Speakers offer tips for robust, sustainable HIE

When it comes to health information exchange (HIE), each community should phase in its model driven by its own needs and market characteristics, Kim Pemble of the Wisconsin Health Information Exchange, said during a March 13 National eHealth Collaborate webinar that tackled all things related to HIE sustainability.

“A real important message is to engage with your community, to work with them to identify high-value use cases, and see wherever that may take you in that one model of a roadmap,” said Pemble.

In one case study, he said three years ago 46 percent of Milwaukee County Emergency Department visits were classified as non-emergencies. Through an Emergency Department Care Coordination Initiative spearheaded by the Milwaukee Health Care Partnership, they created a common “ED to Medical Home” process at EDs.  Using data from the HIE, they were able to reroute patients, especially those with four or more visits that had made up 31.8 percent of ED encounters, to a better care setting, he said.

This initiative decreased the timeline to get benefits to patients, Pemble said, noting successes in moving diabetic and hypertensive patients away from EDs to the proper specialists.

Complex technical infrastructure is not necessarily required to provide high value HIE services, according to Scott Afzal, HIE program director for the Maryland-based Chesapeake Regional Information System for our Patients (CRISP).

In particular, he pointed to the benefits of HL7 ADT (admit, discharge and transfer) data. While ADT messages are the building blocks of a master patient index, he said they also are an end in-and-of themselves. Of particular value are alerts generated from ADT messages that CRISP receives from all Maryland hospitals.

“Notification services are becoming our most popular service quickly, and they were probably the lowest expense and easiest to deploy in terms of complexity and easily to articulate in terms of value proposition,” he said.

ADT can produce valuable readmission reports. For instance, an ED can receive data on the top one percent of ER visit with non-emergency codes and act accordingly to prevent them in the future, he said.

“We all need to do a much better job of articulating the financial value proposition;” weighed in Jeffrey Rose, CMIO at TriZetto Corporation. ADT capabilities and corresponding reductions in ED visits “monetize that,” he said.

To achieve HIE sustainability, including product development and sales/marketing costs, ongoing investment is required, he said. Major investments in interoperability are of particular importance.

No matter the size of a provider network, he said HIEs are worth the effort and investment. Gaining critical mass in a smaller market is in fact easier, and consequently buy-in comes more quickly, he said.

Other keys to sustainability, he said, include eliminating conflicts of interest among HIE boards of directors and reducing grant-related expenses when grants expire. Rose strongly felt that monthly subscriptions are a better way to charge hospitals for access to the HIE. “As soon as you put in a transactional fee, people wonder how to avoid it,” he said.

Michael Sims, CFO of the Delaware Health Information Network (DHIN), said it took five years for the HIE to achieve near-complete market penetration in Delaware. This saturation spurred increased funding from data senders and payers, and relied on 50/50 state funding support, he said.

Sims said the benefits of DHIN’s provider penetration are threefold: more places to send results from data senders; greater payer benefit; and more customers for value-added fee products. Customers are charged two to ten cents per transaction when seeking a record from the HIE. “Our goal is to make information available in one place at the right time,” he said.

All speakers said they have yet to include mental health and substance abuse data in their HIEs, and make extra efforts to remove any information that tips off a viewer to a certain behavioral condition.