At a time when the broad survival of health information exchanges (HIEs) is in question nationwide, and a number of statewide HIEs are shutting down or in danger of doing so, a small number of such organizations are actually flourishing, among them the Denver-based Colorado Regional Health Information Organization (CORHIO), which is a public, non-profit HIE run by a private entity, and founded in 2007. It has a staff of about 50 FTEs.
Indeed, on Feb. 6, CORHIO’s leaders announced that their organization had seen the number of participating healthcare users in its network grow by 111 percent, and the amount of data available in the network grow by 118 percent, in the past year. That marks the third consecutive year of triple-digit growth rates for the organization, which now encompasses 5,705 active providers/users, 47 connected hospitals, and with more than 223 million clinical messages having been sent.
The question of statewide HIE sustainability is of such import that it was the basis of one of the Healthcare Informatics Top Ten Tech Trends for 2015. As was discussed in that article, Colorado, along with Michigan and Ohio, is one of the states that has followed (very diverse) paths towards sustainability and vitality. For that Trend article, HCI Editor-in-Chief Mark Hagland interviewed Brian Braun, CORHIO’s chief financial and strategy officer, who described in the article how CORHIO has been working with Colorado’s Medicaid office on ADT alerting, and has also contracted with two large health plans, Anthem, and Kaiser Permanente, to alert them when plan members are having ED visits or admitted to hospitals. Below are excerpts from Hagland’s November interview with Braun.
Your organization has grown very large relative to the size of the provider community in Colorado.
Yes, that’s right; 95 percent of the hospital beds in the region we serve—that of easternand southern Colorado—are represented in our membership, and 90 percent of the population base in Colorado is served by us. And while a lot of HIEs are challenged with regard to ambulatory connectivity, we provide varying degrees of bidirectional and unidirectional connectivity, and a community health record.
What is the secret to sustainability going forward?
I think it’s a couple of things. Everyone’s speaking about payers and payment reform, and how that will drive how providers and hospitals get paid going forward. Long-term, that is the key—that the HIE has to provide value under the new payment mechanisms, like ACO [accountable care organization] and population health, and where clinical data becomes much more important to manage a patient base, and where timeliness of clinical data delivery is critical. So that’s essential to sustainability.
And on the CMS [Centers for Medicare and Medicaid Services] side, when you start talking Medicare and Medicaid, I view that as [similar to working with] one big health plan, to be honest, and they have the same needs as the private health plans. So we have a two-pronged approach, where we work with all payers.
Are any private health plans contributing financially yet to CORHIO?
We have one live contributing, and two in the implementation phase. I’ll be honest, it’s been slow, and health plans are still figuring out how to use clinical information. One’s an ACO—a state ACO, part of the Medicaid program here—Colorado Access. That’s the one we’re sending data to right now; they’re piloting it this fall .
Two getting ready to implement?
We’re working on an alerting system with the state Medicaid office for ADT [admission, discharge, and transfer] alerting, and working with Anthem in the state also. And also working with Kaiser Permanente.
What will you be doing with Anthem and Kaiser?
Similar work—we’ll be providing them with an alerting function when their members are showing up in an ED or are admitted to the hospital. That’s the easiest thing to do right now. What we’re doing with Colorado Access is actually more comprehensive, providing them a full data feed. That’s providing clinical information on their members, which includes lab information, radiology, pathology, and transcribed notes—in other words, more in-depth clinical information, not just alerts.
What do you think is going to happen among HIEs in the next couple of years?
I think if an HIE is not flexible enough in providing information in different forms, and normalizing that data so it’s shareable with different organizations, they’re going to have a hard time getting traction with the payer side. Because the environment is changing so quickly, there needs to be a flexibility in your platform and in the data you have, and standardization of data is becoming more and more critical. And we’re finding that collecting a bunch of data is just a start; the data needs to be standardized and usable and plugged into other tools that users have. And that’s probably one of the biggest challenges for the industry, is that normalization of that data.
How are the plans going to pay—on a subscription basis?
The model is a subscription basis, per volume.
Hospitals and physicians are also paying for connectivity, too, right?
Correct. In our market, hospitals have been a strong supporter of HIE and have been willing to help support the HIE along with the grant funding that’s been available for the last three years. It’s always been expected that grants won’t be the sole supporters of HIE, that others need to be involved in supporting HIE as well.
Do physicians pay at all?
A small amount; they don’t pay enough to cover the costs involved, but we do charge enough for it to be fair.
It seems the stakeholders have been very satisfied with CORHIO in Colorado.
Yes, we survey all our participants every year and get their feedback, and it’s been positive. The level of service we provide provides value. I think there’s still a desire for more connectivity amongst providers in particular. So there’s still more work to be done to make sure we connect as many ambulatory providers as possible. Right now, the bulk of our data is hospital and lab information. We’re just now starting to collect ambulatory physician information and getting that into the network.
Are you live yet in helping to exchange images?
We’ve been doing that with one hospital where we’ve embedded a link to the image. We are looking at some of the newer organizations out there making this technology much more affordable. So we’re checking out the market for imaging vendors to provide links. Right now, we’re collecting image reports, and it would be really easy for us to be able to collect images. Right now, on a limited basis with Boulder Community Hospital. We went live with them… at least a year now. We’re looking at ways to provide that kind of service cost-effectively.
What have the biggest hurdles been in your development so far?
Up to this point, it’s been cost, as well as the need for elasticity in our pricing, to get to where people would be willing to pay more to receive those images. But now that the cost has come down quite a bit with some of the vendors out there, we’re thinking of adding it to our service without having to seek a large increase in fees.
Do you have any advice for CIOs, CTOs, CMIOs, and other healthcare IT leaders in patient care organizations, for how they should prepare for what’s coming?
I think working closely with your data centers, because it’s back to that, it’s only as good as the information being put in. So, data integrity, and being on the front end of that, working with your hospitals, providers, to make sure the data being collected in your EHRs, will be shareable and normalized, will be very important. Catching it on the front end is hard work, but it’s worth it, because you don’t have to do a lot of normalization of at a later point.
Has there been a single critical success factor in CORHIO’s success so far?
I’ve said this many times over the last few years, but it’s the collaboration among all of our health systems, and their believing in the need for a public HIE. Many of these systems are still Epic systems, but they still the need to share across their communities with physicians in practice, long-term care facilities, and for transitions of care, etc. That’s been a huge factor in our success is having this buy-in from just about all our providers in the region. Without that, it would have been a struggle.