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Maine HIE Wrestles with Adoption, Sustainability

September 10, 2010
by Jennifer Prestigiacomo
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Part II: Dev Culver, Executive Director, HealthInfoNet

HealthInfoNet, Maine’s statewide HIE, just finished its two-year demonstration phase with the state’s six major healthcare organizations, which represents about 50 percent of Maine’s population, sharing patient information. The organization is now plowing forward to get the rest of the state on board. HealthInfoNet’s Executive Director Dev Culver, previously the CIO of Eastern Maine Healthcare (Brewer), spoke with HCI Associate Editor Jennifer Prestigiacomo in a two-part interview . In Part II, Culver opens up about how HealthInfoNet’s will address sustainability and possibilities for new, unusual revenue streams.

HCI: You’ve talked a little about reducing the barriers to adoption, but how do you plan on getting rest of the state on board by your goal of 2015?

Culver: First off, I don’t think health information exchanges have a leg to stand on if they don’t create value. So, one of our challenges now is to highlight points of value. Why would someone pay money to participate? The provider is going to pay a portion of the cost of the exchange. And that’s translated into a number of value propositions, and that includes reducing their costs to get to certain data like medication data, supporting them in reaching meaningful use objectives. All of the provider organizations that are connected today already have three of the requirements achieved. For example, they have shared problem lists across points of care. They can see the prescription medication view, which is part of the requirement. Now we’re in the process of getting out in the marketplace and communicating with other providers, hospitals, and physicians to explain why connecting to the exchange is valuable purely from a meaningful use prospective.

HCI: How many Maine providers still don’t have EMRs and how do you plan to encourage EMR adoption?

Culver: We do have a statewide survey that was done by our Medicaid organization, and it looks like Maine is not leading the pack by any means, but the data shows we have 40 percent of our providers who do not have EMRs at this time. HealthInfoNet is also the regional extension center of Maine. We did receive that grant from the Office of the National Coordinator [for Health Information Technology], so we are in contract to support 1,000 primary care providers to achieve meaningful use over the next two years. So I have an entirely separate team from the exchange now working on that objective.

HCI: What grants have HealthInfoNet received?

Culver: We have received absolutely no federal money, by the way, through grants up until this year. So, we’ve been totally running on subscription and private philanthropic contributions and some money from the State of Maine. So the state through its office of health finance secured the HIE grant [State Health Information Exchange Cooperative Agreement Program] from ONC, we’re the prime contractor on that for $6.6 million, and of that amount, $4.4 million flows to HealthInfoNet. Eastern Maine Healthcare Systems got one of the Beacon grants for $12.7 million, and HealthInfoNet [will get] $3 million. And the REC grant was awarded directly to HealthInfoNet; it’s $4.7, but which $3.7 goes to the grant targets, which are oddly the vendors to drive group purchasing and standards.

HCI: How will you sustain HealthInfoNet after the grant money dries up?

Culver: Clearly, the grants are short term. The HIE grant represents about 17 percent of what we need annually. The subscriptions represent between 30 and 35 percent of what we need, and that obviously leaves us with 50 percent of a problem, doesn’t it. So we’re starting to look very aggressively at ways to utilize what we are to create revenue streams. The question is how can you ethically use the data set, what assets do you have that are actually economically attractive without violating the basic premise of who you are. I’m going to defer on highlighting some of the specifics, but we do have a couple of interesting propositions that are unusual, I’ll put it that way.

HCI: What was the thought behind making HealthInfoNet a non-profit instead of a state agency or public trust?

Culver: In our state—and I don’t think we a lot different from other states—our consumer community was very clear they didn’t want the state to own it. They don’t trust the state; that’s one of the key reasons they decide not to participate in the program, as they’re afraid the state’s going to be able to get at their data. That’s particularly bizarre when folks are in Medicaid; basically, the state has your data. It is truly a very hot-button issue for us.

HCI: What projects are you working on currently? You’re going to be releasing a patient portal at some point, right?

Culver: Believe it or not, even though there’s no money in the portal itself, it is part of the sustainability plan. We’re gearing up to do a series of consumer user group tests on the prototype this fall and winter. And [depending] how that goes, hopefully by mid next year we’ll be offering consumers a portal.

We’re trying to figure out how to turn the data that we manage into health analytics, and we’re the only organization in the state that has a complete patient view, regardless of point of service. That along with something that Maine has called an all payer claims database. Basically, every claim that is filed in Maine has to be reported and is managed separately. That database is just begging to find its way to a connection to the clinical data set for quality and metrics. So, I think that’s a key area of development. Again, you have to be cautious because secondary use of data is a hot-button issue. But I think there’s no denying there is a public health and quality improvement value hiding in the connection of that claims data and clinical data, so you could actually see how much resources were used and what’s the impact.

HCI: What are some challenges you have faced with creating this HIE?

Culver: Starting with the question of ‘what is it that you’re doing?’, that’s on both the consumer and provider side, up through the question of ‘why would anyone pay for something they don’t pay for today,’ to the real concern of how do you make it valuable. Every one of those is a major concern. Over the past four and a half years, I’ve come close to shutting down the whole program at least twice for lack of funds. When you’re doing a startup like this, you never know.

HCI: How did you keep HealthInfoNet from shutting down?

Culver: Beg, borrow, whine a lot. A lot of hard work on my board’s part working with state government and private foundations. This is the value of having a strong, committed board.


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