The Denver-based Colorado Regional Health Information Organization (CORHIO) has proven itself as an example of a health information exchange (HIE) that is flourishing, at a time when many are floundering. Last week, in the first part of a two-part interview, CORHIO CEO Morgan Honea revealed how the state of Colorado has become a model for data exchange success, giving specific examples of how the HIE has led to better patient outcomes.
Part 1 of the interview also touched on the nationwide negative perception of HIEs, to which Honea said they aren’t unlike other things, in that there have been both successes and failures. “We don’t have the national studies that have quantified the value of HIE, and we don’t talk at all about the benefit to patients who have received services and better proof of care because of the HIE. It’s an exciting place to be, and also exhausting,” he said. To that end, Part 2 of the interview with Honea digs into the difficulties associated with successful heath information exchange, as well as the role the federal government has, and if vendors are keeping up with provider demands. Below are excerpts of that interview.
Do you think HIE has become too difficult?
It’s very hard, very challenging. There are a lot of different things that can increase or decrease the burden. Colorado is an opt-out state, meaning you have to take action as consumer to get out of it. That policy alone dramatically changes the challenge. As an HIE, you’re not only tasked with selling your services and creating the value proposition for a network of healthcare providers, but also trying to convince the public of value as well. That single thing alone changes the complexity of HIE.
Also, technology is changing. When CORHIO started, we relied mostly on HL7 message exchange. Then, the Office of the National Coordinator for Health Information Technology (ONC) backed Direct messaging with meaningful use and transitions of care, which changed the way we look at our own technology. Now we transition into continuity of care documents (CCDs) and consolidated-clinical document architecture (C-CDAs), as well as fast healthcare interoperability resources (FHIR). The change in technology alone is a challenge to make sure systems are operating and flexible enough to respond to the vendor and industry changes to technology.
Speaking of those technology changes, are vendors keeping up with provider demands?
I think to be objective, you must say yes and no. Some do better than others. Standards have changed since we started the conversation, and that’s a big challenge for them. The number of certified vendors has decreased dramatically as we have gone through meaningful use. Also, the market share is wildly lopsided in some areas. We have a very heavy Epic presence for our hospital systems, and we function fairly well with them. You can’t ignore that every one of these vendors is working tirelessly to keep up with meaningful use standards. From our perspective, we could put more focus on the interoperability of different systems and how they would work to exchange information. Direct and transitions of care methods maybe didn’t get us as far down that road as we could have gotten. It’s not solely anyone’s fault, but they all contribute to where we are now.
What has kept providers from getting more on board?
I am actually an ex-practice administrator who ran a rural frontier federally qualified health center (FQHC), so I understand the challenges of adopting different technology at the practice and provider level. It’s cost, bandwidth, infrastructure, and competing priorities. As you go down the spectrum from large hospital systems that have robust IT staffing and resources to single-doctor rural practices, you have to look at where the best bang for your buck will be as you look at your priorities. Meaningful use has gotten providers to adopt health IT, and we’re hopeful that the programs here in Colorado will do the same. At the end of the day, there’s only so much time and so many dollars.
How much do your participants pay?
We have varying levels of access. Providers wanting to use our community health record portal alone, which means not receiving anything into the electronic health record (EHR), but just seeing that community health record, pay a nominal monthly fee, less than $50 a month. Then you move up the spectrum from there. There is a cap on cost to large hospital systems based on size and geography. We work with our members on the payment system to make sure that we’re not costing them out of participation. With the model we have, we have tried to make the value proposition in participating in the HIE far outweigh the cost of joining.
What role should feds have in this and are you comfortable with the direction they are giving today?