic information,” Peterson said. “They also feel responsibility for the state as a whole.”