HIEs get a new evaluation framework
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The center assessed the DC Regional Health Information Organization (DC RHIO), the District’s primary health information exchange (HIE) and from this research developed a general evaluation model to assess the value and sustainability of any HIE.
“HIEs have been a hot topic for the past several years,” said Ritu Agarwal, PhD, co-author of the framework, professor and dean’s chair of information systems and director of the CHIDS at the Robert H. Smith School of Business at the University of Maryland in College Park, in an interview. “We know that the federal government has provided a lot of resources [toward setting up HIEs]. Unfortunately, in the last decade or so that these HIEs have been around, there hasn’t been a lot of evidence of whether they are sustainable and can exist in the long run.”
“The DC RHIO Current Progress and the Road Ahead,” published in September 2010, was an assessment report based on the CHIDS HIE Evaluation Framework, and offers a methodology for assessing any RHIO across the nation.
The research and associated recommendations are based on the information and documents provided by key stakeholders of the DC RHIO, an environmental scan of HIE efforts across the nation, best practices published in literature and benchmarking with three HIE efforts.
DC RHIO uses Microsoft’s Amalga Unified Intelligence System to connect six community health centers and two hospitals with two additional health centers. Two more hospitals are in the process of adopting real-time access to shared EHRs, according to a statement from CHIDS.
Value and sustainability are the focal points for the framework. “The key to RHIO sustainability is to identify sources of value for each stakeholder group, create services to deliver the value and monetize that value through appropriate pricing,” according to CHIDS. “A sustainable HIE reflects a situation where the costs and benefits of HIE are constructed so that ongoing HIE operations are funded based on the value generated from HIE.”
Factors influencing stability include transaction efficiency, ability to quantify value and the presence of competition. According to P. Kenyon Crowley, MBA, MS, associate director at CHIDS, at the base of value and sustainability of an HIE lies four interlocking components:
- Governance: Appropriate governance is a critical factor for the HIE as it defines the roles and functions for the top management, determines organizational structure and operational strategy to achieve the objectives, according to Crowley.
- Community Engagement: Evaluates whether the RHIO has been successful in engaging a sufficient number of participants to ensure a viable financial model. Some metrics can include market penetration (number of participating hospitals and number of connected health records) and community involvement (willingness to participate in improvement efforts and unsolicited suggestions for improvement), said Crowley.
- Public Trust: High levels of public trust are the foundation for sustainable and successful RHIO for both participating organizations exchanging data and healthcare consumers. Some examples of metrics for this include existence of privacy policy, nature of consent and quality of security precautions.
- Technology: Metrics to measure the design and user acceptance of the technical features of the tool.
"Getting these HIEs to stand up and be utilized is the first step in meaningful use,” said Agarwal. “The value of the framework is that if an HIE wants to ask ‘how are we doing,’ [the organization] can use the framework for a self assessment or for benchmarking. The value really occurs on a longitudinal basis to ascertain if the organization is moving in the right direction or not. Continual monitoring is a performance assessment tool.”
“As we better understand the services that are most valued in a community and are able to share the impact of those services on patients, health organizations and clinicians and share them with other HIEs, that will help favorably impact the growth of the industry,” concluded Crowley.
Read the report here.