HIE Profile | Competitive Collaboration in Kansas
In June 2010, Kansas Gov. Mark Parkinson signed an executive order creating the Kansas Health Information Exchange (KHIE), a quasi-public agency to oversee the activities of health information organizations (HIOs) that provide health information exchange (HIE) services in the state. One year later, the state legislature passed the Kansas Health IT and Exchange Act (K-HITE), synchronizing state privacy policies with federal ones, such as HIPAA. Now, the intention is to let the free market deliver communities the HIE services they need, and with two HIOs approved for business and scheduled to go live with HIE this summer, Kansas is hoping for success.
“Kansas has encouraged ‘collaborative competition’ because we feel that providers should have choices about which HIO offers the services that best fits their practice,” says Laura McCrary, MD, executive director of the Kansas Health Information Network (KHIN) in Topeka.
With entities in place to provide HIE services and “a governor and legislature that believed in the free market, why not just let the free market handle the situation?” asks Jeff Bloemker, executive director of the Lewis and Clark Information Exchange (LaCIE) in St. Joseph, Mo. “The K-HITE legislation was a phenomenal step that outlined what Kansas believes in and what they want to do, so they made it law.”
The Office of the National Coordinator for Health IT refers to the HIE governance structure in Kansas as an orchestrator model. KHIE’s 17-member board of directors, representing the state’s various stakeholders, draft regulatory policy and approve applications for certificates of authority to provide HIE services. Approved HIOs commit to sharing data with one another and using interoperable transmission standards, and K-HITE protects providers exchanging data through approved HIEs from litigation resulting from inadvertent loss of data.
LaCIE was created in 1984 by Heartland Health, an integrated health network headquartered in St. Joseph with facilities in three states. LaCIE itself serves patients in five states: Missouri, Illinois, Iowa, Nebraska and Kansas, at sites like the Shawnee Mission Medical Center in Shawnee Mission, Kan.
The LaCIE network is a hybrid standards-based, open-source clinical network that is built on simple technology and provides bare-bones HIE services “without the bells and whistles,” according to Bloemker. While LaCIE can supply providers with more advanced functionalities or refer them to someone who can, Bloemker points out that many of Kansas’ cash-strapped rural healthcare facilities can’t afford them. Kansas has more critical access hospitals than any other state with 83, in addition to 12 rural hospitals and approximately 180 rural health clinics.
While LaCIE is 22 years old, KHIN has yet to reach two. Formally established in July 2010, KHIN is the result of the combined efforts of the Kansas Hospital Association and the Kansas Medical Society, as well as other local trade associations and health IT advocates, such as the Medical Society of Sedgwick County, which established the Wichita Health Information Exchange in Wichita to build a community HIE in 2009.
“KHIN offers technical infrastructure so those communities can build their own local HIEs,” McCrary says. “The idea is that each community takes responsibility and ownership. We see this as a way for them to take control. We provide technical policies and procedures and they take it from there.”
KHIN currently supplies secure clinical messaging to approximately 1,500 providers, has signed participation agreements with 45 hospitals, approximately 85 clinics and several laboratories, and is negotiating with other healthcare organizations including mental health clinics and long-term care facilities, as well as exploring a partnership with the Department of Veterans Affairs.
KHIN’s services will cost clinics $125 per provider per year and hospitals will pay different rates based on their size and location; rural healthcare organizations pay less than larger organizations.
As the state approaches a tentative July go-live date for full data exchange, collaboration among all stakeholders has been crucial, but especially between LaCIE and KHIN.
“It has been a collaborative approach,” says Michael Aldridge, MBA, vice president of IT for the Kansas Foundation for Medical Care, which serves as Kansas’ regional extension center (REC) and quality improvement organization. “KHIN and LaCIE have been sitting in the same room together and they should be given a lot of credit for their willingness to work together.”
Bill Wallace, executive director of KHIE, agrees. “The applicants seem to be well funded, they have sound sustainability models, there’s widespread support among stakeholders and we’re comfortable with the technology.”
“The cost of building interfaces with vendors” has been the most consistent challenge, Aldridge says. “They’re our friends, they’re one of the key players, but we’re going to have to get our arms around the costs.”
Active engagement from EHR vendors and the long-time lines for building EHR interfaces has been the most prominent challenge, according to McCrary. “That was one of our early eye-opening experiences. It was an expense that we frankly hadn’t fully taken into consideration for our providers.” KHIN had initially planned to use HITSP standards to exchange data, but because it would take 12 to 18 months for vendors to build the interface, KHIN adopted HL7 standards instead.
Vendors’ costs and time lines aren’t the only challenge. LaCIE, KHIN and the REC still are working together to ensure that the two HIOs’ networks are completely integrated and that silos of information don’t exist, or are inaccessible to providers when and where they need it, according to Aldridge.
In addition, KHIE is completing negotiations with a communications firm to conduct a public awareness campaign beginning this spring. It’s important that Kansas’ citizens “know that HIE is coming to their communities and understand its benefits,” Wallace says. “We’ve got a good nucleus in terms of leadership and commitment from the medical community across the state, but the awareness is not yet there.”
Kansas also will have to decide how to proceed should additional HIOs express interest in conducting HIE business in the state. LaCIE and KHIN are operating on temporary certificates of authority until the KHIE board provides formal certificates this summer. According to Wallace, the board will address the issue of how many HIOs can conduct business in the state, an issue unique to states choosing the orchestrator model to conduct HIE.
“Kansas has encouraged ‘collaborative competition’ because we feel that providers should have choices about which HIO offers the services that best fits their practice,” says Laura McCrary, MD, executive director of the Kansas Health Information Network (KHIN) in Topeka.
With entities in place to provide HIE services and “a governor and legislature that believed in the free market, why not just let the free market handle the situation?” asks Jeff Bloemker, executive director of the Lewis and Clark Information Exchange (LaCIE) in St. Joseph, Mo. “The K-HITE legislation was a phenomenal step that outlined what Kansas believes in and what they want to do, so they made it law.”
The Office of the National Coordinator for Health IT refers to the HIE governance structure in Kansas as an orchestrator model. KHIE’s 17-member board of directors, representing the state’s various stakeholders, draft regulatory policy and approve applications for certificates of authority to provide HIE services. Approved HIOs commit to sharing data with one another and using interoperable transmission standards, and K-HITE protects providers exchanging data through approved HIEs from litigation resulting from inadvertent loss of data.
Inside the health information organizations
Both HIOs are nonprofit organizations that share the goals of reducing healthcare costs and improving quality of care, but their origins and modes of operation differ.LaCIE was created in 1984 by Heartland Health, an integrated health network headquartered in St. Joseph with facilities in three states. LaCIE itself serves patients in five states: Missouri, Illinois, Iowa, Nebraska and Kansas, at sites like the Shawnee Mission Medical Center in Shawnee Mission, Kan.
The LaCIE network is a hybrid standards-based, open-source clinical network that is built on simple technology and provides bare-bones HIE services “without the bells and whistles,” according to Bloemker. While LaCIE can supply providers with more advanced functionalities or refer them to someone who can, Bloemker points out that many of Kansas’ cash-strapped rural healthcare facilities can’t afford them. Kansas has more critical access hospitals than any other state with 83, in addition to 12 rural hospitals and approximately 180 rural health clinics.
While LaCIE is 22 years old, KHIN has yet to reach two. Formally established in July 2010, KHIN is the result of the combined efforts of the Kansas Hospital Association and the Kansas Medical Society, as well as other local trade associations and health IT advocates, such as the Medical Society of Sedgwick County, which established the Wichita Health Information Exchange in Wichita to build a community HIE in 2009.
“KHIN offers technical infrastructure so those communities can build their own local HIEs,” McCrary says. “The idea is that each community takes responsibility and ownership. We see this as a way for them to take control. We provide technical policies and procedures and they take it from there.”
KHIN currently supplies secure clinical messaging to approximately 1,500 providers, has signed participation agreements with 45 hospitals, approximately 85 clinics and several laboratories, and is negotiating with other healthcare organizations including mental health clinics and long-term care facilities, as well as exploring a partnership with the Department of Veterans Affairs.
KHIN’s services will cost clinics $125 per provider per year and hospitals will pay different rates based on their size and location; rural healthcare organizations pay less than larger organizations.
As the state approaches a tentative July go-live date for full data exchange, collaboration among all stakeholders has been crucial, but especially between LaCIE and KHIN.
“It has been a collaborative approach,” says Michael Aldridge, MBA, vice president of IT for the Kansas Foundation for Medical Care, which serves as Kansas’ regional extension center (REC) and quality improvement organization. “KHIN and LaCIE have been sitting in the same room together and they should be given a lot of credit for their willingness to work together.”
Bill Wallace, executive director of KHIE, agrees. “The applicants seem to be well funded, they have sound sustainability models, there’s widespread support among stakeholders and we’re comfortable with the technology.”
Expanding minimal exchange
While the finish line is in sight, the race isn’t over. “The reality is there’s only minimal exchange occurring in Kansas today,” says Aldridge. Obstacles have presented themselves, been overcome and more have appeared along the way to exchange data, with cost as the most difficult hurdle.“The cost of building interfaces with vendors” has been the most consistent challenge, Aldridge says. “They’re our friends, they’re one of the key players, but we’re going to have to get our arms around the costs.”
Active engagement from EHR vendors and the long-time lines for building EHR interfaces has been the most prominent challenge, according to McCrary. “That was one of our early eye-opening experiences. It was an expense that we frankly hadn’t fully taken into consideration for our providers.” KHIN had initially planned to use HITSP standards to exchange data, but because it would take 12 to 18 months for vendors to build the interface, KHIN adopted HL7 standards instead.
Vendors’ costs and time lines aren’t the only challenge. LaCIE, KHIN and the REC still are working together to ensure that the two HIOs’ networks are completely integrated and that silos of information don’t exist, or are inaccessible to providers when and where they need it, according to Aldridge.
In addition, KHIE is completing negotiations with a communications firm to conduct a public awareness campaign beginning this spring. It’s important that Kansas’ citizens “know that HIE is coming to their communities and understand its benefits,” Wallace says. “We’ve got a good nucleus in terms of leadership and commitment from the medical community across the state, but the awareness is not yet there.”
Kansas also will have to decide how to proceed should additional HIOs express interest in conducting HIE business in the state. LaCIE and KHIN are operating on temporary certificates of authority until the KHIE board provides formal certificates this summer. According to Wallace, the board will address the issue of how many HIOs can conduct business in the state, an issue unique to states choosing the orchestrator model to conduct HIE.