For years I have been reading (and writing) articles about the challenges nascent health information exchanges face, especially in terms of reaching financial sustainability. And it has always felt like a momentum killer when HIEs such as CareSpark and the Santa Barbara County Care Data Exchange shut down. That’s why it was nice to attend a National eHealth Collaborative University webinar last week to hear some concrete success stories from Rhode Island and Indiana.
Gary Christensen, COO and CIO of the Rhode Island Quality Institute, said that in early 2010, when RIQI was about to take responsibility for the technological build-out of currentcare, Rhode Island’s statewide HIE, there was a flood in the state and the data center housing the system was destroyed.
“What we assumed would be the transfer of a fully functioning system turned into a blank sheet of paper we had to start over on,” he said. But since then the Direct Project has been the major enabler of the system’s growth, Christensen said. He added that the currentcare HIE team started from a straightforward use case of point-to-point referrals using Direct, and has added extensions once users are up to speed.
“We can use Direct to send from EHRs to the HIE,” he said. (For that to work, practices need to be populating their EHRs the right way, and RIQI offers consulting help.) Another extension of the baseline network is the ability to send information from the HIE to the EHR in CCD format. “All the information the HIE has from wherever care has happened in the state is available,” he said.
Still another extension is HIE-to-provider notification. When a patient is discharged from the hospital, it can trigger a message to the primary care physician to follow up. Currentcare now gets lab data feeds from all the major labs in the state. It is receiving CCD data from individual practices. It gets medication history data from pharmacies, and by next year all the hospitals in the state will be contributing data. “We have gone from a standing restart in 2011 to 18 clinical data feeds with 5.8 million records,” Christensen said.
John Kansky, vice president for product management for the Indiana HIE, said the key to Indiana’s success is to keep the focus on providing value to customers. “We approach it and sustain it as a business,” he said. Afilliated with the Regenstrief Institute, the HIE connects 90 Indiana hospitals. And 19,000 physicians use it.
Perhaps its most valuable services is DOCS4DOCS, which provides physicians lab and radiology results in a web-based inbox.
The Indiana Network for Patient Care is a clinical data repository that has grown to have data on half the state population. It is primarily used in emergency departments. Clinicians can send an inquiry and get back a summary of the patient’s clinical data. “It informs clinical care to improve quality and reduce costs,” Kansky said. IHIE also offers a service that enables hospitals and physicians to electronically share clinical images.
IHIE's Quality Health First is a chronic disease management and preventive care program that helps physicians identify and prioritize health screenings and provide early interventions. Providing pay-for-performance data to payors, it now has more than 1 million patients enrolled out of 6.4 million in Indiana.
Lynne Dunbrack, an analyst with IDC Health Insights, recently identified some best practices for HIEs, and the top three seem to line up well with Indiana’s model of running it like a business service from day one:
1. Plan for sustainability from the beginning.
2. Define the HIO’s goals and objectives, before beginning the system search.
3. Demonstrate value early by prioritizing high value data and functionality.