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Ohio HIE Hits 101-Hospital Mark

Posted on September 12, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

This is a very busy time for HIE builders.  In recent months several states have either announced that they’d completed their preparations for a broad-based HIE or reached a new milestone in HIE participation.

For example, earlier this month the state of Wisconsin announced that it is gearing up to kick off a statewide HIE network that would embrace hospitals, clinics, nursing homes and other care facilities, powered by HIE technology vendor Medicity.

According to Health Affairs, this is part of a larger trend. A recent piece in the journal noted that health data exchanges between hospitals and other healthcare providers have climbed 41 percent between 2008 and 2012.

The latest in state HIE news comes from Ohio, where the state’s HIE has just announced that it had signed two hospitals, 25 bed Harrison Community Hospital in Cadiz as well as 91-bed Wilson Memorial Hospital in Sidney, reports Healthcare IT News.  With the new additions, Ohio’s CliniSync HIE now boasts 101 of the state’s hospitals.

CliniSync, which is run by the nonprofit Ohio Health Information Partnership, is based on Medicity technology as well.  With these new members, and the momentum it has underway, CliniSync might well be one of the largest public HIEs in the U.S. by 2014, Healthcare IT News reports.

According to Healthcare IT News, CliniSync makes it possible for physicians, hospitals, nurses and others who do patient care to share patient data electronically. What’s really neat, if true, is that CliniSync will allow doctors and hospitals with varied EMRs to share data. Previously, the HIE members could only share data regionally or within their own systems.

Hospital-Backed HIE On The Rocks

Posted on January 2, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

In an all-too-familiar tale of conflict, turf wars and financial doubts, a three-year effort to bring some of the Chicago area’s largest hospitals into an HIE seems on the verge of collapse.

The proposed HIE is backed by the Metropolitan Chicago Healthcare Council, a nonprofit group of about 150 hospitals and healthcare providers. But despite industry backing, the effort hasn’t gotten any momentum. Though the Council has been flogging the HIE concept since 2009, just 18 hospitals and physician groups have agreed to join, according to a report in Crain’s Chicago Business.

In theory, the massive, sophisticated health systems that serve the Chicagoland area would see the value in sharing medical records if anyone would. If nothing else, they’re doubtless thinking about or already participating in risk-bearing ACO contracts, so cutting down on needless duplicated tests would be a plus.

But apparently, potential HIE members are balking at the cost of sustaining the HIE, which can run to six figures annually depending on the institution. Apparently, they’re not sure that they’ll get a decent return on their investment. And of course, there’s little doubt that these systems are already investing many, many millions in EMRs and supporting systems, tying up most if not all of their IT investment budget.

What’s more, while Crain’s doesn’t mention this issue, I’d argue that hospitals are also skittish about cooperating with their competitors. Particularly in an intensely competitive market like Chicago, hospitals and health systems may feel that HIEs are a step too close to the enemy.

Now, even if the major hospitals refuse to invest in the HIE, the Council does have other ways that it might be able to pay for the exchange.  For one thing, the group has begun discussions with health insurers to see if they might be interested in helping to fund it. And there’s always government grants, which are available to help kick off startup HIEs.

The bottom line, though, is that hospitals are still conflicted when it comes to HIE involvement. Though most CIOs say that they’re interested in being involved, financial — and let’s not forget competitive — issues prevent them from getting on board.

Expanding HIEs Taking Role As Backbone For Reform Efforts

Posted on December 3, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

It looks like we may be seeing a tipping point for HIEs, which for many years have seen only isolated successes. According to a new report from the eHealth Initiative, the number of HIEs has grown meaningfully between last year and this year, and this year should see many new HIE organizations form.  Perhaps more importantly, it looks like HIEs are taking their place as the backbone for up and coming reform efforts.

When eHI reached out to survey HIEs, it found 322 organizations to survey, up from 255 last year.  Of that group, 88 HIE initiatives are at the highest stages of development on eHIs HIE development scale, an increase of 13 from last year.  As researchers see it, we’ll see even more growth and maturing technologies in 2013.

Over the last several years, the HIEs which have stayed on their feet and matured have almost all been propped up by federal dollars. Twenty-seven of the advanced HIEs surveyed said that the single most substantial source of funding they had was from the federal government; also, 22 of these HIEs were classified as state designated entities.

Unlike the past, however, it seems that HIEs believe they can survive without grant money from the government.  Of 39 state-designated entities responding to the study, 37 said they believe it is ‘very likely’ or ‘likely’ that they will remain operational after the HITECH dollars stop flowing.  An additional 31 of the SDEs said t hat it is ‘very likely’ or ‘likely’ that they will be financially sustainable three years from now even without additional federal dollars.

Now, here’s where it gets really interesting (to me at least). As part of the study, the eHealth Initiative asked some questions about how HIEs were playing into preparations for the full rolllout of health reform.

What they found out is that HIEs are increasingly playing a major role in health reform-related efforts such as ACOs and/or Patient-Centered Medical Homes.  More than half (109) of the HIE respondents said that they are supporting ACOs or PCMHs.

The HIEs aren’t just dumb pipes either;  not only are they offering technical infrastructure, they’re providing data analytics services around cost efficiencies and quality improvement.

Looks like 2013 should be a pivotal year for HIEs. I for one am excited to see what HIE organizations will be able to accomplish over the next 12 months prior to full rollout of health reform.  Go team HIE!

Largest Two Kansas Health Systems Take First HIE Steps

Posted on August 23, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

While the project still seems to be in its early days, the two largest health systems in Kansas have completed the first stage of connecting up to a common HIE.  The two systems did so by joining forces with KHIN, an HIE which serves 130 hospitals and more than 4,500 physicians across the state.

The two systems — Via Christi Health Systems and  HCA Wesley, both of Wichita — haven’t gone very far with the process. The two simply managed to transfer clinical data successfully into the KHIN production environment.   The two systems prepared for a year to conduct the exchange, including a two-week final period during which both sides verified that patient data was coming into the system properly.

According to a report in HIEanswers.net, the implementation allows for interoperability across all certified EMR vendors in the network (would like to know more about that!) and had appropriate controls in place to let patients specify privacy preferences.

The next step for KHIN is to connect with the Lewis and Clark Health Information Exchange, a Missouri-based HIE which stretches into northern Kansas. The idea is to begin pushing data from one HIE to the other, broadening KHIN’s 83,000 square mile reach further.

As a veteran, cynical HIE watcher, I’d give this effort better chances than most. For one thing, it’s backed by the state medical society and state hospital association, which certainly never hurts. And if — a big if, I’d say — KHIN has somehow achieved interoperability between the varied EMRs on the network, they’re miles ahead of the game.

That being said, I smell a rat when it comes to the interoperability claims. If hospitals and clinics can’t connect slightly different installations of the same EMR, making a large handful of ambulatory and hospital-based EMRs talk to one another sounds rather unlikely.  But as I’ve often said here, I suppose it’s a matter of “wait and see, folks.”

UPMC Kicks Off Competitive HIE

Posted on July 5, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

The University of Pittsburgh Medical Center has kicked off a new HIE connecting its properties with other health systems in western Pennsylvania.  The project, which should bring together access to more than 7 million patient records, goes into direct competition with that being launched by major state health insurer Highmark Inc.

UPMC’s HIE, ClinicalConnect, brings together its facilities with clinicians at Butler Health System, Heritage Valley Health System, Altoona Regional Health System, Armstrong County Memorial Hospital, Excela Health, Jefferson Regional Medical Center, St. Claire Hospital and Washington Hospital. While reports don’t describe how ClinicalConnect is being funded, you’ve gotta believe the $9 billion UPMC is fronting a lot of cash.

This move sets up an interesting competitive situation on the state, a fairly unusual one given that it’s built around an HIE.

Right now, UPMC is the 2,000 pound gorilla of western PA. Meanwhile, $14.6 billion Highmark is one of the dominant health insurers in the state. And now they’re going head to head on the HIE front. Mean ol’ Highmark has publicly announced its intention to build a system with UPMC’s bitter rival West Penn Allegheny Health, and as part of its plans, expects to launch a statewide HIE that could conceivably bypass UPMC’s regional effort.

When asked by a reporter whether the two HIEs can work together, their spokespeople basically said “Humph!” and denied that anyone cared about competition.  Oh yeah, we definitely believe that.

What interests me about this hoo-haw is that it both organizations seem to see their HIE as critical to their delivery network development efforts. While it makes perfect sense, it hasn’t been a big theme in HIE discussions to date. (My sense is that most hospital CIOs have seen HIEs as plumbing rather than a value-add.)

Interesting stuff here. I’m eager to see what happens next.

Memphis HIE Lowers Readmissions, Study Says

Posted on May 31, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

HIEs may still be struggling commercially — to my knowledge nobody’s found a business model that works without big subsidies  — but data is coming in to suggest that they can have a major impact nonetheless. That seems to be the case  in Memphis, where a study concluded that the local HIE saved $2 million by significantly reducing readmissions.

The study, which appears in the Journal of the American Medical Informatics Association this month, looked at a 13-month stretch during which emergency physicians at 12 hospitals had access to patient information through an HIE.  The hospitals are all members of the the MidSouth eHealth Alliance, which runs the HIE.

To determine what effect the HIE was having, researchers examined every ED encounter that happened between July 2007 and September 2008 that involved the use of HIE data.  All told, the researchers ended up crunching numbers for 15,798 HIE-related encounters. They then paired that data with an equal number of non-HIE-using encounters to look for differences.

One of the most interesting datapoints to be found here was that reduced admission levels for the 12 hospitals accounted for 97.6 percent of the $2 million in savings.  That’s a remarkable number, though it does leave me wondering whether the patients did equally well on other outcomes measures.

Even more interesting was that these results come from a relatively small number of ED encounters. ED physicians weren’t required to use the HIE, only accessed it about 6.8 percent of the time. You’ve got to wonder what would happen if ED doctors used the HIE most of the time.

Having learned all of this, here’s hoping the researchers dig in to other measures of care quality. For example, do ED physicians make fewer mistakes when they use HIE data?  Do they order fewer tests, or perhaps more given that they know more about patient needs?

This is a promising study. Now let’s see someone compare the financial and technical models for HIEs and tell us which, if any, are proving themselves.

As They Grow, HIEs Face New Privacy Protection Issues

Posted on April 18, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

For quite some time, providers have struggled with how to manage and protect the  PHI that flows across their internal network.

Now, the game is getting even tougher. Joining HIEs puts an even greater strain on the process; after all, keeping your internal data safe is one thing, but seeing that only authorized outside parties get the data makes the picture far more complex.

“We’re really struggling with this,” says Freeman , who works closely with a number of health providers. “If  you have, say, 32 entities in an HIE, does the patient have to authorize data use for each one?” asks attorney Bill Freedman, a partner with the Cincinnati office of Dinsmore & Shohl, LLC.

According to Freedman, the law still isn’t clear on some critical issues related to HIE data sharing:

*   Under HIPAA, other facilities can access HIE-based patient data if it’s used for treatment, billing/payment or operations.  Some legal minds have interpreted data sharing for archival purposes as “operations” but others disagree.  And if the HIE data can’t be shared freely without explicit  permission, you’ve got some serious logistical issues.

* If a state has tougher privacy protection laws than HIPAA in place — which happens regularly — the providers must abide by those, not  not the HIPAA rules, Freedman notes. Some hospitals are locking down data access until it’s clearer how state law and HIPAA ultimately interact, he notes.

As if these issues weren’t difficult enough, providers must also make a point of tracking who accessed a patient’s file, and when they did so.  This is a complicated and difficult security issue even within one facility;  tracking access across facilities and data exchange points is yet another level of complexity.

Then add on the fact that providers (especially doctors, who have the most contact with the patient) must manage and keep track of what disclosure agreements patients have signed, and things get even trickier.

I’m confident that HIE members will eventually work all of this out, but we haven’t heard the last of these issues either. Seems to me they should keep security geeks in the money for many years to come!

HIEs May (Or May Not) Lower Volume of Physician Lab Tests

Posted on April 9, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Can you really generate a significant medical cost savings by making patient test history available electronically? The answer seems to be a ringing “maybe.”

Two studies from highly prestigious journals seem to have drawn far different conclusions as to how having data available on a patient’s test history affects their propensity to test further. I’d argue that some of the controversy is out of line — that the two tests really seem to be looking at different issues — but controversy there has been.

First, in early March, a paper came out in Health Affairs which concluded that the physicians studied were ordering more tests when they had access to a patient’s previous imaging and blood tests via an EMR. The study found that doctors with access to imaging and lab results online led to a big uptick in new imaging and blood test orders. (Interestingly, the researchers attributed the uptick in part to a “convenience” effect engendered by the EMR — that the doctors would get their results for new tests  far more quickly when delivered to them electronically.)

Then, a study came out last week in the Archives of Internal Medicine which found that physicians with HIE access ordered less tests for patients with prior test results than their peers without HIE access. The researchers based their study on data from more than 117,000 patients treated in the HIE-linked outpatient departments of Boston-based Brigham & Women’s and Massachusetts General Hospitals between 1999 and 2004.

So, what do we have here? The Archives study seems to imply that doctors felt they needed less input to treat when they had the tests, while the Health Affairs study suggests that archived patient test data encourages doctors to drill down further.

Honestly, I think we’re looking at two different phenomena here. The first study, as I see it, suggests that doctors are more likely to test when you embed testing orders and results reporting in their workflow, particularly the workflow as they treat known patients. (Improving workflow is largely what EMRs are for, right? Oh wait, different story.)

The HIE study, on the other hand, implies that these networks can do what they’re supposed to do, which is to increase doctors’ understanding of a patient’s baseline or recent problems, cutting down on needless tests.

Honestly, I don’t see the contradiction that others see here. Do you?

Hospitals with EMRs, HIEs Serious About Cloud Possibilities

Posted on March 27, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

For a few years, the notion of cloud-based data sharing has been a least a bit controversial, with questions of security, control, throughput and the like slowing down adoption.  But it seems like those days may be coming to an end. A new survey by Harris Interactive for the Optum Institute found that more than half  of  CIO respondents plan to do some cloud investing.

According to the researchers, almost 60 percent of CIOs with both an HIE and EMR in place plan to invest in “cloud-based open systems.”  More specifically:

* 36 percent plan to use the cloud for both their EMR and HIE
* 12 percent plan to go cloud for their HIE only
* 11 percent plan to implement only cloud-based EMR technology

According to FierceHealthIT, top reasons for going cloud include access to additional apps, at 57 percent, and access to additional functionality, at 56 percent.

While it’s hard to tell whether the group selected by Harris is particularly savvy, it was interesting to hear that 71 percent of respondents participate in an HIE, and that almost two-thirds actually own the exchanges in question.  (OK, I take that back; HIE ownership does seem to me to suggest extra sophistication.)  On the other hand, according to the research firm, the HIEs in question are somewhat limited.

All told, these are interesting findings, though not incredibly surprising given that CIOs have to find a way to get interoperable under Meaningful Use Stage 2.  My question is whether the cloud implementations (especially security) will differ so much that they defeat the purpose. Let’s hope we don’t end up with another layer of opacity.

Hospital Mergers Make HIE Integration Even Tougher

Posted on February 8, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

In the fantasy world of shared healthcare data, all hospitals will gradually join HIEs, share data regionally and then nationally, and patient care will substantially improve. Or at least hospitals will be in a better position to avoid errors due to critical missing information.

Sure, that’s already happening in some regions of the country. For examples, check out the list of rock-solid HIEs identified by the National eHealth Coalition, including Rochester RHIO, MedVirginia and Availity, all interesting in their own way.

But at the same time, hospitals continue to merge and sell out to larger health systems, in some cases at an almost manic pace. I don’t have the space to list even a few of the mergers that are dominating business coverage, but I’m sure you know of one in almost every market where you work or have business.

These mergers will frequently bring together different EMRs, or even the same EMR configured differently. Not only that, within each hospital, in all likelihood the EMR will have been integrated with internal departments and systems differently. In other words, even two Epic systems aren’t going to marry up easily.

What’s more, when a well-funded hospital buys one in desperate financial straits, which is often the case, what’s the odds the smaller will have a costly Epic or Cerner or Meditech system in place? Not very high, I reckon. So the systems integration problem is even worse. Now, doubtless a large, well-funded system will ultimately put their system of choice in place eventually, but that won’t happen overnight.

So, as merger activity proceeds apace, it’s creating islands of discord and disconnected data. And my best guess is that those hospitals won’t be HIE-ing anytime soon, though I may be off base here.

I do have some hope that the Direct Project will be able to work around some of these obstacles. Though it’s still at the pilot stage, and participants are sharing only a small subset of clinical data, it does seem promising. I’m particularly intrigued by the notion of a HISP (Health Information Service Provider) which helps to push information from one provider to another.

Let’s hope that models like the Direct Project continue to emerge. Otherwise, the Tower of Babel we’ve got is likely to keep babbling.