Health information exchanges can help solve problems that plague the healthcare system, an executive with one of the country's oldest community health information exchanges told attendees at the National Regional Extension Center/Health Information Exchange Summit West in San Francisco on Oct. 5.
Getting that message across to all stakeholders and demonstrating real-world solutions are the challenges and tasks of HIEs, said Trudi Matthews, director of policy and public relations for HealthBridge.
The health information exchange, which was founded in 1997 and serves the Cincinnati region, is financially sustainable, thanks to its business model of offering multi-services and products.
HealthBridge's "results delivery" service sends out 3 million clinical messages monthly. HealthBridge also provides ambulatory order entry, e-disease reporting and public health alerts, e-prescribing and medication management, and quality reporting and registry.
HealthBridge delivers summary record exchange through its Social Security Administration pilots and Centers for Medicare and Medicaid Services C-HIEP project, and basic and comprehensive EHR services through the launch of its Tri-State Regional Extension Center.
The HIE averages between 5 and 8 percent return, which is reinvested into the nonprofit, community-based organization. HealthBridge boasts total healthcare cost reduction of $20 million, with 2009 costs reduced by $6 million.
HIEs need to be treated like a business, and grants should be treated like capital or investments, not used for operations, she said. In the pre-American Recovery and Reinvestment Act environment, 97 percent of HealthBridge's revenues came from fees, with only 3 percent coming from grants.
Leaders must think like hospital or large practice CFOs and apply costs to internal budgets, and they need to ask themselves if the service can be defined in a budget line or department, where it can cut out costs, Matthews said.
While HIEs should start small with funding and with payer or hospital funding, hospitals and labs should fund the largest piece of the results delivery service because they are the main benefactors. "Get them to write a check on the front end," she said.
Matthews gave additional advice:
- Automate paper-based or labor-intensive processes.
- Conduct IT collaboration across sites and leverage where you can so avoid reinventing the heel.
- Balance between choosing experienced vendors without spending a fortune.
- Consider deploying open-source tools.
- Size matters; collaborate with other markets to reduce costs and develop a large network.
- Sequencing of services is critical, Matthews said. Portals should be developed first, then follow with other services such as public health reporting, order entry and so on, she said.
Although state HIEs will receive federal funds, they will need to charge early to fund operations and charge based on value received, she said.
There are numerous funding opportunities ahead, including quality improvement, care coordination and performance measures, and federal agency data exchange projects, Matthews said.
HIEs can prove very valuable in this ARRA environment by helping to drive EHR adoption, she said. Adoption becomes inevitable when small independent practices receive data from HealthBridge directly into their EHRs, she said.
