The state of Pennsylvania has nearly 250 hospitals with some 13 million people spread across 67 counties—statistics which lead to a significant need to make sure that when a patient sees a Pennsylvania provider or goes to the hospital, the most updated information is readily available.
To help spur health information exchange (HIE) progress in the state, the Pennsylvania eHealth Partnership Authority is responsible for the creation and maintenance of Pennsylvania’s HIE, known as the PA Patient & Provider Network, or P3N. The P3N network—composed of healthcare providers, regional health information exchanges, health insurance care coordinators, and public health agencies—helps providers find their patients’ medical records—in real time—anywhere on the P3N network, its officials say. Regional networks electronically connect healthcare providers to each other, and in turn, these HIEs connect to the P3N hub to enable statewide health information exchange.
Throughout Pennsylvania, there are five state-approved regional HIEs that operate under the eHealth Partnership Authority, of which the leaders of two of them—the Keystone Health Information Exchange (KeyHIE) and the HealthShare Exchange of Southeastern Pennsylvania (HSX)—were interviewed for this article. HSX is now five years into existence, and operates in the Philadelphia metro area connecting some 40 hospitals; KeyHIE was founded by Danville, Pa.-based Geisinger Health System in 2005, making it one of the oldest HIEs in the nation, and now connects 18 hospitals and 400 facilities overall.
The two organizations have separately, but also collaboratively, made real strides in increasing their networks and the volume of the data being exchanged. Between 2011 and 2017, the number of unique patients with health records in KeyHIE grew from 2.1 million to 4.75 million; meanwhile, HSX, which actually only started exchanging data on its network in 2013, now has more than 5 million patient records right now in its clinical data repository, up from zero just a few years back.
Indeed, the state has had some real success in being able to effectively exchange data, an area of healthcare that has had its fair share of struggles to date other than in a few pockets across the U.S. Rather, stakeholders have encountered barrier after barrier, from creating a value proposition for the provider community it serves; to getting stakeholders to agree on governance and policies; to developing standards; to determining how to exchange information with competing organizations; and more. As such, the number of skeptics who believe that HIEs can be financially sustainable has only increased in recent years.
How is PA Making it Work?
Most experts would agree that there is no one-size-fits-all approach to a successful HIE model as there are so many variables at play that could differ from one to another. In metro Philadelphia, Rakesh Mathew, program manager at HSX, says a few reasons his organization has been successful are because it gets funding from both payers and providers, and due to the collaboration that it has brought into the market.
“You have this market trend in that hospitals keep buying practices, so hospitals have their own practices as part of the larger health system,” Mathew says. “So we have over 2,000 practices that are part of health systems, some independent [practices], some long-term care organizations, behavioral health facilities, ACOs [accountable care organizations] and IDNs [integrated delivery networks] all as part of our membership. Our membership is a mix of payers and providers,” he says.
Mathew notes that in metro Philadelphia, where a patient can walk from ED to another, there is a lot of leakage happening, and the hospitals and payers all know that. As such, HSX has become a solution for patient traffic between those systems, he says. But still, like many HIEs, HSX needed to figure out a way to make sure that the data it was getting on those patients was of high quality.
To this point, HSX invested in a tool from Diameter Health, a solutions company which has a product that allows for the scoring of consolidated-clinical document architectures (C-CDAs), document standards governed by HL7. The tool, explains Mathew, is able to look at both the structure of the C-CDA and the content inside, making sure that the content is consistent. “We got the payers and providers in our community together, created a task group, and they came up with a score they agreed upon, so we started scoring the C-CDAs based on that. If they didn’t hit that score, you couldn’t send the data in,” Mathew says.
What’s more, when HSX first began to exchange data in 2015, its leaders did a mass review of other HIEs across the U.S., specifically looking at the core issues its peers were facing. Mathew recalls that it was decided internally that HSX would be stricter in the data that it would be putting in the clinical data repository. “We created an ADT [Admit, Discharge and Transfer], specification [for HSX], and we made all the hospitals [on the network] adhere to that specification, which is not something that’s normal across other HIEs—usually they just take what the hospitals give. But we were able to convince the hospitals that for the common good, it was better to put in good quality data rather than garbage. And most of the hospitals agreed; they were ready to do the work to get the ADTs to our standard,” Mathew says.