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HIE Is a Marathon, Not a Sprint

June 10, 2013
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Slow but steady may win the interoperability race

Earlier this year, six U.S. senators released a report questioning the government’s investments in health information technology, particularly in the area of interoperability. Understandably, they are impatient to see data flowing between provider settings, and they were probably politically opposed to the EHR incentive program from the outset.

But several presentations I’ve seen recently by successful regional health information exchanges had in common that their progress was slow and building governance processes took years. I think it’s important for us to remember that successful HIE leaders tend to think more like marathon runners than sprinters.

Yvonne Hughes, executive director of Coastal Connect in North Carolina, said oneof the organization’s cornerstones of success has been its governance structure. “We worked on it for two years before putting any technology in place,” Lee said at a recent presentation with the National eHealth Collaborative.  Stakeholders range from regional hospital CIOs to rural and urban physicians to Community Care of North Carolina, the state Medicaid agency. Coastal Connect established some guiding principles to keep itself on the right track and focused. “Our most important mantra was keep the patient in the middle,” Lee said. “We had to provide value to providers and be patient-centric.” They deliberately went slowly so as not to overwhelm partners or any technology vendors.

Physicians responding to initial surveys were very willing to access data, but a little less willing to contribute. Coastal Connect had to show them that it had strong policies to ensure the safety of data and the integrity of information they were looking at. Physicians were also concerned about costs and that the HIE wouldn’t disrupt their workflow.

Coastal Connect coupled the users’ expressed needs with meaningful use requirements to create a value equation. Providers would gain in clinical efficiency, meet meaningful use requirements and improve the patient experience. They would be able to share information at a level that would help them understand their patient populations.

Today Coastal Connect HIE is deployed in 11 counties in southeastern North Carolina. It is used by 210 physician practices with more than 750 providers. It links to five hospitals and has nearly 1 million patient records.

Lee said working on a sustainability model from the beginning was key. “Make sure you understand the total cost of ownership going in,” she said. “Work on governance with committed partners at the table. Affordability equals sustainability,” she added. “Ours is a subscription model, so we had to keep fees as low as possible if we were going to create a data-rich HIE.”

Joining Lee in the NeHC presentation was Dan Porreca, executive director of HealtheLink, a regional health information organization serving eight counties in Western New York. The progress there has been even more slow and steady than in North Carolina. Clinical data has been flowing since 2008, and the current success is a continuation of more than 12 years of collaborative efforts by the region’s four major hospitals and three health insurance plans, starting with the exchange of administrative data starting in 2001. Today, Porreca said, almost all area hospitals (representing 98 percent of the beds in Western New York) and major radiology practices are connected. More than 90 milliontotal clinical results are available and the RHIO is adding an average of 1.9 million newrecords every month. Nearly 1,000 providers are receiving these results directly into their EHRs.

The approach of both HealtheLink and Coastal Connect was “crawl, walk, run,” and that may be one of the reasons they are touted as success stories. Both took several years to accomplish. They were careful not to push too much technology on physicians too soon or utilization would suffer. They first connected providers, then enterprises and now they are connecting communities.

 “Have a cohesive message around data sharing,” Lee recommends. Make sure you are providing value. Be mindful of the demands on providers’ resources, she added. Make sure growth of the HIE doesn’t outpace functionality. And keep an eye on technology vendor market instability. “The market is like shifting sand under our feet. You have to remain flexible.”