HIMSS: Florida writes prescription for HIE sustainability

NEW ORLEANS—Florida prepared for future health information exchange (HIE) sustainability by establishing a strong set of guiding principles, 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, spoke during the Health Information and Management Systems Society (HIMSS) annual convention.

“We built a strong community of stakeholders and established stakeholder committees,” said Fox. “We made a great effort to include everybody and listen to everybody.”

They also implemented two services. The patient lookup service (PLU) is based on the Florida implementation of CONNECT standards that query for records from multiple data sources at the point of care with patient consent. Currently, 20 nodes have been approved for the service and are in the process of facilitated deployment, she said.

The other service is Direct secure messaging which establishes a provider directory and a secure communications network that allows for pushing of data from one source to another.

“Adoption is a moving target,” Fox said, but the numbers are certainly encouraging. The majority of the 67 county health departments have signed up for the Direct secure messaging service as well as six health plans.

The Florida HIE’s plan for sustainability includes the following elements:

• Establish guiding principles
• Perform an analysis of the benefits of statewide HIE
• Establish infrastructure cost estimate
• Formulate pricing models
• Vet proposed models with stakeholders

“It’s been very helpful to lay out the guiding principles and hold to them,” said Fox. They include the following:

• • Encourage adoption. “Participation creates value.”
• • Create a lean infrastructure that delivers value commensurate with costs.
• • Ensure predictable cost.
• • Develop a cost structure that encourages, not deters, use. The HIE has no transaction fees. Participants “pay and play as much as they want.”
• • 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.”
• • Achieve stakeholder buy-in.

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 Aact 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.

Hofmeister said they examined many HIEs and found that in most cases, the payers benefit the most. That created a dilemma because physicians did not want payers to have unlimited access to the data. They came to an agreement that clinicians would allow payers to see data requested through Direct but no queries on the PLU system would be allowed. As a result, payers are not charged to use system parts they cannot access.

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.”

Costs of PLU service participation were estimated anticipating 20 nodes connected but they have 48 applications. They expected to have 10 payers using the Direct secure messaging service, accounting for 33 percent of the statewide ensured or almost 5 million lives. There are now 20 payers participating.

“We want and need payers to join us so we’re taking a hard look at what we’re charging to make sure it’s reasonable.” They’ve also worked to establish a democratic process of how the HIE evolve to build consensus with stakeholders. A website for the HIE offers ROI worksheets, savings calculators and price lists.

Recent studies estimated savings of 41 cents per record by moving from paper-based systems and a reduction in average handling time from 10 minutes to six minutes. Connecticut estimated a 25 percent reduction in readmissions and about $60 million in savings for a medium-sized hospital thanks to access to continuity of care documents by primary care providers. “It’s a big deal,” said Hofmeister.

Going forward, adoption remains extremely important, said Fox. A recent report found that one year less than 20 percent of Florida physicians were aware of Direct and the HIE but one year later that figure is more than 60 percent. The organization must continually follow changing federal requirements, she said.