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Larger CO Hospitals On Board With RHIO

Posted on July 29, 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.

Colorado’s hospitals have reached an interoperability turning point. With the addition of Exempla Healthcare’s three Colorado hospitals to CORHIO, the Colorado Regional Health Information Organization, all of the state’s hospitals with 100 beds or more are now connected to an HIE network, reports EMR Daily News.

Right now, 29 hospitals are connected to the CORHIO HIE, with 15 preparing to connect, making a total of 44 hospitals now participating in the exchange. The latest to join are Exempla Good Samaritan Hospital in Lafayette, Exempla Lutheran Medical Center in Wheat Ridge and Exempla Saint Joseph Hospital in Denver.

Along with the hospitals, a total of more than 1,800 office-based physicians, 100 long-term and post-acute facilities, 13 behavioral health centers and five national/regional labs are either connected to or in the process of connecting to CORHIO, according to EMR Daily News.

As impressive as CORHIO’s progress is, there’s still more to be done. There are a total of 61 hospitals located in CORHIO’s service area, which means that the exchange still needs to sign up just under a third of hospitals with access to the network.  Some of the hospitals which haven’t connected up are in rural areas; to help bring them under CORHIO’s wings, the exchange is partnering with the Colorado Rural Health Center.

The ultimate question here, as it is with any HIE, is whether the business model is sustainable.  For the financial year ending September 30, 2012, CORHIO had total revenue of  about $9.7 million (between grants, contracts and implementation fees), and total expenses of $9.5 million. That’s not much of a margin, especially in the capital-intensive world of health IT.

Now, there’s no need to make big profits to provide a public service, but it’s helpful to know that your money is coming from a business model that works. I’d say that this is in doubt in CORHIO’s case. I wonder: are other notable HIEs are doing better?

Health Information Exchange

Posted on November 2, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In an email response to my EMR and HIPAA post on HIE Waste, Edward Fotsch, M.D. and CEO of PDR Network offered these insights into the state and some history of Health Information Exchanges:

The fundamental question for HIEs is two-fold: 1) what is their purpose and 2) who benefits and will pay for them- the latter is a question of revenue model not grant funding which always runs out sooner or later. Relevant facts include:

1. HIEs are not a new concept. I was around when Community Health Information Networks; or CHINs (The ‘C’ in CHIN stands for communism where we all do the right thing because it’s for the good of the order) came and went. Then RHIOs came and went. Now HIEs. What these have in common is grant funding but generally no business model.

2. The idea of providers paying for the opportunity to share their patient (‘read “Client”) information with competitors is novel I must admit. But in the old days when I was seeing patients, when you sold your practice you largely sold your charts. It was the charts as much as anything else that kept patients coming to the new doctor after the sale- ‘it still works this way for many dentists. Now docs are supposed to pay for the privilege of having their charts opened to competitors? Now I know that the hospital execs all salute this flag when the discussion of HIEs occurs at the rubber chicken dinners. But when I was on the exec committee at a community based hospital we spent time trying to compete with, not empower, competing hospitals. You may say that is not right- but that’s a fact.

3. HIEs I’ve seen that have any hope serve a specific business purpose and often exist within an economic entity. Kaiser has a large HIE- they just don’t call it that.

4. Data exchange between competitors has worked in many venues- the obvious example is ATMs where competing banks collaborate. BUT this occurs because customers demand it. Unless or until patients/consumers begin to select healthcare providers who participate in some level (i.e. CCD-level sharing at least) of basic patient information exchange (i.e. refusing to go to providers who hand them a clipboard), the HIE concept is massively challenged. ‘Though it’s always fun right up until the grant funding runs out.

Tampa Hospitals, Physicians In Tug Of War Over RHIO

Posted on April 4, 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.

Sometimes, RHIOs fail to gel or fall apart because of technical issues. But in one Florida community, it seems like pure politics may doom efforts by area doctors and hospitals to connect.

According to the Tampa Tribune, there’s a tug-of-war going on between the Hillsborough Medical Association and a consortium of local hospitals over how providers in the Tampa Bay area will share data.  Hospitals want doctors to follow their lead, not too surprising given how much they’ve probably invested in big-ticket systems like Epic.  The medical association, meanwhile, is arguing that its members are a better choice to coordinate things, since they have more frequent contact with patients and know them better.

The crux of the matter seems to be this.  HITECH may have laid out a lot of money to encourage EMR adoption, but the feds haven’t spelled out who should control the HIEs binding them together.  As a result, nobody seems to agree on how to build and share a medical information exchange.

So now it’s come down to a matter of statistics, financial and organizational.  A group of seven hospitals would like to lead a RHIO, driven by their knowledge of integration and data exchange they’ve spent tens of millions of dollars to acquire. The hospitals are currently shopping for a medical data exchange technology vendor and estimate it could take 18+ months before data exchange between hospitals gets rolling.

Meanwhile, the medical association is more interested in a north Florida group, Big Bend RHIO, which is operated in part by the Florida Medical Association. Big Bend RHIO has won the support of some of the region’s largest medical practices, the Tribune reports, and represents more than 1000 doctors.

Yet another option is for local hospitals to sign on to a statewide HIE managed by Harris Corp., which got a $19 million grant to create the exchange two years ago. Some hospitals and doctors are asking whether it might not be better to jump on board with the Harris project (something that sounds pretty sensible to your editor).

My guess: it will be preeeetty darned close to 2015 before these folks figure out how to work together.  It’s a pity there’s no simple technology for ego information exchange.

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.

An Important Shift, Most Hospitals Now Favor HIEs, Whatever Those Are

Posted on November 14, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

For quite some time — I’d estimate five years at least — health information exchanges were the dark horse of the health IT world.  A few successful ones emerged, but far more foundered, in many cases because hospitals involved couldn’t or didn’t want to share information. Today, on the other hand, everyone seems pro-HIE. The question is, is everyone even talking about the same thing?

These days, with the big bad government breathing down their neck, hospitals are scurrying to connect with HIEs. According to new data released by healthcare technology research firm CapSite, which surveyed about 340 hospitals on HIE adoption:

  • 74 percent either plan to buy new HIE solutions or already have them in place
  • 32 percent are already
  • 16 percent plan to engage a consulting firm to help move their HIE planning and vendor selection process ahead
Hospitals planning HIE tech investments were most interested in buying MPI/patient and provider indexes, immunization reporting and results reporting/delivery solutions, CapSite’s survey found.Now, these results aren’t incredibly definitive.

As an InformationWeek story on the study wisely points out, CapSite didn’t do much to narrow down its definition of an  HIE before people there did the research.

The thing is, just about any networking technology could be called an HIE if you try hard enough.  For example, here’s Chilmark Research’s definition:

A Health Information Exchange (HIE) is a technology network infrastructure whose primary purpose is to insure the secure, digital exchange of clinical information among all stakeholders that are engaged in the care of a patient to promote collaborative care models that improve the quality and value of care provided.

If that wasn’t vague enough for you, here’s what HIMSS has to say on the subject:

A health information exchange is the electronic movement of health-related information among organizations according to nationally recognized standards.

The real clincher, though, is the breadth of vendors CapSite included in its research. Check out this list:

Accenture, ACS, Allscripts, athenahealth, Bass & Assoc., Carefx, Cerner, Covisint, CPSI, CSC, CTG, dbMotion, Deloitte, Dell, Dr. First, eClinicalWorks, Epic, GE Healthcare, Healthland, HIMformatics, HP, ICA, InterSystems,  KPMG, McKesson, Medicity, Meditech, MedPlus, MEDSEEK, Microsoft, MobileMD, NextGen, Northrop Grumman, OptumInsight (formerly Axolotl), Orion Health, Prognosis, QuadraMed, RelayHealth, SAIC, Siemens 
All that being said, I’m happy to see additional data suggesting that hospitals are making HIE progress. Got a feeling 2012 is going to be a good year — for vendors at least.