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One Health System CIO's Perspective on the State of HIE

August 23, 2013
by Mark Hagland
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The University of Pennsylvania Health System’s CIO, Michael Restuccia, shares his perspectives on HIE evolution

As health information exchange (HIE) becomes more and more widely adopted, leaders of patient care organizations nationwide are sharing with each other and learning from each other, in terms of key lessons to be gleaned from pioneering efforts in that area. In that regard, Healthcare Informatics will be publishing its September cover story on the top challenges facing HIE innovators nationwide right now.

One of those interviewed for the cover story was Michael Restuccia, vice president and CIO of the University of Pennsylvania Health System, otherwise known as Penn Medicine. Penn Medicine has been participating in a regional HIE sponsored by the Delaware Valley Health Council, with member hospitals, as well as several payer organizations, in southeast Pennsylvania. At the same time, Penn Medicine is using the CareEverywhere data exchange capability built into the core electronic health record (EHR) solution from the Verona, Wis.-based Epic Systems Corporation.

Recently, Restuccia shared his perspectives in this important area with HCI Editor-in-Chief Mark Hagland. Below are excerpts from that interview.

Tell us about your broad general involvements in the health information exchange area.

We have two or three current courses of action around information exchanges. One is a regional HIE known as HealthShare Exchange. HealthShare Exchange will securely transmit healthcare data among hospitals, doctors, other healthcare providers and insurers to improve communications and the efficient delivery of care. HealthShare Exchange is being funded by more than 90 percent of the acute-care hospitals in the Philadelphia region; by the area’s largest health insurer, Independence Blue Cross (IBC); as well as by AmeriHealth Caritas, one of the nation’s leaders in healthcare solutions for the underserved; by Health Partners, a Philadelphia-based, not-for-profit health plan owned by a group of local hospitals; and by federal and state grants.

Michael Restuccia

When was HealthShare Exchange incorporated or created?

The specifics are on the website, but about a year ago. You can go to

Has any data been exchanged yet?

No, we have just finalized our vendor selection, and anticipate pilot activation in the fourth quarter of 2013. We have multiple committees, which have identified the initial use cases we’re going to address. One is an exchange of medication lists among providers and payers; a second would be a discharge summary release, in PDF format. The first two use cases are much more about direct messaging. Our plans after these two are to move towards more robust HIE capabilities.

Do you have a volume expectation?

I don’t think we do at this point.

Are you involved in any other HIEs?

The other one surrounds the use of our Epic ambulatory clinical system. We participate with what’s called CareEverywhere, the connective capability available to all Epic facilities. We very readily exchange data with other Epic users.

Are there other area hospitals exchanging data with you through CareEverywhere?

I’ll give you the hospitals and then tell you the story why. There are several facilities we have clinical alliances with. One is Lancaster General, about 75 miles west of us. And Geisinger Health System, as well, about 200 miles away. We sort of serve as a referral center, particularly for cardiac transplants and cardiac specialty services. So receiving the information on a patient prior to their arrival here at Penn, is of great value.

How much volume of data exchange is involved in that initiative? Would you say that information on dozens of patients or more is being exchanged?

Yes, data is being exchanged on multiple patients per month, is maybe a good way to put it. And the reciprocal of that is that when patients leave Penn, they go back to their homes, some distance away. And then the data we’ve gathered on them here travels back to their home facility.

Would you say that what is possible through Epic’s CareEverywhere is full HIE capability?

As an organization, you have to define what data you want to exchange. And first and foremost, I personally think we should focus on exchanging the clinical patient data. If you put the patient at the center of the universe, what do you want to be exchanging first? I think it becomes a fairly easy question to answer.

One West Coast CMIO I’ve spoken with has told me he is helping to lead his organization to replace their current electronic health record [EHR] with the Epic solution, primarily to participate in the CareEverywhere-based information exchange process, as all the neighboring hospitals and health systems in his community are already doing so, even though that exchange process is not as robust as what is taking place in some HIEs nationwide.

I would agree with that CMIO on the West Coast, that to locally to locally exchange data on the immediate care of the patient, is most important. If you put the patient at the center, getting to a platform that allows for ease of transfer of data, should be first and foremost. That was one of my observations about exchanging data via Epic’s CareEverywhere, versus trying to create a regional HIE. There’s a lot of infrastructure that has to be created in a regional HIE, there’s a governance structure that has to be established; you have to come up with a sequencing plan, priorities, and funding. The simplicity of the Epic situation is remarkable, no? You basically just have to set up a system of approvals, obtain consents, and then you go ahead. It’s remarkable.