HIE: Sustainability Crossroads

Sustainability is the buzz word of the summer, as health information exchanges (HIEs) are pondering this tall order. Not only are HIEs facing this challenge, so are the organizations entrusted to dole out the health IT funds from the Health Information Technology for Economic and Clinical Health (HITECH) Act. One of these state-designated entities, Cal eConnect, an Emeryville-based non-profit designated by the California Health and Human Services (CHHS)to oversee the development of HIE policies and services in California, is charged with distributing HIE grant funds, as well as creating new products and services to support state HIE efforts. Cal eConnect incorporated in March 2010, with a board made up members of two pre-existing HIE boards: San Francisco-based California Regional Health Information Organization (CalRHIO) and California eHealth Collaborative (Walnut Creek, Calif.). So far, Cal eConnect has awarded HIE funds to four organizations: Orange County Partnership Regional Health Information Organization (OCPRHIO), $795,761; Los Angeles Network for Enhanced Services (LANES), $996,070; Redwood Mednet, $476,900; and North Coast Health Information Network (NCHIN), $200,105.

Currently, Cal eConnect is working on several projects, including assessing the challenges and barriers of lab interoperability. The organization is also performing an assessment for a provider directory service, as well as a issuing a request for proposal for help with its infrastructure. HCI Associate Editor Jennifer Prestigiacomo spoke with Carladenise Edwards, Ph.D., Cal eConnect’s president and CEO, about these projects and what new revenue streams her organization is exploring to sustain itself. Here are excerpts from that discussion.

How is your organization working towards sustainability?
HIE sustainability is a hot topic. I don’t think we’ll ever have a board meeting without that front and center. Because one of the things they’ve charged us with the funding is coming up with a sustainability plan. The stimulus funding intended to stimulate; it wasn’t intended to sustain. How do you sustain this effort so that our tax dollars are used for the best and we get what we paid for? We have been working with Deloitte and CHHS on what are some of the options on sustaining HIE based on the plan that California put out. We actually won’t have our business plan and sustainability report completed till October.

What are you working on with lab translation services?
Preliminarily, what we did was kind of a landscape. We found that, as of today, there are not that many HIEs that have strong or valid business plans. The majority was dependant on grant funding, and the ones that weren’t 100 percent dependant on grant funding, had other lines of revenue which typically related to doing translation services, primarily for labs. That’s a hot topic. You want to get the lab information from point A to point B electronically. One of the challenges is with the new standards that are being developed for interoperability, it’s trying to get away from scanning and faxing. If that has been the sustainability model and the value proposition for the existing HIEs, then those HIEs are going to be in trouble. So it was a little disheartening that we weren’t able to borrow from somebody else’s great idea about how to sustain HIE, because there really wasn’t one out there.

Lab translation is still going to be huge; it’s a matter of now not just taking paper documents and scanning or faxing them, it’s a matter of coming up with the appropriate implementation guide and transport language/protocols, and then creating a consistency across the enterprise. What keeps coming up is how to do bidirectional immunization reporting. If you think about all the players that are involved in the immunization report pool—public health department, physician practices, hospitals, parents with children who are in the middle of that equation—so we’re really excited about looking at ways that we can bring some value to sharing of immunization records

What about other alternate revenue streams like provider directories, or eligibility and credentialing services?
The outcome [of the Deloitte and CHHS consulting process] turned out to be a list of the business options for Cal eConnect that could help us sustain the core infrastructure. One is trying to provide this trusted network, or framework, for exchanging data that is structured and secure. That was really confirming the provider directory approach that we decided to launch. Now we’re deep into trying to explore and identify the value propositions and build revenue models on some of these other exchange services that we think we can deploy. I hope we’ll have some of that data in front of our board by August.

Other [revenue streams include] eligibility and credentialing services. The health plans and the hospitals consider this to be the bane of their existence. If there is some way that Cal eConnect can do it faster, friendlier, easier once we’ve developed this provider directory—that in essence houses all this information for providers. Is there a way to bring value to the health plan helping them with eligibility, and hospitals with credentialing?

Is your organization incorporating Direct messaging in any future projects?
One [possible revenue stream] that excites me the most is kind of new age and out there—using the Direct messaging and protocols to populate PHRs. If there was a way from the physician EMR, to directly populate the PHR, I think that people would get patients more engaged in their healthcare delivery. I think there is a huge potential out there to do something innovative [in this space].

These business propositions and ideas will be submitted to the board for us to determine the revenue streams for Cal eConnect and what products and services we should sell. Then, we’ll produce a sustainability report that will go to the legislature in October.

The thing that is so interesting about exchange is that it’s kind of like a pipe, or the wires behind the TV. No one really wants to pay for that. They want to pay for the outcome, but they don’t want to pay for the infrastructure. Trying to build a business off of infrastructure is really, really hard.