There are few leaders in the health information exchange (HIE) space in healthcare IT whose work is more advanced than that of Devore (Dev) Culver, the executive director of HealthInfoNet, the statewide HIE in Maine. Culver, a well-known figure in the healthcare IT world, has been leading pioneering change at the Portland, Maine-based organization since 2006.
Most recently, HealthInfoNet has been moving into uncharted territory, leveraging a data analytics platform to create provider notifications based on clinical data, allowing physicians and others to know when patients in their care are admitted to hospitals or treated in emergency departments (EDs). Because of the maturity of HealthInfoNet’s work, Culver is in great demand as a speaker at conferences around the U.S. Indeed, he will be a panelist in the panel discussion session, “Health Information Exchange: New Models of Interoperability to Support Value-Based Healthcare,” on Wednesday, May 14, during the Boston Health IT Summit, sponsored by the Institute for Health Technology Transformation (iHT2). (Since December 2013, iHT2 has been in partnership with Healthcare Informatics through HCI’s parent company, the Vendome Group LLC).
In that context, HCI Editor-in-Chief Mark Hagland interviewed Culver recently regarding HealthInfoNet’s ever-expanding innovations. Below are excerpts from that interview.
Tell me about the latest developments at HealthInfoNet.
There are a number of pieces of good news for us, including our ongoing sustainability. As all the federal funding goes away, we’re making enough money to sustain ourselves through core subscriptions. We have annual subscriptions with different classes; there’s a whole pricing structure for hospitals, and a different one for physician practices; and within that physician pricing structure, specialists pay a little more than primary care physicians. We also have separate structures for long-term care and behavioral health. We recognize that some sectors, like long-term care, have very little margin; and yet they’ve become integral to the continuum of care around accountable care.
So at this point in time, every hospital in the state is under contract, and 34 of the state’s 37 are actively sharing data; and by the end of the year, we’ll have all of them connected. And we’re at 400 ambulatory practices connected, which encompasses about half of the primary care structure in the state. The specialty practices have been really slow to come to the table; at this point, I have one cardiology practice live. But employed practices that are hospital-based are already connected, and at this point, about 80 percent of physicians in Maine are employed by hospital-based organizations.
Why is it that most independent physicians haven’t yet connected?
I don’t think they fully understand the value to care management yet. The cardiology practice that is connected has set this up as a matter of policy.
So the physicians at that cardiology practice are recognizing the value to their patients?
Yes, absolutely. And the practice’s clinicians and staff used to have to call all over town, because their patients had been obtaining care at various locations. This is in the town of Bangor, which had one of the Beacon Communities. And we’ve got an FQHC [federally qualified health center], as well as the two hospitals in town, and specialty practices. Northeast Cardiology Associates is the name of the cardiology practice that’s connected; they’ve got 14-15 cardiologists, and in the past year, they became part of Eastern Maine Medical center. So we have a lot of specialists, but they’re hospital-employed.
And your connectivity across Maine has continued to grow successfully, hasn’t it?
Yes, we have over 1.3 million lives in the database; Maine is a state with 1.3 million people, but there are also out-of-staters who have data in the HIE. But we’ve got 90 percent of Maine residents with data in the HIE. And our opt-out rate remains at about 1.1 percent. So we’re seeing over 1.2 million messages a week being shared. Our user population is up about 2,000 users, and last month, we hit 22,000 patients accessed by those users. And that grew over 200 percent in the past year. Also, in January, we started doing real-time notification for inpatient admitting and discharge and ED admitting and discharge. So last month, we provided 8,000 notices of patient action, whether admission, discharge, or lab result coming in. And so care managers can associate themselves with patients. That’s really taken off significantly.
I definitely want to hear more about that. Broadly, with regard to the panel discussion that will take place in Boston on May 14, what are the most important steps healthcare leaders need to take around HIE for accountable care and value-based care?