After a stop and start, Middle Tennessee eHealth Connect (MTeHC) is in the process of connecting its community hospitals, with the eventual goal of linking up with the Health Information Partnership for Tennessee (HIP TN) and the Nationwide Health Information Network (NwHIN).
Tennessee, like other states including Texas and Oklahoma, is planning for a network of networks approach, with the Franklin-based HIP TN as the statewide convener of other active HIEs like MidSouth eHealth Alliance in Memphis.
MTeHC got its start in 2007 when the four CEOs of the metro Nashville hospitals, St. Thomas, Nashville General, TriStar/HCA, and Vanderbilt University Hospital, began discussions on how they might collaborate with each other to improve health care delivery in Davidson County and middle Tennessee.
“The first task we had with Middle Tennessee was, should we piggyback on Memphis? That’s where the leadership of the hospitals and health systems in Middle Tennessee first thought we should go,” says Janet King, executive director, MTeHC .
Ultimately, the decision to combine with MidSouth eHealth Alliance was not pursued, and so an RFP was distributed to multiple vendors in late July 2009, with a selection process planned for that fall. At the request of the newly formed HIP TN Board, MTeHC vendor selection activities were placed on hold in September 2009 because of the imminent passage of the American Reinvestment and Recovery Act/Health Information Technology for Economic and Clinical Health (ARRA-HITECH) Act. The State of Tennessee received in $11.6 million from the State HIE Exchange Cooperative Agreement Program, and none of that funneled to MTeHC. So in December, the MTeHC Board re-started their planning effort and chose technology partner Informatics Corporation of America (ICA) to move forward.
MTeHC is now in the process of connecting eight hospitals to the exchange and preparing three safety net hospitals to on-board next. Data exchange is expected to begin mid-year. MTeHC offers providers access to the patient records from other participating organizations to support care delivery processes.
The HIE also provides LOINC (Logical Observation Identifiers Names and Codes) coding for labs, and focused on the top 25 labs ordered in the ED to do LOINC coding across 14 hospitals. “From one hospital they might get a CMP [Comprehensive Metabolic Panel ], and from another hospital they might get a Chem 12 [blood test]; and those two have some components that are the same, but they may not be all the same,” says King. “We were able to go through that LOINC coding to be able to set them up as comparable results and be able to trend that. So it is a single view for the provider.”
In the future, MTeHC plans to offer a personal health record (PHR) for organizations that may not have the funds to create their own. “If you look at economies of scale it would be better to have a product like that at the HIE level, at least for the organizations who could spend their dollars a different way to benefit their patients more,” says King.
In late July, MTeHC is poised to link to HIP TN to transmit vaccine records to the statewide immunization registry for providers to access a full immunization record for their patients. Another future goal is to have a state-level medication history and to connect other care providers like long-term facilities and specialty clinics. In Q4 of this year the exchange plans to connect with NwHIN.
Finding a Subscription Model that Works
King doesn’t see MTeHC heading down the same path as the recently departed Carespark, a Northern Tennessee-based HIE which folded in July 2011 due to its inability to transition from a grant- and contract-based nonprofit organization to a user subscription and revenue sustained entity. MTeHC’s model is very different from the CareSpark model in both total cost to operate and focus of operations, says King.
For initial funding, MTeHC received start-up financial support from the state, and participation fees from its core hospital contributors. In early 2010, MTeHC received a one-time $150,000 grant from health insurer Cigna (Bloomfield, Conn.). “Our plan is to jointly work with the other regional HIEs in the state and the state Office of eHealth to discuss and determine with the payers what services we can provide that they are willing to financially support,” King says.
MTeHC will have a subscription model, based on inpatient and outpatient admissions, that won’t be cost prohibitive to rural hospitals, King says. “We weren’t going to try to fund it on the backs of the hospitals that would subscribe to participate, so we came up with a model that we thought was affordable by small and mid-ranged hospitals that would want to connect with us,” she says.