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What Dev Culver Knows: The Secret of HIE Sustainability

February 18, 2015
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What the executive director of Maine’s HealthInfoNet knows—as do his counterparts in Michigan, Ohio, and Colorado—is how to provide practical value to stakeholders across the healthcare spectrum

It was great to speak with Dev Culver back in November, as I prepared the Top Ten Tech Trends article on health information exchange (HIE) sustainability. In reporting on and writing that Trend, I wanted to give readers a sense of the landscape around the sustainability of statewide HIES in particular, at a time when numerous statewide HIEs are failing outright, or at least faltering.

HealthInfoNet, Maine’s statewide HIE, is flourishing at the same time that other statewide HIEs are stumbling. Indeed, along with the statewide HIEs in Ohio, Michigan, and Colorado, HealthInfoNet is serving these days as a shining beacon of success at a time of great peril for the health information exchange sector. So what gives?

Basically, what Dev Culver of HealthInfoNet—as well as what Dan Paoletti of the Ohio Health Information Partnership/CliniSync, Doug Dietzman of Great Lakes HealthConnect, and Brian Braun of Colorado’s CORHIO, know—is this: the only way to survive these days is to be useful—that’s right, useful. For all the high-minded conversations five and even two years ago, about how health information exchange would transform the U.S. healthcare industry, when the proverbial rubber really came to meet the proverbial road, particularly once most of the federal and state funding began to dry up two years ago, HIE survival was suddenly no longer a sure thing.

But Dev, Dan, Doug, and Brian, and their colleagues, all knew that from day one. And all are creating real, concrete value, value that people are actually willing to pay for (not that more abstract value is not without its own significance—only that the more abstract forms of value are no longer strong enough to keep the doors open anymore). And most of that value derives from very practical things.

As Dev told me back in November, HealthInfoNet is now providing leading-edge support to providers, as they move towards full population health management and value-based purchasing models of care delivery and payment. “We have a set of tools in the field that is dynamic—the data being used is a day old, driven by clinical and event data," he noted, “and is predicting things like who will show up in the emergency department. Who’s going to get readmitted in the next 30 days? That runs while the patient is in the bed.”

When I asked Dev whether some of what has been created by some HIEs was not truly needed, he told me that “I think part of what leads to success starts with the building out of consensus among diverse stakeholders, so that there is at least the potential for value. And so you know,” he added, “when I think about our history, the work started in 2004, and we didn’t have an operational health information exchange until late 2008, early 2009.” He and his colleagues spent quite a long time building consensus among the HIE’s stakeholders on the organization’s purpose, and also spent time raising seed money for the long journey ahead.

But the revolutionary thing they’re doing now that really makes a difference is this: HealthInfoNet is sharing live data—usually one day old—with providers in Maine, data that is predicting which patients will show up in the ED, and helping them to be able to predict which patients will be readmitted within 30 days. That kind of data, delivered in a far more timely way than ever before, is like gold for patient care organizations, as they become involved in accountable care organizations or respond to value-based purchasing demands.

So this will be the currency of health information exchange going forward: HIEs will need to be able to offer practical data and information, in a far more timely way, that can help providers survive and thrive in the new, more connected healthcare.

On one level, this shouldn’t be so terribly surprising. After all, on a very broad level, we all know the direction in which U.S. healthcare is headed, as driven by purchasers and payers. On the other hand, actually coming up with concrete services that other stakeholders in healthcare find valuable on a practical level—turns out to be terribly challenging to actually design, develop, and deliver. Thus, CliniSync’s facilitating the sharing of CCDs (continuity of care documents) among providers, and CORHIO’s alerting health plans in Colorado when their plan members are cared for in EDs or admitted to hospitals—all these services are not only quite valuable in the abstract, but very much so, too, in the practical world of transactions and money and self-generated survival.

So the “secret” of HIE sustainability, particularly of statewide HIE sustainability—is not really such a big secret after all. But making it real—now that seems strangely to be a closely held stratagem. So really—it seems well past time for a whole bunch of people out there to make pilgrimages to Maine, Michigan, Ohio, and Colorado—and to strike while the proverbial iron remains hot.