Health IT Summit: Adding value to HIEs
BOSTON--“I can’t tell you how many times I said no. There was no business case; it was like suicide. But I took the job anyway,” said Devore Culver, executive director and CEO of HealthInfoNet, Maine’s health information exchange (HIE), on why he took the position. He spoke during a panel session at the iHT2 Health IT Summit on May 14.
Seven years later, every hospital in Maine is under contract with the exchange, and it links 400 practices and facilitates 13 million messages. About 90 percent of the state's residents have data in the exchange, he said.
The key to success is tapping analytics and other value-added services, Culver said. “The post office function of an HIE is not a sustainable model. If you are thinking about HIEs like a post office, you’re probably in the wrong business. It’s all about the data."
Critical factors to achieving success include standardizing data to remove variability from data sources, and harnessing data for meaningful analytics. HealthInfoNet, which utilizes a data warehouse that stores and analyzes data in real time, currently is tapping the data to mine four predictors for key events, including risk of admission of the emergency room, probability of admission in six months, the most expensive asset in six months and who will return in 30 days, Culver said.
Vish Anantraman, MD, MS, director of information architecture and interoperability at North Shore LIJ Health System, said analytics is a key function of the private HIE, which is used to “glue together different systems and communicate with external partners.”
Analyzing the data, the exchange culls together data to predictively identify which patients require care management services in real time. “We leverage data as it comes into the HIE,” he said.
“Don’t underestimate the energy that goes into standardizing data in an HIE,” Joe Hamdorf, director of Global VNA Solutions for Perceptive Software, also said. “There is a lot of noise in the data that are not valuable and we’ve been working hard to get that noise out.”
Hamdorf said he believes in the notion of starting small. “We’re finding value in small things that can be aggregated, reported on and actionable” like issues around diabetes, weight loss and smoking, he said.
“You don’t need to do everything to the nth degree,” added Greg Killian, senior director of care management at Siemens. Instead of focusing on millions of pieces of data, HIEs should focus on the hundreds of pieces of data that are actually actionable. This entails an investment in normalizing the data, and bringing evidence-based medicine into its use.
“For example, if you have nine things you can do today to improve outcomes with patients with COPD, you can embed that into the data,” he said.
“One lesson we’ve learned that is that you can kill your user with too much data. We literally had to back off the concept of completeness, as it had no value,” said Culver. “The natural inclination is to dump everything on a user, but you shut people off.”
Instead, he said HIEs need to show “they are more than a fax machine.” One way to show the value proposition, he said, is utilizing an HIE for patient identification.
“You can supply a single identifier with organizations that have multiplier identifiers,” he said.
Pioneer Valley Information Exchange (PVIE) in Massachusetts is in the early stages of providing portals, or patient engagement platforms, layered onto its HIE platform for HIE partners and providers, said Heather Nelson, senior director of enterprise clinical applications & IT operations at Baystate Health and senior director of IT at the PVIE.
“What a great value-added service,” she said. “We’ll give you the portal and you can brand it and add on top of it, but it all comes back to the HIE. We’re generating a lot of energy and excitement in the community on this.”