Webinar: Successful HIEs disseminate funds in disciplined manner

Successful health information exchanges (HIEs) tend to charge per subscription, rather than per usage, which could potentially discourage data sharing, according to a report released from National eHealth Collaborative (NeHC),  which includes case studies from 12 sustainable HIEs.

“With a new environment of increasing accountability in healthcare, the need for effective, sustainable HIE to improve quality, care coordination and cost-effectiveness is becoming even more important,” Kate Berry, CEO of NeHC, said during a webinar. “This report distills the critical dimensions required for a successful and lasting HIE operation and is intended to contribute to a cohesive national roadmap for nationwide HIE. We believe others will learn from the triumphs and challenges of these 12 HIEs.”

The report, titled, “Secrets of HIE Success Revealed: Lessons from the Leaders,” examines 12 successful HIEs, and explores extensive interviews with HIE executive leaders. The HIEs in the report represent for-profit entities, nonprofit entities and a government agency. The 12 organizations were chosen based on their innovative strategies and business models, the value and impact they have in their respective communities and their maturity in achieving sustainability, Berry said.

The HIEs highlighted include: Big Bend RHIO, HealthInfoNet, Quality Health Network, Taconic Health Information Network and Community, HealthBridge, Sandlot, MedVirginia, Inland Northwest Health Services, Rochester RHIO and SMRTNET.

Berry said that gaps in the use of interoperability standards remain a challenge for these HIEs; something that was echoed in an earlier eHealth Initative report.

“The complexity of managing patient privacy and consents are an ongoing challenge, as well as developing trust, competition and limited proof of benefits,” Berry said.

Some common HIE business models that have shown success include participants who are paying fees to connect. “Physicians and hospitals typically pay subscription fees rather than transaction fees, which tend to discourage the use of the information,” she said. “Health plans, labs and other data suppliers pay fees typically based on their size and the volume of the information. In some cases, payors are contributing most of the HIE operating costs.”

Berry described these 12 HIEs as being “disciplined” in how they use grant monies. “They segregate grant funds from operations and invest in their strategic initiatives,” she said. “The grants are not expected to be used for their operations.”

Most of the HIE leaders said they are using multiple approaches to connectivity and exchanging data with organizations with whom they share information. “Two-thirds of the organizations will be connected to the Nationwide Health Information Network, and are doing so now to exchange information with Veteran’s Administration facilities, Social Security Administration, Beacon communities and other HIEs. And, these HIEs are always thinking of new ways to create value for their participants,” Berry said.

HIEs also are expected to grow geographically by expanding their service offerings. Keith Hepp, interim CEO, vice president of business development at Cincinnati-based HealthBridge said in an interview that there were other HIEs in the company's geographic area that had wanted to “leverage the technology and didn’t want to recreate the wheel.

“Other communities, including CCHIE in Ohio and Healthlink in Indiana, have their own status as a 501(3)c organization, but who wanted to communicate seamlessly with us and are interconnected to us,” but who maintain their autonomy, Hepp said. “What we have found is that the more the communities control their destiny, the more they’re going to interconnect. One of our core beliefs is that if an HIE remains unique, then where we connect with them is in sharing the technology.”

Kimberly Alise, CEO at Sandlot, an HIE in Fort Worth, Texas, said her company is looking to expand its geographic reach into north Texas. “We are also looking to enter new markets in other parts of Texas and potential markets in the Midwest,” she said. 

“The NeHC HIE project is timely to several hundred new HIEs who are just now getting underway across the country,” said Mark Jones, COO and principal investigator of SMRTNET, an HIE based in Oklahoma. “While every HIE project is unique, they all share the same problems of participation, value, security, growth and especially sustainability. Widespread distribution of the solutions and lessons learned from the real world success stories regarding these issues from the NeHC report could have a major impact in helping to assure the efficiency and success of these new efforts.”

Jones said the core group who created SMRTNET consisted of physicians who became part of a statewide medical association network. “There was this approach to using an organized base to create the network, but focusing on the ability to share data in a community was important. We wanted to have 30 or so small communities develop, and create a community based on health improvement organization that would expand the geographic reach from there.”

During the first year of SMRTNET’s existence, as an outgrowth of an AHRQ grant, “it became clear that U.S. healthcare was going to have to be a network of networks. As we worked with our customers, what evolved was a network for the state medical association for optometry, hospitals, the uninsured and tribes,” Jones said.

“We developed this methodology to create networks within 60 days with two meetings, and it has been adaptable. How do you do a network of networks when each network wants to govern itself? It’s a representation that is very interested in controlling the future use of their data with other organizations and payors. They have common interests around EHR vendors. And, all the networks share two members on the SMRTNET management committee. What we all share is security, mutual use of data, sustainability, common technology and marketing,” Jones said.

“We are delighted to have been selected to participate in this project. Maine has always been an early adopter, innovator and supporter of health IT, and we’re proud to be highlighted as a leader in NeHC’s report and to show our state’s progress in this area,” said Devore Culver, executive director and CEO of HealthInfoNet.

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