The Future of Health Information Exchange

Whitney L.J. Howell
January 9, 2012

One of the biggest growth areas in healthcare over the past few years has been the significant expansion of health information exchanges. Some health systems have built their own; efforts are also underway to create coordinated efforts at the state level. But with meaningful use and accountable care deadlines rapidly approaching, many industry experts wonder what 2012 will bring for the networks that attempt to make transfer of patient data quick and easy.

Without a doubt, health information exchanges (HIEs) - both public and private - will continue to grow, potentially in size and number. The number of HIEs nearly doubled to 230 between 2010 and 2011, with many are in various stages of complexity. This progress has opened up more opportunity for hospitals to purchase HIEs. In fact, 74 percent of U.S. hospitals confirmed their intent to implement the technology in 2011, according to healthcare advisory and research firm CapSite.

"When hospitals become involved in an HIE, they see having access to a greater amount of patient data helps them improve diagnoses and increase the value of healthcare," said Claudia Williams, director of the state HIE for the Office of the National Coordinator for Health IT (ONC). "They also realize there is a cost savings."

These cost reductions could be significant in many cases. For example, Indiana's HIE (IHIE) currently connects 90 clinical settings, 10 million patients, and more than 19,000 physicians. Healthcare Information xChange New York (HIXNY) includes clinical data on 1.9 million patients throughout 17 counties in Upstate New York. However, other states, such as North Carolina, are just beginning to form their exchanges.

The Path to Standardization
Many providers and payers already see the importance of HIEs, but they cite one overarching problem. Many existing HIEs were designed for individual health systems, with each having unique functionalities and characteristics. The solution - and a big push for 2012 - is HIE standardization, according to Glenn Keet, president of California-based HIE vendor Axolotl.

"The bottom line is that standardization is necessary and important to the future of HIEs to provide for population health and analytics that will improve patient care," he said, noting that standardization is particularly important for public HIEs. "Unless HIEs are standardized, the industry won't be able to reach its goals and impact care delivery the way it wants to."

Work in this area is already underway. In November 2011, seven state HIEs and 11 healthcare information technology vendors collaborating as the EHR|HIE Interoperability Workgroup announced they had agreed to follow the same technical specifications when connecting the HIEs, providers and other partners.

Standardization is also a significant concern for the ONC, Williams said. In December 2011, the office announced HIE standardization would be mandatory, meaning each system must include the same sets of information, allow for lab results transfers, and use the same terminology to avoid any confusion between providers and facilities. According to Keet, the ONC's standardization decree also calls for point-to-point search capability. In doing so, HIEs will be able to both send patient data to another network and accept outside messages.

Additionally, Keet said, private HIEs must consider how providers and facilities will be paid under the impending accountable care model.

A Change in Technology
While standardization is the hot button issue for how HIEs will operate, there are two buzzwords associated with the technology behind the tools. During the coming year, the key topics around HIE usage will be interoperability and open platforms, according to Todd Densley, Director of Strategic Accounts - Healthcare with Ontario-based HIE vendor NexJ Systems. Both concepts will allow providers and payers to leverage patient data to their maximum potential.

"There's often a need for hospital systems or providers to connect to the electronic health records (EHRs) of another institution," he said. "Open platform allows hospitals with different healthcare information technology teams and different HIEs to connect and talk to each other. That interoperability - that ability to transfer data outside your network - is the next area of growth for HIEs."

NexJ created its open platform, NexJ Health Exchange, two years ago to allow facilities and providers with different HIEs and EHRs to quickly and easily share patient data. A second layer, known as NexJ Connected Wellness, is a cloud-based application that lets patients and providers work together to manage chronic diseases and other health issues.

Axolotl also offers HIE solutions that give hospitals and providers near-instantaneous access to patient data. Through its Elysium Express and Elysium Exchange Solutions, Axolotl offers providers HIE-quality access to health information directly through its EHR. These systems also integrate seamlessly with similar products, Keet said.

Even with sophisticated technology, HIE expansions faces challenges this year, said Harold Apple, CEO and President of IHIE. Hospitals must create provisions that ensure patient data remains secure. Perhaps the greatest obstacle to overcome will be designing a method that allows all the disparate HIE formats to talk to each other.

"We must make sure their languages are compatible and that they can speak clearly to one another," Apple emphasized.

Providers' Perceptions
The price tag for some facilities to belong to an HIE can be a steep disincentive for physicians and hospitals. Often, the fee is $85 per month, per doctor. For some hospitals in Colorado, monthly payment can reach $10,000 a month to access the Colorado Regional Health Information Organization (COHRIO), according to the Boulder County Medical Society.

Although a significant cadre of physicians worry about the ongoing cost, using the technology is good for doctors and patients, said Jesse Flaxenburg, M.D., a nephrologist with Pikes Peak Nephrology - a physician practice associated with CORHIO.

"If you have a tool that's readily available to you that will dramatically improve the level of care you're able to provide, why not use it?" he said. "We're in the 21st Century. This isn't the 1800s anymore, and we need to practice like we're in the 21st Century."

HIE access has also helped Good Samaritan Hospital in Vincennes, Ind., provide superior care for its patients, said Charles E. Christian, the hospital's Chief Information Officer. However, he wasn't always certain that his hospital needed an HIE.

"For a long time, I struggled to see what the benefit of an HIE could be for us as a single-hospital facility," Christian said. "But once we were able to hook up to the HIE of other facilities, the added value of getting information to other places and back was clear."

Often, the facility provides emergency care to patients who received open-heart surgery in an Indianapolis hospital, and having instantaneous access to necessary medical files is critical to helping someone in distress, he said.

The Unnoticed Danger
While HIEs hold great promise for improving continuity of care and reducing costs, there is one looming danger as this technology continues to spread, Densley said. There is a movement within healthcare for payers, in an effort to diversify their portfolio holdings as payment models change, to purchase HIEs."

On paper, the payer has all that patient data. There's no existing policy regulating what they can and cannot do with that information, so right now we can't know what will happen," he said. "But we have a situation where the people who are making policy decisions that affect us and our families have all the details of our health histories. That's a situation that could likely go either way."







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