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The Value of Early Stakeholder Engagement

October 31, 2011
by Gabriel Perna
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NeHII, Nebraska’s statewide HIE, has gotten off the ground thanks to early participation by physicians and organizations

Last year, Healthcare Informatics received many submissions as part of our annual Healthcare Informatics Innovator Awards Program, which recognizes leadership teams from patient care organizations—hospitals, medical groups, and health systems—that have effectively deployed information technology in order to improve clinical, administrative, financial, or organizational performance. While three organizational projects won and received honors at last year’s HIMSS conference in Orlando, Fla., plenty of other laudable submissions impressed us as well. Here’s a look at one of last year’s finalists, the Nebraska Health Information Initiative (NeHII), a statewide health information exchange based in Omaha, Neb.

There was nothing easy about the launch of NeHII, Nebraska’s statewide health information exchange, (HIE) according to CIO Deborah Bass, R.N.

The HIE was first proposed in 2005 by several health organizations in the state that had expressed a need for an information exchange to improve patient care. While the initial group had enough stakeholders involved, it stalled for varying reasons, including cost and failed business plans, says Bass. “As what happens a lot with these kinds of projects, people begin to question whether or not it is realistic and if it can be done,” Bass says. “It truly is a mountainous task when you first look at health information exchange.”

From there, with her background in nursing and IT consulting, Bass was brought in as CIO. Her involvement, along with a critical decision accelerator meeting in 2007, which involved all important stakeholders, helped move the HIE along quickly. In the span of two years the NeHII business plan was rewritten, a request for information (RFI) was initiated, a request for proposal (RFP) was written and a vendor Axolotl, Inc. (San Jose, Calif.) was chosen.

By March 2009, NeHII was running a 90-day test pilot that included several major hospitals in Omaha. The successful pilot led to statewide implementation in July of that year. In September ’09, the State of Nebraska named NeHII the statewide integrator of HIE.

Today, the HIE encompasses more than 1.9 million patients , including some in neighboring states, and it has nearly 1,500 healthcare professionals on board with a goal of 1,800 by the end of the year. It recently added 14 Critical Access Hospitals in rural locations to the exchange, with more expected to come says Bass. She says the organization is now offering consulting services for other states that are trying to get their HIEs off the ground.

Bass recently spoke with Gabe Perna, assistant editor at Healthcare Informatics, to talk about the success of NeHII. Below are excerpts from that interview.

Deb Bass

How has NeHII helped its stakeholders achieve meaningful use?

Stage 1 talks about the ability to share information across disparate systems; it can be in an electronic format. But Stages 2 and 3 definitely have elements of health information exchange. So for instance, connecting to the state immunization registry, that is a requirement of meaningful use. We offer physicians the ability to do that as well as e-prescribing, the ability to send lab and x-ray results – all of those occur over the health information exchange.

For those 14 critical-access hospitals, they are working to connect with their clinics, and NeHII’s HIE gives them the master-patient functionality. This allows them to connect with their clinics even if they have different EMRs. We give them master-patient index for $750 per month, so they don’t have to buy the expensive one. That’s huge ROI (return on investment) for those small hospitals and it helps them achieve meaningful use.

Speaking of ROI and cost, how have you been able to prove to organizations that this is a worthy investment?

We have developed value statements. From there we developed use cases, and then we applied formulas to demonstrate ROI. On our site, we can demonstrate money we can save your organization. It’s a unique situation; they still have to spend dollars to implement health information at this point. That’s why these demonstrations of ROI are so valuable. That’s what we have to focus on to show the value of HIE.

What role did Dr. Harris Frankel, President of NeHII’s board of directors, play in reaching out to the physician community and getting them on board?

He’s been involved in this project since 2005. Many states have implemented great systems but they can’t get doctors and physicians to use them. You have to have that physician engagement. That’s where Dr. Frankel has been so important. He helped give me contacts in the physician community to enlist those early adopters and then from there, you’re constantly working these circles of physicians to get them to use this. Dr. Frankel opened up doors for us.

What does getting them to use this HIE involve?

It’s one-on-one training, support and contact and you have to get them when they are available. It’s early hours and after hours. It’s really working with that physician to demonstrate ease-of-use and also the value they will see. It’s fun when you win over someone who was tentative and suddenly they become a spokesperson.

What are your selling points in getting organizations, such as the 14 Critical Access Hospitals, on board?

The biggest selling point is we are the universal portal. By using NeHII, they don’t have to develop one-on-one portals for those that want to access electronic information. We maintain and support those portals. Now with HITECH and concerns about cyber security, we work with them on portal access to address those concerns. We address the auditing. We work their data, to help them with integrity of that data. If we see an issue with unmatched reports, we’ll report it to them. Because we work with so many facilities and software applications, we get to be the masters of data and how it flows.

What advice can you give to states that are just getting their HIEs off the ground?

You need broad stakeholder engagement and input. Have everyone involved early on. Major players are important, they sit on many boards and can be influential. And copy as much as you can. Look at what other states have been doing. Look at who has been successful. We offer our operational manual, policies. You can spend a lot of time and dollars if you start from scratch on everything, so all of us are open and willing to share things.

Where does NeHII go from here?

Our goal is to have 80-percent adoption of physicians, hospitals, health systems – all of the participants – within three years. Our original goal was 80-percent adoption within three years of July 2009. But with meaningful use, we’ve had to redo things. So I would like to say by July of 2013 we’ll have public health, immunization gateway, disease surveillance reporting and 80 percent of participants involved in a fully functional health information exchange across the state. We’d also like to help our neighbors across other states so we can become regional and hopefully someday there will even be a national health information exchange.

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