HIE Profile: History Factors Into Minnesota HIE Consolidation
An alternative to a bevy of paperwork is attractive. That was partly the case when the Minnesota Health Information Exchange (MN HIE) decided to close up shop and consolidate its business operations into the Duluth, Minn.-based Community Health Information Collaborative (CHIC) and it's HIE offering, HIE-Bridge, this summer. Yet, as history goes, to understand the present, one must understand the past.
In 2007, the state of Minnesota passed legislation that allowed healthcare organizations to build a record locator service, a step toward an HIE that details information about where patients have been treated. In 2009, Minnesota's legislation defined a health information organization (HIO) as the type of organization that can be certified as an HIE service provider in the state. An HIO is defined by the state as "an entity that provides all electronic capabilities for the transmission of clinical transactions necessary for meaningful use of EHRs in accordance with nationally recognized standards."
Why did MN HIE decide to consolidate? To become a certified HIO, it had to be a Minnesota-based nonprofit entity. When MN HIE opened its doors in 2008, it began as a limited liability corporation in Delaware, explains Cheryl Stephens, PhD, president and CEO of CHIC. One of the reasons for the MN HIE/CHIC consolidation was the burdensome paperwork and processes required to achieve 501(c)(3) status whereas CHIC had been in the data collection and exchange business since its inception as a nonprofit in 1997. In addition to building out the record locator service, and providing clinical interoperability and exchange, CHIC also is a participant in the Nationwide Health Information Network (NwHIN), currently renamed the Direct Project.
"CHIC was made self-sufficient because its value to the community is more than the cost of services," says Clark Averill, board chair at CHIC and IT director at St. Luke's Hospital in Duluth, Minn. CHIC also has signed a contract with the SSA to take part in a pilot program to electronically pull patient's records for disability determination, a project that went live in September. Along with the 267-bed St Luke's Hospital in Duluth, two other CHIC-member hospitals are working with the SSA to determine whether electronically retrieving information about disability eligibility will decrease the cost of hospital and provider operations. "The SSA contract's success and what we learn will allow us to move rapidly into exchanging data," says Averill.
However, disparate data from separate organizations need to talk to each other. CHIC has been working with the SSA since May 2010 to enable interoperability between the data, because SSA has a specific use requirement and CHIC is modeling its continuity-of-care document (CCD) specifically for the SSA model.
The Minnesota Department for Health (MDH) received a $9.6 million award from the Office of the National Coordinator for Health IT (ONC) through the State Health Information Exchange Cooperative Agreement Program/3013 Program. The health department is providing services for the trusted exchange of electronic health information regionally using standards-based components and services. The 3013 Program funds are designed for the development and implementation of strategic and operational plans for statewide HIE through building on an existing statutory framework that enables HIE and establishes a process for state designation of HIOs.
A request for proposals for the 3013 Program funds was slated for release in October (as of press time), though Stephens is not aware how the $9.6 million will be divided in terms of mission or organization. She hopes that CHIC can obtain some of the funding to assist healthcare providers with implementation costs for connecting to HIE-Bridge, CHIC's certified HIO. She also hopes that internal connections built for vendors and connections with its federal partners will lead to subscription rates that are affordable for providers.
The current subscription rate for an integrated delivery network in CHIC is based upon a formula of $150 per bed and $75 per provider, with an additional maintenance fee. Stephens estimates that a critical access hospital could pay between $5,000 and $6,000 annually as a CHIC HIE-Bridge subscriber.
However, the HIE services and federal monies are not the only revenue for the organization. CHIC's curriculum vitae also contributed the spark for consolidation between MN HIE and CHIC. Because CHIC already had connected to NwHIN, and MN HIE had not begun the process, these costs were factored into the decision to consolidate. In a projected 2012 budget, 42 percent of the organization's budget will be coming from HIE revenues, Stephens says. The remainder of the budget will be filled by other long-standing services, such as contracts to provide administrative coordination for emergency preparedness, recruiting and training of providers in the Minnesota Immunization Information Connection and application services for the Universal Services Administration.
From a sustainability perspective, CHIC's initiatives with SSA and NwHIN mean the organization is poised to outlast federal funds, like those for meaningful use. "Part of our sustainability planning included being the conduit to social security for Minnesota, and that helps our services become a value add, something above and beyond meaningful use," Stephens says. "Meaningful use is wonderful, but the funds won't be around forever."
The VA contract has CHIC exchanging clinical records with VLER for active and retired service men and women, which soon will include the ability to push a patient's military records/information and their insurance benefits out to the physician and to pull their data from the private providers into the VLER. "That's another federal contract and a value-add because hospitals get paid a stipend for sharing those records in this program," she says.
However, one question looms: How are MN HIE's data going to be integrated into CHIC? Stephens says MN HIE turned off access to the data as a part of shut down. Through the consolidation deal, MN HIE partners agreed to continue to provide information to HIE-Bridge. CHIC currently is renegotiating its data source contract with the payor groups so that their information can flow into the HIE-Bridge system. Once the contracts are finalized, the switch will be flipped back on so that providers linking to the CHIC system will be able to look up medication history and eligibility information.
In 2007, the state of Minnesota passed legislation that allowed healthcare organizations to build a record locator service, a step toward an HIE that details information about where patients have been treated. In 2009, Minnesota's legislation defined a health information organization (HIO) as the type of organization that can be certified as an HIE service provider in the state. An HIO is defined by the state as "an entity that provides all electronic capabilities for the transmission of clinical transactions necessary for meaningful use of EHRs in accordance with nationally recognized standards."
Why did MN HIE decide to consolidate? To become a certified HIO, it had to be a Minnesota-based nonprofit entity. When MN HIE opened its doors in 2008, it began as a limited liability corporation in Delaware, explains Cheryl Stephens, PhD, president and CEO of CHIC. One of the reasons for the MN HIE/CHIC consolidation was the burdensome paperwork and processes required to achieve 501(c)(3) status whereas CHIC had been in the data collection and exchange business since its inception as a nonprofit in 1997. In addition to building out the record locator service, and providing clinical interoperability and exchange, CHIC also is a participant in the Nationwide Health Information Network (NwHIN), currently renamed the Direct Project.
Prelude to a consolidation
Through NwHIN connectivity, CHIC has contracts with federal agencies to increase its funding. It works with the Social Security Administration (SSA) on the exchange of EMRs for disability determinations and the U.S. Department of Veteran Affairs (VA) on the Veterans Virtual Lifetime Electronic Records (VLER). Also, the Centers for Disease Control and Prevention has contacted them regarding the states, communities and HIEs for a prevention and public health project to share aggregated, de-identified clinical information on specific chronic conditions. Stephens suggests that CHIC can provide value-added services as a conduit to federal agencies."CHIC was made self-sufficient because its value to the community is more than the cost of services," says Clark Averill, board chair at CHIC and IT director at St. Luke's Hospital in Duluth, Minn. CHIC also has signed a contract with the SSA to take part in a pilot program to electronically pull patient's records for disability determination, a project that went live in September. Along with the 267-bed St Luke's Hospital in Duluth, two other CHIC-member hospitals are working with the SSA to determine whether electronically retrieving information about disability eligibility will decrease the cost of hospital and provider operations. "The SSA contract's success and what we learn will allow us to move rapidly into exchanging data," says Averill.
However, disparate data from separate organizations need to talk to each other. CHIC has been working with the SSA since May 2010 to enable interoperability between the data, because SSA has a specific use requirement and CHIC is modeling its continuity-of-care document (CCD) specifically for the SSA model.
The Minnesota Department for Health (MDH) received a $9.6 million award from the Office of the National Coordinator for Health IT (ONC) through the State Health Information Exchange Cooperative Agreement Program/3013 Program. The health department is providing services for the trusted exchange of electronic health information regionally using standards-based components and services. The 3013 Program funds are designed for the development and implementation of strategic and operational plans for statewide HIE through building on an existing statutory framework that enables HIE and establishes a process for state designation of HIOs.
A request for proposals for the 3013 Program funds was slated for release in October (as of press time), though Stephens is not aware how the $9.6 million will be divided in terms of mission or organization. She hopes that CHIC can obtain some of the funding to assist healthcare providers with implementation costs for connecting to HIE-Bridge, CHIC's certified HIO. She also hopes that internal connections built for vendors and connections with its federal partners will lead to subscription rates that are affordable for providers.
The current subscription rate for an integrated delivery network in CHIC is based upon a formula of $150 per bed and $75 per provider, with an additional maintenance fee. Stephens estimates that a critical access hospital could pay between $5,000 and $6,000 annually as a CHIC HIE-Bridge subscriber.
However, the HIE services and federal monies are not the only revenue for the organization. CHIC's curriculum vitae also contributed the spark for consolidation between MN HIE and CHIC. Because CHIC already had connected to NwHIN, and MN HIE had not begun the process, these costs were factored into the decision to consolidate. In a projected 2012 budget, 42 percent of the organization's budget will be coming from HIE revenues, Stephens says. The remainder of the budget will be filled by other long-standing services, such as contracts to provide administrative coordination for emergency preparedness, recruiting and training of providers in the Minnesota Immunization Information Connection and application services for the Universal Services Administration.
From a sustainability perspective, CHIC's initiatives with SSA and NwHIN mean the organization is poised to outlast federal funds, like those for meaningful use. "Part of our sustainability planning included being the conduit to social security for Minnesota, and that helps our services become a value add, something above and beyond meaningful use," Stephens says. "Meaningful use is wonderful, but the funds won't be around forever."
The VA contract has CHIC exchanging clinical records with VLER for active and retired service men and women, which soon will include the ability to push a patient's military records/information and their insurance benefits out to the physician and to pull their data from the private providers into the VLER. "That's another federal contract and a value-add because hospitals get paid a stipend for sharing those records in this program," she says.
Moving forward
The MN HIE/CHIC consolidation will provide better support for meaningful use criteria and minimize the expenses related to infrastructure costs for the HIE. The services provided post-consolidation include access to clinical summary information, immunization information, patients' prescription medication history and eligibility information. The consolidation leaves a single state-certified HIO, HIE-Bridge, an organization serving 10 hospitals, 50 clinics, two long-term care facilities and three federally qualified healthcare clinics. The future state goal for all healthcare settings is to have an interoperable EHR in place by 2015.However, one question looms: How are MN HIE's data going to be integrated into CHIC? Stephens says MN HIE turned off access to the data as a part of shut down. Through the consolidation deal, MN HIE partners agreed to continue to provide information to HIE-Bridge. CHIC currently is renegotiating its data source contract with the payor groups so that their information can flow into the HIE-Bridge system. Once the contracts are finalized, the switch will be flipped back on so that providers linking to the CHIC system will be able to look up medication history and eligibility information.