Sustainability takes careful planning, hard work

There were numerous educational sessions focused on health information exchange (HIE) during the Healthcare Information and Management Systems Society’s 2013 annual convention.

While most speakers offered tips for success, not everyone is moving along the path toward sustainability. For example, Denise O'Hora Webb, MA, Wisconsin’s state health IT coordinator, admitted that the state’s HIE is “in serious jeopardy. We only have a little more than six months left until the September funding expiration,” she said. 

With funding from the Office of the National Coordinator for Health IT, the state planned and designed a State-Level HIE business architecture and underlying governance structure, and a statewide technical architecture for HIE. Wisconsin’s Department of Health Services entered into a contract with Deloitte Consulting on May 11, 2009, to complete the project. 

However, Webb expressed difficulties in getting buy-in from providers throughout the state. To be sustainable, she intimated that private investments might be necessary. 

Speakers from the Florida HIE explained that they prepared for future sustainability by building a strong community of stakeholders. “We made a great effort to include everybody and listen to everybody,” said Heidi Fox, MS, HIE project manager for the State Agency for Healthcare Administration.

Fox and Janet Hofmeister, BSCS, PMP, program manager, Florida Health Information Exchange, Harris Healthcare Solutions, said establishing—and sticking of—a set of guiding principles was crucial to a successful exchange. The principles include encouraging adoption, said Fox. “Participation creates value.” Develop a cost structure that encourages, not deters, use. Share costs among organizations that benefit. “That’s challenging but that’s our commitment.” Openly communicate costs and benefits. The HIE did this early on and it really helped, Fox said. “The more you can establish what you want to do, what it will cost and sell it to stakeholders, people will get over the sticker shock.”

There were several initial challenges to sustainability. For example, the requirement for Direct implementation was established just as the organization was issuing its contract with the Harris group, Fox said. That brought about new infrastructure costs which took more than half our resources, she said, to implement and refine. However, it brought new participants on board for a source of funding.

Also, the American Recovery and Reinvestment Act's State HIE Cooperative Agreement funding was originally slated to go until March 2014, but was changed to September 2013. “That doesn’t give us as much time to move this out and get the use that’s critical to sustaining the project.”

Despite the challenges, the Florida HIE does not anticipate the need for any future government or grant funding.

The benefits to participation are still significant, Hofmeister said. Time transferring records per physician has decreased by 80 percent and duplicative procedures were cut in half. Lab administrative costs avoided per person per year were calculated at $36.22. These numbers are anecdotal but are impressive for an HIE that has estimated annual costs of $2.32 million. “That’s very low and easily paid for in a state as large as Florida.”

Is there a sustainable HIE in your region or are there funding challenges threatening its success? Please share your experience.

Beth Walsh

Clinical Innovation + Technology editor

bwalsh@trimedmedia.com