Statewide HIEs: The Development of a Sustainable Model

In March 2010, the Office of the National Coordinator for Health IT awarded 56 states, eligible territories and qualified state designated entities grant money to develop health information exchanges.

These grants fostered the development of many HIEs that have succeeded in joining physicians and hospitals together for data exchange. The more than $9 million from ONC, along with the selection of a technology vendor, allowed the Colorado Regional Health Information Organization to "ramp up" operations, says CEO Larry Wolk, MD. CORHIO now has 45 hospitals participating with the network, including all hospitals in the state with more than 100 beds, and many behavioral health centers and office-based physicians. The HIE currently has data on 2.5 million patients —half of the state's total population of 5 million.

Finding value in an HIE
While all of CORHIO's funding initially came from grants, the long-term goal was to transition to a fee-for-service model, says Dr. Wolk. The transition was not without hesitation from providers. Some "felt that it was the patients and payers benefitting from HIE, but that they were having to pay for it at the same time their reimbursements were shrinking," he says.

CORHIO's ability to demonstrate a measurable return on investment for participation in the HIE helped the organization overcome provider resistance. "Working with some of our existing participants, we discovered that most small practices on average are able to repurpose a half of a full-time employee to other office responsibilities, save $1,600 per year in paper and printing costs and get rid of lab interfaces that were costing some practices $2,500 per year," says Dr. Wolk. "These cost savings more than cover the $35 per provider, per month subscription fee for CORHIO's HIE services."

Participants in the Delaware Health Information Exchange, which include every acute-care hospital in the state, also see the benefit of participating in the HIE and are willing to pay for the benefits. "Our financial philosophy is simple — we are paid for the services we provide by those who derive value from our services," says Randy Farmer, director of provider relations and business development at DHIN. Providers pay up to $0.25 per result panel delivered to the community health record, and DHIN is also paid for services rendered to insurers or to the state. DHIN has not required grant support since 2011, says Mr. Farmer, and it is currently fully self-sustaining.

Mr. Farmer recognizes DHIN's business model, which relies heavily on transmitting lab results, is different than that of other states, but it is a niche that will allow the exchange to both maintain financial stability and also continue expanding. Because all of the state's hospitals are part of the exchange and the major independent labs also participate in DHIN, "we're basically capturing 100 percent of lab results," says Mr. Farmer. "With that high-level penetration, hospitals and private labs start turning off more expensive ways to transmit this data because we're delivering it in a more cost-effective manner."

Looking beyond state borders for sustainability
DHIN has also been able to grow by working with out-of-state providers. The exchange recently became the first statewide HIE to have a live connection to a hospital outside the state's borders. Atlantic General Hospital in Berlin, Md., is close to the state line, and the hospital's providers "see Delaware patients and had a clear need to see their information and lab results," says Mr. Farmer. He says another Maryland hospital was recently signed to the exchange as well, and DHIN continues to pursue more connections with hospitals along the border.

"It really serves everyone's interest to extend HIEs beyond state borders," says Mr. Farmer. "Soon, more and more HIEs will be looking to these border areas to encompass more providers and be as comprehensive as possible."

"CORHIO will also be working to exchange on a national level," says Dr. Wolk. "We are currently exploring ways to exchange data with other states, the Department of Defense and the Social Security Administration."

Ohio's CliniSync, another fee-supported system which currently has 101 of the hospitals in the state on contract and 38 of those live on the exchange, is also widening its reach beyond state lines. "We have an agreement with Michigan Health Connect where physicians on both sides of the state can now share information directly with one another," says Dottie Howe, director of communications at CliniSync. The HIE plans to connect to HIEs in other states as well. "Our ultimate goal is to connect with others nationally," she says.

A little help from HIE friends
To this end, CliniSync executives support the development of strong, sustainable exchanges across the nation. "Every state will be somewhat different, but we plan on being in a situation to help other regions who may need some assistance with their models," says Dan Paoletti, CEO of the Ohio Health Information Partnership, which runs CliniSync.

DHIN's leadership is also eager for other statewide exchanges to benefit from their experiences. "We've been mentoring others, both formally and informally," says Mr. Farmer. DHIN executives also recently helped the Hawaii Health Information Exchange launch its network and train employees on best practices.

Mr. Farmer believes more established HIEs will continue to serve as a helpful resource for developing HIEs across the country. HIEs like DHIN "have the benefit of experience and provide best practices for up-and-coming exchanges," he says. "We may not have all the answers, but we'll help in any way we can."

More Articles on HIEs:

Massachusetts HIE Gives $1.3M in Grants to IT Vendors to Increase EHR Interoperability
Competing Kansas HIEs Could Lose Licenses, Funding by Not Connecting
Statewide HIE Coming Soon to Wisconsin

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