With the federal programs in place under the HITECH Act, hospitals feel pressured and rushed to purchase an HIE platform, according to Ed Duryee, CIO of Elyria, Ohio-based EMH Regional Healthcare System. "We're in the throes of deciding how to get into the HIE game," he said.
Duryee spoke at the Healthcare Stimulus Exchange Conference in Chicago in late June, where executives found common themes in health information exchange ROI and benefits, as well as challenges and barriers.
Duryee's independent two-hospital system, which also includes a number of outpatient facilities, is already in major organizational changes. It expects to increase the number of physicians from 11 to 100 by end of year and has made a $20 million investment in core systems and modules. Last year, EMH reached Stage 3 of the HIMSS Analytics EMR adoption model.
Trying to get into the HIE game is easy, but it's expensive to do everything, Duryee pointed out. While some healthcare providers are planning to hook up to the Ohio HIE, no one is expecting speed to market. Duryee said preoccupation with internal EMR implementation to get to Stage 1 of the incentive program, staffing, cost, vendor selection, integration with physician office EMR are all barriers to HIE.
Still, he said, sharing data will help eliminate duplications of tests and procedures, which will drive down the cost of healthcare. "It's where the industry wants to go," he concluded.
"The journey is challenging, but every piece of it is extremely rewarding," said Deb Bass, interim executive director of the Nebraska Health Information Initiative and CEO of Bass Consulting Group.
NeHII is a statewide Web-based HIE that provides a virtual health record, EMR, clinical messaging and e-prescribing through a CCHIT-certified platform. Sponsored by physicians, hospitals, clinics and payers, and funded by license fees paid by participants, NeHII is owned by the NeHII Collaborative and managed by a board of directors.
In its development stage, NeHII received $90,000 in grants and seed capital, with pilot stakeholders investing significant funds for implementation costs, Bass said. Today there are nearly 1.6 million patients and nearly 565,000 requests in the system, with 11.4 million results and more than 9,600 e-prescriptions being sent through the exchange.
The opt-out rate for patients as of the March 30 go-live date is less than 2 percent, Bass said. When patients realize they don't have to deal with clipboards at the physician office, they opt in. "Consumers are ready for this," she said.
Bass said NeHII faced challenges in how it would be run - data-sharing agreements, privacy and security policies, liability insurance coverage and recruitment. However, the success factors outweighed the challenges, she said.
It takes visionary physician leadership, committee structure, focus on patients, entrepreneurial approach, pilot studies, site visits, accountability for milestones and public/private collaboration to overcome the barriers, Bass said.
NeHII's next stage of growth will move away from advertising but incorporate transactional or clearinghouse functionalities - subscription fees, transaction fees, licensing and use fees, and professional services. In its mature stage, NeHII will deliver information for clinical decision support, population health, research and reporting. "There are lots of opportunities here," she said.
Michigan RHIO
The same could be said for Capital Area RHIO in the Lansing, Mich., which serves three counties in the central part of the state and was created as a not-for-profit organization in January 2009. "There is tremendous amount of activity going around because of the stimulus funding," said acting director Valerie Glesnes-Anderson. Developed by Capital Area Health Allicance and representing major healthcare stakeholders and more than 40 organizations in the region, Capital Area RHIO is currently training physicians, finalizing data-exchange agreements and inputting data.
Weaned of grants, the RHIO is being funded by the participating organizations, including Community Mental Health, Lansing Community College, Michigan State University, State of Michigan (Medicaid, Office of the State Employer and Office of State Retirees), Ingham County Health Department, providers and hospitals systems. "It's a reflection of the investment made in the community," said Glesnes-Anderson. Leaders wanted to ensure that public health and research were represented.
Capital Area RHIO developed a "workable but complicated" sustainable model, with the breakdown of financing by sector, she said. RHIO stakeholders estimated cost to build and maintain, and then determined allocation of relative percentages of cost to the participants. An ROI analysis was completed for all 14 major stakeholders.
Despite the common challenges, such as focus on EMR installation and bringing non-EMR physicians into the system, "the activity of the community in general has been extraordinarily good," she said. "The physicians have felt like they've been actively involved in driving this system," Glesnes-Anderson said, which has created a sense of identity and sense of belonging among physicians. That sense of community will be needed as Capital Area RHIO must keep maintaining and proving its value, she said.
