Amid the swirl of activity and discussion at HIMSS16, it can be very valuable to get beyond the hype and hear about accomplishments taking place in the trenches of U.S. healthcare. In that context, HCI Editor-in-Chief met with Martin A. (Marty) Lupinetti, executive director of HealthShare Exchange of Southeastern Pennsylvania (HSX), a major Philadelphia-based health information exchange (HIE). Lupinetti, a software developer by background, became executive director of the organization in 2013, after helping to bring it into existence, in a consulting role. HSX was incorporated in May 2012, and went live with its first data sharing in December 2013.
Lupinetti heads a staff of nine, but is able to make use of the talents and work of over 225 volunteers as well. HSX now connects 40 hospitals—every hospital in the Philadelphia metro area except one (and the HIE is in conversation with that hospital, as well as three major health plans-Amerihealth Caritas, Independence Blue Cross, and Health Partners. HSX works closely with the Horsham, Pa.-based NextGen Healthcare as its vendor partner. Lupinetti spoke with Hagland in the Healthcare Informatics booth on the exhibit floor of the Sands Expo Center, on Thursday. Below are excerpts from that interview.
Tell me about the growth of volume of health information exchange at HSX.
Our first transitions, CCD [continuity of care document] transmissions, went live in December 2013, with the Crozier-Keystone Health System and Penn Medicine. We started by using Direct, offering whatever connectivity they wanted, including sending CCDs.
And what is your current volume of transactions?
More than 27,000 Direct messages are now being sent per month. And the plans pay two thirds of this, while the hospitals pay one third. And with 40 hospitals, that's pretty small cost. And if you're an IBC member, within hours of your discharge, your CCD will be sent from the hospital or ED to your primary care physician. And if you're in the ED or are admitted as an inpatient, when you are registered, your CCD is automatically sent to your PCP. And ADT messaging is the trigger. So our volume of transactions is 27,000 a month, with six hospitals fully live now, and all the remaining hospitals going live this year. And we’ve got 2 million patients whose records and information are connected in our HIE, and we’ll have 4 million by the end of the year.
What has been the biggest challenge in all this work?
One of them has been scaling this level of service. Organizations have many priorities; so it's jockeying for attention and priority with providers and plans.
So that is interesting. The technical mechanics have not been an issue, then?
That's right. The next challenge is the clinical workflow. Do the physicians in practice need to put someone in charge to triage the information coming into them? Or do the physicians do it themselves? It's different in every organization. The next thing we're looking at is encounter notifications, based on physicians selected a subset of their patients—presumably those at highest medical risk—and subscribing those patients’ names to the service. So let’s say that you treat 75 high-risk patients in your practice out of a panel of 1,000, and you end up getting one or two notifications a day. And one quarter or so out 1.5 million of those 6 million patients and plan members, are under subscription now.
What's in the notification?
It’s simply an alert, with diagnoses or medication information—enough information to know that one’s patient is admitted or discharged or has had or is having an ED visit. You can call it either a notification or an alert. So while that's all going on, we are starting to collect, we're taking copies of those messages and ADTs and populating our clinical data repository. We have about 2 million patient records in the repository now; by the end of the year, we’ll have 4 million, and eventually 6 million.
What are the couple of biggest lessons learned so far in your journey?
The biggest one is that you can only move at the speed of trust. It's a trusting community that will enable this. Until trust and comfort are there, you will get resistance, even if they can see the benefit of something, until something is more proven and stable.
Why are some HIEs succeeding right now, while others are failing?
Traditional HIEs started out by moving to query functions. Doing so means that you need to be notified, and there needs to be a reason to query. And our folks said, let's just go with push notifications to start, and we'll move to query and CDR [clinical data repository] later, and that's been our success. And from a financial sustainability standpoint, I got our plans involved and the plans are getting data value out of it, so they're willing to pay two-thirds of the cost.
Health information exchange is going to become increasingly important as we move into ACOs and population health, wouldn’t you agree?
I say that our main goal here is knitting together all these parts of the healthcare system--inpatient and clinics and outpatient care and long term care and everyone. You've got to give data to get data and give value to get value. And people get that.
Also, one thing related to this is that we view this as a community asset. We're in the middle, it's a community benefit. And we're planning a family reunion service that will help people locate their family members in the event of a major disaster or emergency that would send people to hospitals for care. We decided to ready the program for the Pope’s visit last September. So the system was ready to be used on the week before Pope Francis visited. And it remains live and ready. The other event that prompted this was the Amtrak train derailment in May 2015. We were aware the many people had difficulty finding out where family members had been taken for care. In fact, we learned that one family still didn’t know what had happened to their family member 12-15 hours after the train crash. So we thought, let's offer this family location service. And we knew the Pope was coming already back then. And all the hospitals wanted to be involved.
With regard to the Pope’s visit, we also considered the idea of international health information exchange. For example, what if the Pope or someone in his entourage had a health incident and didn’t have their health record with them? As it turned out we never could locate the right official in the Vatican to connect with, but we did test a query retrieval for a potential Italian visiting Philadelphia. We worked with Daedalus and did a query retrieval test. We didn't address issues around language translation or CCD mapping to a European system, but the Pope’s visit inspired this work. And we're working with Daedalus on an Italian exchange, looking at other potential international data exchanges.
Are you optimistic overall in this moment in the evolution of HIE in U.S. healthcare?
I am, I am. We see that when providers start to adopt this technology, they suddenly see the value; that's why we're doing this. And there's so much need, and when you start to fill that gap, it's pretty cool to be a part of it.