A reciprocal opportunity

Mary Stevens, editor, CMIO

During a web presentation last week regarding getting on board the Nationwide Health Information Network, Holt Anderson, executive director of the North Carolina Health Information & Communications Alliance (NCHICA), discussed the requirements for joining and exchanging data. The questions that followed his presentation quickly brought the discussion to familiar territory: Who pays? His answer: All sides, which shows the importance of having a strong business case.

You talked about the significant ‘onboarding’ costs. What are the key ongoing costs associated with the network?
Anderson: We’re talking about several components here. The cost to the community is in putting their interfaces in place, building the [master patient index] and building an adapter so their communities can connect. As new versions emerge, they will continually need to support their interfaces and adapter on their side. When we did an RFP for the gateway, we had nine proposals that ranged from an initial setup of $50,000 to around $800,000 for same specifications for a gateway. For ongoing costs [for] the same nine vendors, the operation range was from $2,500 a month to more than $20,000 per month.

Did the opportunity for stakeholders to exchange information with government agencies factor into your road map with regard to NwHIN?
Anderson: What really drives us at NCHICA [is] we started with a clinical problem. [And we] start with clinical leadership, with physicians who want their practice of medicine to be better informed if they can get information from these other sources. We had tremendous support during phase 1 [prototype architectures and trial implementations] and phase 2 [emergence implementations].

We know [there is a great deal of information] across enterprises and across state boundaries, and we know a lot of this information resides in federal agencies. The provider organizations really stepped to the plate with their clinical staff and tech staff. It was significant commitment on their part to engage.

Q: Has the early group of adopters found any major ‘gotchas’?
A: The up-front costs of engaging are a surprise. I’m not sure we’ve worked through those factors. How do we measure [benefits] of health information exchange vs. costs? What about the liabilities, do we have laws and statutes in place to protect patients from this?

Another [issue] was the business prospect: Competition for patients and dollars is significant, but [it's important to] realize that the No. 1 job of these organizations is care of patients. We’re elevating that as a priority, and yes, we’ll have to share information with competitors sometimes, but it’s a reciprocal opportunity.

Are you investigating a connection to NwHIN? Let me know at mstevens@trimedmedia.com

Mary Stevens, Editor