HIE in 2013: Climbing past the low-hanging fruit

Unlike western and central Pennsylvania, providers in greater Philadelphia are not linked by a health information exchange, perhaps because until recently there wasn’t a huge need for one among uber-competitive, highly-rated providers like the University of Pennsylvania Health System and Hahnemann University Hospital.

Now though, providers in and around Philadelphia are in the late stages of planning for HealthShare of Southeastern PA, developing governance and funding models and hoping to have a rough framework by February, said Michael Restuccia, University of Pennsylvania Health System CIO.

“Then we can push it forward from a use case perspective,” Restuccia said. About 20 hospitals are set to participate by 2014, with two use cases initially: medication history lists and discharge summary.

HIE: The industrialization of healthcare

With a new focus on, and in some cases requirements for, healthcare cost control and quality improvements, 2013 is likely to bring the formation of HIEs long coming — like one in greater Philadelphia — and the standardization and improvement of ones in existence. Indeed, some observers think HIEs, especially state-based exchanges, need to prove their value.

In Philadelphia there’s “an aggregation of entities, which all have different cultures, and there’s a lot of competition,” said Hahnemann physician liaison Thompson Boyd, MD. That’s in large part why the region never developed an HIE, compared to western and central parts of the state, where the dominant providers, UPMC and Geisinger, created their own HIEs.

“We have been in negotiations with a common regional HIE for at least three to four years, and probably longer than that,” Boyd said. “Now we’re having people at the table who probably wouldn’t be found at the table a couple of years ago.”

The post-health reform landscape and financial pressures that have been simmering for a while are large drivers, he said. “The margins that we have are slimmer and we have to do better with less.”

“One of the most important issues we face right now is transitions of care,” Boyd continued. “When our patients leave the hospital, they either go home or to a skilled nursing facility or to a long-term care facility. Our ability to communicate with that receiving provider really needs to be enhanced.”

Philadelphia providers are starting to realize that “if they’re going to stay in business, they’re going to have to communicate with each other,” Boyd added. “The silos are going to have to be broken.”

Breaking down those silos while using HIE for business value is necessary for the “industrialization of healthcare,” Scott Lundstrom, group VP at the Massachusetts-based consultancy IDC Health Insights told Government Health IT during an interview.

“Healthcare is the last craft industry,” Lundstrom said. “We’re going through a process now where we can’t afford that anymore. The reality is we’re starting on a 20 year industrialization cycle, and we’re just in the formative days.”

That means HIEs are going to have to develop use cases beyond just patient look-up services if they’re going to survive, and more than that, deliver value.

Lundstrom thinks a lot of state-based HIEs have a business model problem, in that they’re focusing largely on regulatory compliance and simple use cases, while missing the demand for more enterprising exchange and analytic services.

“Integrated delivery networks are using HIEs to create a single view of the patient across their payer and their provider business. Payers are using HIEs as the basis of their care management systems,” Lundstrom said.

HIEs already eyeing value-added services

A number of state-designated HIEs are offering exchange services that ensure a revenue stream and also bring clinical value.

The Delaware Health Information Network (DHIN) is creating business lines with insurers and the government, in addition to its exchange services for labs and providers. DHIN is currently floating ideas for new services and pilots — potentially doing hospital readmission analysis, for instance. The HIE is doing a five month medication history pilot service for providers, using federal funding to study medication history of patients in the DHIN system, which includes almost every Delaware resident and a few thousand from neighboring states.

Created by the state legislature as a private nonprofit in 1997, DHIN is aiming to generate 100 percent of its revenue from service fees during its current fiscal year, which ends in June.

“We’re expected to generate revenue and turn a profit,” Michael Sims, DHIN CFO, said. “Our goal is to be really self-sustaining.”

Other state-designated HIEs working to create a viable business model include HealthShare Montana and Maine HealthInfoNet, which is launching a statewide clinical-claims data warehouse.

In addition to provider exchange services, HealthShare Montana is using the i2b2 open source software as a basis for a statewide clinical repository and analytic software that William Reiter, MD, an internist and the HIE’s CMIO, hopes to use for comparative effectiveness treatment.

Reiter thinks the analytic potential of HIEs will get physicians much more interested in the meaningful use of health IT. When Reiter gives presentations to physicians around the state, “they’re fast asleep” when he talks about meaningful use criteria. “They consider that more of an administrative rather than a physician thing. When we start talking about analytics, and when we pull up i2b2 and the docs see what they can do with it and how they can interrogate their own data, it’s almost like literally the audience goes wild.”

Indeed, Hahnemann’s Boyd said that Health Share of Southeastern PA’s “low hanging fruit is not doing the unnecessary duplication.”

“The whole idea of having rules and incredible amounts of data to be able to drive the physician and provider decision-making right at the patient level is going to be incredible,” Boyd explained, pointing to Mentioning HIMSS clinical business intelligence initiatives as one example. “Docs, physicians, providers love to look at data.”

 Thompson Boyd, MD, is physician liaison at Hahnemann University Hospital. This article was first published on Government HealthIT.