How physicians should choose a health information exchange

A practical look at information technology issues and usage

By — Posted July 2, 2012.

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A year ago, most physicians hoping to connect with a health information exchange probably weren’t faced with decisions such as statewide versus communitywide, or public versus private. They were lucky if they had any choice at all.

But that is all changing.

There was an estimated 40% growth in the HIE market last year, most of it from private organizations, according to health information technology market research firm Chilmark Research. As a result, depending on the size of their community, physicians may have two or three choices in HIEs, which allow them to exchange health information with other physicians and hospitals electronically.

“Exchanging information comes in a lot of shapes and sizes,” said Jim Morrow, MD, a family physician in Cumming, Ga. HIEs vary in what they offer, how they are managed, and under what business models they operate. Most important, they differ in what they can offer physician practices. So choosing between two HIEs is no mere coin-flip decision — and the practice might decide it’s best to join more than one.

In addition to public HIEs that involve several stakeholders across an established geographic area, such as a community or a state, many hospitals and health care systems are launching their own private HIEs as they prepare for better care integration through participation in an accountable care organization.

All models of private and public HIEs are still developing, said Dixon Davis, vice president of business development for AAPC Physician Services, a Salt Lake City-based practice management consulting firm. Most HIEs in operation today will look completely different in a few years, he said. Physicians need to look at what they hope to gain from participation in an HIE, prioritize those things, then find the HIE solution that gives them the most bang for their buck, Davis said.

Some things physicians should consider:

Efficiencies the practice hopes to gain. When practices think about workflow and practice redesign, there are probably areas that are considered “pain points.” It might be the time involved with getting lab results, or the staff time spent making referrals. Some, if not all, of those points might be addressed by an HIE.

Dr. Morrow said one of his biggest pain points came from tracking down medical records from other facilities that saw his patients. If they were hospitalized, or sent to a lab for tests, his staff spent valuable time tracking down that information. Now that he’s connected to his local hospital’s HIE, he has all the information in real time, waiting in his electronic health record system.

Some HIEs are tied to local hospitals, but not to a certain lab. Or they might be tied to a lab, but not to an insurer. Some practices, particularly those hoping to qualify for meaningful use incentives, may need an HIE that allows them to gather and submit reports, such as immunization data to immunization registries or syndromic surveillance data to public health agencies. Physicians need to consider who they need to share information with and find an HIE that will connect them.

Geographic footprint of patient population. Because the Coastal Women’s Healthcare practice in Scarborough, Maine, treats patients from all corners of the state, having access to an HIE that connected the entire state was important, said Bev Neugebauer, executive director of Coastal Women’s Healthcare. Right now, the statewide exchange, HealthInfoNet, is the only HIE available to them, but Neugebauer said that as the number of patients the practice treats from New Hampshire increases, they eventually will need an exchange that crosses state lines.

Dr. Morrow, on the other hand, said that even though there is a statewide HIE launching in Georgia, he is more concerned with what is going on in his community. There is only one hospital in town, so Dr. Morrow said it’s important to be connected to the hospital as well as the labs.

“When you connect the local facilities, it makes a huge difference in the quality of care,” Dr. Morrow said.

Business model/sustainability. For physicians reliant on participation in an HIE to meet the data exchange objectives of meaningful use, they may have to wait until their local exchange is up and running and has a business model that will keep them running.

A report released in October 2011 by the eHealth Initiative found that there were 255 multistakeholder community initiatives to build HIEs in that year. Only 24 of them reported that they were sustainable. Many of the initiatives were launched, or are being launched, with their share of $560 million in federal funds that were made available through the Health Information Technology for Economic and Clinical Health Act of 2009. That money eventually will run out, and these organizations will need sustainable business models to stay afloat.

Some are investigating per-transaction fees, while others are looking at monthly or yearly membership fees, which physicians will have to pay to stay in the network. Practices have to consider what business arrangement would work best for their budgets. Many of the hospitals or health systems launching private HIEs are heavily subsidizing the cost of them for physicians. There’s concern about whether some public HIE models will ever become sustainable. A report released in June by the ratings service Black Book Rankings found that one in five operating HIEs either ceased operations or merged in 2011.

There are other ways of facilitating exchange that do not involve a formal HIE. Electronic prescribing networks, for example, provide a lot of information about patients. In 2010, the Health and Human Services Dept. Office of the National Coordinator for Health Information Technology launched the Direct Project, a technology that many vendors are incorporating into their EHR or personal health record systems that allow direct and secure communication between two parties. For example, a physician could send a patient’s care summary to another physician.

Davis said there are many options when it comes to health information exchange. Physicians hoping to accomplish a lot with their participation in an HIE may have a challenging time during the next few years finding an HIE that meets all of their needs.

“In the meantime, it’s about what will provide me the most opportunity right now,” he said. “And you may have to join a couple of HIEs.”

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