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The area served by QHN includes western Colorado and eastern Utah and it will eventually be connected to both statewide networks, Thompson says. But even after that happens, QHN's focus will remain local, he stresses: “Our founding organizations envisioned an all-inclusive non-profit, apolitical network focused on improving quality. Our focus was to create a medical neighborhood. The best return on investment is to create a locally driven HIE. I think that's the key, because healthcare is largely local.”
Driven mainly by physicians, a non-profit health plan, and acute-care facilities in the area that have contributed the initial $2.75 million in private funding, QHN chose Axolotl for its connectivity solution. “At the time, there wasn't anyone else that had proven they could do this work,” Thompson says.
According to Allphin, most HIEs still need to work on making their systems physician-friendly, both in ease of use and in delivering data where it's needed. “Among the live HIEs that KLAS validated for this report, only 43 percent were delivering patient data directly into physicians' electronic medical records [EMRs],” he says.
But that's not the case with QHN. “There are many EMRs that we interface with,” Thompson says, noting that participating providers can also use Axolotl's lite-version EMR, which does not include billing and scheduling, or opt for another vendor's “full-blown” EMR.
Although Thompson says that Axolotl's connectivity solution was “a great way to start,” and he values the system's ability to connect disparate systems, he acknowledges that his HIE is outgrowing its capabilities. “We're now moving more extensively into data warehousing and data mining, and this system is somewhat limited as it stands today,” he says. “We are in the process of soliciting for a ‘data layer’ that we can plug into the existing clinical messaging system so we can do more comprehensive analytics.”
QHN is not alone in seeking another vendor to add more layers of operability to its HIE. Among the findings of the KLAS study was that many HIE vendors still cannot offer every piece of technology that is needed, so providers often turn to vendors that can supply them with pieces like an enterprise master patient index, patient record locator, or central data repository.
MEETING CHALLENGES
While the need to expand a system's offerings is a logical step in the growth of an HIE whose mission is to share as much patient data as possible, not being able to transmit data directly to an EMR has become a major challenge, Allphin says.
The cost of interfaces is the biggest barrier, according to the KLAS report. In some cases, neither the provider nor the HIE is able nor willing to pay the high price demanded by EMR vendors.
Chris Henkenius, president of the Healthcare Technology Center at the Omaha, Neb.-based Bass & Associates Inc., is familiar with this challenge. His firm has assisted more than 30 states in building their HIEs and, by working with various vendors, has been involved in the implementation of private HIEs throughout the country. “Everyone wants the same thing: connectivity and the sharing of medical records,” he says. “But the biggest complaint is always the cost to the clinic or independent practitioner to connect to the HIE.”
EVERYONE WANTS CONNECTIVITY AND THE SHARING OF MEDICAL RECORDS. BUT THE BIGGEST COMPLAINT IS ALWAYS THE COST TO THE CLINIC OR INDEPENDENT PRACTITIONER TO CONNECT TO THE HIE. -CHRIS HENKENIUS
The second biggest barrier, according to the KLAS report, is that despite incentives available under meaningful use criteria, many clinics have not yet installed an EMR, so they have not had to deal with the challenges of interfacing with an HIE.
Many that do have an EMR are concerned about the integrity of data-including diagnoses-that can be pushed directly into that EMR by the HIE. “Some clinics want only certain types of data to be pushed in, while others want to keep HIE data completely separated from their own records,” the KLAS report states.
Getting physicians on board continues to be another major hurdle. Henkenius says that the faster you can get an HIE to the pilot stage, the better your chances for success. “As you begin to show value, others will come on board.”
Thompson likens the process to nuclear fission. “You have to have critical mass [of senders and receivers] coming together to sustain an HIE,” he says. Interestingly, the KLAS report found that among the providers interviewed, 37 percent said they measure the success of their HIE by the number of physicians that actually use the data.
In addition to getting data into an EMR, a recurring problem has been the disruption of physicians' workflow. “With that challenge in mind, more HIEs are striving for ways to deliver useful data to physicians without requiring them to leave their normal workflow, but so far progress has been slow,” the report states. Allphin adds that: “What we're told over and over is that if it's not put into the physician's workflow, it's harder to get adapted.” Thompson agrees: “It's all about clinical workflow,” he says. “It's about being able to adapt technology to enhance clinical workflow.”
