Joe Heyman, M.D. is an obstetrician/gynecologist who practices half-time and who also serves as CMIO of Whittier IPA, an independent practice association of about 200 physicians based in Newburyport, in the northeastern corner of Massachusetts, near the New Hampshire state line. His own practice is in Amesbury. Whittier IPA encompasses about 40 practices, caring for about 25,000 patients, in that part of Massachusetts.
Earlier this year, Heyman and his physician colleagues came together with the people at Alere Accountable Care Solutions, a Waltham, Mass.-based division of Alere Healthcare, which is focused on helping patient care organizations move forward on health information exchange (HIE) and connectivity. Heyman spoke recently with HCI Editor-in-Chief Mark Hagland regarding the HIE initiative that his organization is involved in. Below are excerpts from that interview.
Your HIE initiative is part of a broader set of forward-moving initiatives. In that context, what brought you and your colleagues together with Alere?
We were one of the three communities that won a grant from the Massachusetts eHealth Collaborative about seven years ago. It was a grant of about $12 million used by the Massachusetts eHealth Collaborative to provide electronic medical records in each of three communities—Newburyport, North Adams, and Brockton. About 37 communities had submitted grant proposals, and we were fortunate to be selected. So practically all of our physicians have had EMRs for at least six years. We were introduced to Wellogic [now Alere Accountable Care Solutions] through the grant proposal, but it didn’t all work out. So we have a health information exchange in North Adams, though everyone’s on the same EMR. And the goal was a health information exchange that was physician-owned.
We wanted to be able to create a health information exchange for a number of reasons, including that it gives us virtual clinical integration, which helps us in contracting, and helps us to do our own quality improvement. It also makes us stronger as an organization, and puts us in a better contracting position. So, for five or six years, we’ve been looking at all kinds of different vendors for an HIE platform, and got very close to several different vendors, but when we got down to the bottom line, it wasn’t doable for an IPA like ours. But the president of the IPA and I were at HIMSS 2013, and we bumped into Sumit Nagpal [the president and CEO of Alere Accountable Care Solutions], and he was carrying a mini-iPad with him, and said, “I just want to show you something.” And it was this amazing software that provides a longitudinal record that provides all the patient encounters for any period of time you choose; and it can bring up all the details, and it really is a marvelous thing. And he offered it at an affordable price. So in about two minutes, he showed us something we had looked for.
Is the solution live yet?
We’re going live with our first three practices right now; we’re in a testing phase with them, but we’re very confident this is going to work. We just signed the contract in the middle of the summer. But everybody’s very excited.
So it’s a longitudinal record that will work across all your practices?
Yes, and you’ll be able to pull information directly into your EMR; and even physicians who don’t want to directly contribute information, will be able to participate.
So you’re not all on the same single EMR?
No, we’ve got 17 EMRs, including some that even I’ve never heard of. The predominant system here is eClinicalWorks, as it is for most participants in the Massachusetts eHealth Collaborative.
When will everyone be live?
My goal is to have everyone up by the end of the year. We’ve also been approached by some laboratories, some hospitals, and we’re talking to a nursing home. So we’re quite confident this will work out.
What have been the biggest barriers until now? Cost, governance, others?
For us, it’s been cost, by far. This will be used on a subscription model, and we believe it will be sustainable regardless of which other providers, like hospitals, participate. And one of the things we had as a principle, from the beginning, was that we would not depend on a grant. We did not want to do it unless we knew we could sustain it.
What level of data exchange are you anticipating?
I’m not an expert on how you measure this, but we’re anticipating that probably 95 percent of our 200 physicians will participate.
Any volume projection?
I have absolutely no idea.
What lessons have been learned around trying to get an HIE going?
To be honest, we had a lot of help from the Mass eHealth Collaborative in the beginning, in terms of governance, and getting documents going, and so on. I would imagine that for many, that would be a huge roadblock. We actually had that taken care of, but we were looking at sustainability. Now, most vendors want at least a hospital to be involved; Alere was much more flexible. And I’ve just basically taken all of our old documents, modernized them, and gotten them approved quickly by our policy committee. I can tell you that we spent about six or seven months on our privacy and security policies and procedures; even our consent forms took us about six or seven months to create. But we’re moving along rapidly. And Alere has been able to help us with document preparation. Also, there’s a book that HIMSS has about how to start an HIE. And I basically bought that book and read it in about a day and half, and used it as the basis for getting this off the ground.
So it worked?
Yes, for me, it was wonderful.
Have you had to add any staff, as you’ve built the infrastructure for your HIE?
Well, what we’ve done is that we have a chief medical information officer, namely me; I’m working about half-time in that role. And I might increase my time later. We have one person—we call her the HIE technical analyst, who helps Alere. She’s the technical side of the thing, and Alere provides most of the other stuff.
So you don’t have an actual permanent IT staff?
No, right now, we use Arcadia for our hardware. But to be honest, this is a cloud-based system, so all that is going to be done by Alere; and the individual practices are responsible for their own hardware and software.
Based on your progress and experiences so far in creating this HIE, what would your advice be for others in your position?
Well, what’s happening in healthcare reform in terms of ACOs [accountable care solutions], and value-based purchasing and such, I think that smaller IPAs like mine should seriously consider HIE development, if they want to stay in business and stay independent, because it adds value in so many different ways. I think that it adds a different atmosphere for anybody looking at the IPA. Most IPAs, the only way they can gain any income is through getting some administrative money from insurance companies, or dues. Basically, that’s it. But if you can establish an HIE, you also have a revenue source, as well as all the other benefits the IPA provides.
