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Sometimes, HIEs Need a Do-Over

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HIEs are retooling their strategies to be sustainable for the long haul

I think Henry Ford articulated it best when he said, "Failure is only the opportunity to begin again, only this time more wisely." We all learn from our mistakes, and I think one area rife with redos and re-tinkering of strategies is the health information exchange (HIE) market.

HCI Senior Contributing Editor David Raths reported that many statewide HIEs have been switching midstream and taking a simpler approach to information exchange. Health Information Partnership for Tennessee (HIP TN), which was originally created to provide a statewide “network-of-networks” model for sharing of health data, winded down operations in July because the state and the HIP TN board of directors decided to change direction and focus on getting more providers to sign up for Direct, which allows for the secure e-mail transmission of health information between providers. Oregon is also using the Direct project to be the onramp that many Oregon providers take to health information exchange.

It may be that many states are recognizing that they will not have enough time or money to stand up a platform for broader exchange and find a sustainable business model to support it. Some states may not have a business case for many statewide interoperability services,” David Raths writes.

Southern Piedmont Beacon Community, one of 17 Beacon communities around the country, is a good example of a redo that led to a reinvigorated approach. The Southern Piedmont Beacon covers three counties in North Carolina, northeast of Charlotte. Each county has a fiercely competitive health system and its own public health department. The region originally had more than 60 percent EMR adoption, and a largely employed physician group landscape.

Some initial challenges the Southern Piedmont Beacon faced was that it had to administer a large award, almost $16 million, via a small organization that was a divestiture from each hospital. This formed a nonprofit that sought to develop and deploy a centralized set of interventions and a single health system HIE solution. Due to the competitive environment and opposing system priorities, this approach failed.

Starting in June 2011, Southern Piedmont Beacon took a new tack. “We really looked at retooling our Beacon oversight committee,” said Deborah Aldridge, R.N., Beacon program director, Southern Piedmont Beacon Community, in a National eHealth Collaborative webinar. “We had a large oversight committee with various stakeholders across the community, and what we determined is we had to identify the key executives and key members from our community, to really serve as a Jedi Knight squad, a very small number of folks that had well-intentioned interests within their communities, but could come together to help make decisions.”

Southern Piedmont Beacon decided to take individualized approaches within each community. “Our new approach to how we would spend the funding was to allocate dollars to each county based on their population, so we thought the population percentages was a fairly neutral way to break down dollar funding,” said Aldridge.

Southern Piedmont Beacon is focusing on IT enhanced care management with a data informatics center hub that powers medication reconciliation, provider portal, and care management population tools for participating organizations. The Beacon is working with health systems to figure out what NQF-based clinical decision support they want. The Southern Piedmont Beacon is employing the patient-centered medical home model to fill gaps in care and provide patient education through providing a complete medication review by a PharmD at no cost to patients, as well as employing care managers.

“These care managers go into these patients’ homes and can really deliver the message about what’s going on in the patients’ home, not only support structures, but are [patients] able to provide their own care and services in the home and are there any opportunities for interventions that we might have not already known,” said Aldridge.

The informatics center will be able to represent data in different ways to aid in two upcoming randomized controlled trials: a home monitoring pilot for morbidly obese patients using iPads and a virtual visits pilots with diabetics with A1cs greater than 9 percent.

Just as Henry Ford perfected the assembly line, HIE leaders across the nation, including Aldridge and the Southern Piedmont Beacon, are mechanizing healthcare to create a more seamless care continumm. There are myriad challenges along the way, including wading through politcs, sorting through the legal thicket of data use agreements, and aligning competitng priorities among stakeholders. But at the end of the day, sometimes you just need to press the reset button to achieve what’s best for everybody.