Can health information exchanges (HIEs) survive the present moment? The question might seem overly simplistic, but the reality, as knowledgeable observers note, is that broad-based, and particularly statewide, HIEs are indeed failing or faltering across the country. Indeed, many public and semi-public statewide HIEs are struggling these days, in the wake of the dwindling of federal and state grants to support them. What are industry observers seeing? Largely this: that many of the statewide and regional HIEs created with wonderfully high-minded intent, but without a hardheaded business focus on long-term sustainability, are finding it difficult to make ends meet as the grant money begins to wither.
At the same time, a small number of statewide HIEs are moving forward strongly, buttressed by broad stakeholder support, state government-level policy directives, and above all, clever strategy. Their biggest secret? Providing stakeholders with services they will pay for, particularly in the areas of alerting providers and payers to patient events like emergency department (ED) visits and inpatient admissions.
Four statewide HIEs are among those setting an example for their peers in other states: those in Maine, Michigan, Colorado, and Ohio. In Ohio, the Columbus-based Ohio Health Information Partnership (OHIP) runs CliniSync, Ohio’s statewide health information exchange. OHIP, established as the regional extension center (REC) for its region, is set up as a privately run 501c3 organization, but is Ohio’s state-designated entity, explains Dan Paoletti, CEO of OHIP.
Part of OHIP’s success lies in how it was created, Paoletti says. “We were created in the late summer of 2009 by the administration at that time,” he explains. “We spent the first two years planning, developing, and getting the technology in place. In other words, we spent a good two years at a very low budget cycle, with only a couple of employees, trying to get everything arranged. We really started our implementations in 2011, and our first hospital went live in December 2011.” Now, he notes, 143 hospitals across Ohio—all but about 20 in the state—are working with CliniSync, and 73 have gone live in data-sharing. What’s more, 600 practices representing over 3,000 physicians not already connected to CliniSync via their participating hospitals, are also participating.
Three elements in particular have helped OHIP to thrive: providing results delivery, DIRECT messaging for clinicians, and enabling the sharing of continuity of care documents (CCDs). “Results delivery is important, even though it’s very basic,” Paoletti says. “But you’re talking about potentially $60,000 to $100,000 per primary care physician in ancillary revenue, and that’s money that is up for grabs or moving. And us being a delivery mechanism for the community hospitals not only saves them money, but allows them to grow their ancillary services.” Indeed, OHIP is now racking up between 1 and 2 million transactions a month solely through results exchange.
A similar story is playing out in Michigan, where Great Lakes HealthConnect—the result of a July 2014 merger between Michigan HealthConnect (based in Grand Rapids) and Great Lakes Health Information Exchange (based in Lansing)—has created a nearly-statewide exchange across that state. There, according to Doug Dietzman, the organization’s executive director, “What’s been driving our business the most has been meaningful use requirements—so, immunization data-sharing, reportable labs, and syndromic surveillance; and we’re a HISP for folks who need a HIS for Direct as well,” he reports.
As Dietzman puts it, “Operating on a private model as we do, you have to build a business, just like anybody else does. You have to sell services and solutions that people will pay for, and if you can’t, you’ll be out of business just like anybody else who doesn’t.” Thus, as has OHIP, Michigan HealthConnect has found a path to sustainability through the provision of services that subscribers will willingly pay for.
And the same is true at HealthInfoNet, where executive director Devore Culver is able to boast that his organization is providing leading-edge support to providers. “We have a set of tools in the field that is dynamic—the data being used is a day old, driven by clinical and event data," he notes, “and is predicting things like who will show up in the emergency department. Who’s going to get readmitted in the next 30 days? That runs while the patient is in the bed.”
Meanwhile, in Colorado, CORHIO, a Denver-based statewide HIE, is not only working with that state’s Medicaid office on ADT alerting, as Brian Braun, CORHIO’s chief financial and strategy officer; it has also contracted with two large health plans, Anthem, and Kaiser Permanente, to alert them when plan members are having ED visits or admitted to hospitals.
Meanwhile, a small number of HIEs are also attracting smaller physician practices as subscribers, as is Greater Houston HealthConnect, reports CTO Phil Beckett. The secret? Providing them with very timely data and information they really need on current patients, Beckett says.
Greg McGovern, a director at the Pittsburgh-based Aspen Advisors consulting firm, and a former health system CTO, note that while enterprise HIEs—private HIEs established by individual hospital and health system organizations—are mostly doing fine, because their raison d’être is built into their function, “When states provide something, if all that they offer is a way to get stuff from point A to point B, that’s not very useful, because most organizations are able to do that through their EHRs. But if you’re going to offer other services, or direct functionality to long-term care services, for the transmission of continuity of care documents, for example—people will pay for those kinds of things.” He agrees completely that the statewide HIEs doing well now have figured that out, and cites CliniSync as a particularly successful example.
In the end, all those interviewed for this article agree: statewide and regional HIEs can survive—and even thrive—but it’s going to take considerable business sense and a good dose of ingenuity, to do so, going forward. Time, everyone agrees, to stop thinking castles in the air, and instead, think boots (data) on the ground, instead.
