The need for robust health information exchange (HIE) continues to grow, and not just because it is a part of the meaningful use incentive program. Having infrastructure to support HIE will be a critical component to enable new payment and care delivery models like accountable care organizations and medical homes.
Background on HIE Efforts
There has been a strong national effort in developing the Nationwide Health Information Network (NwHIN), as well as a dramatic increase in local and regional efforts to create viable health information exchange organizations (HIOs). These efforts include the Direct Project, which created a simple, secure, scalable, standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the Internet. The Direct Project -- which was sponsored by the Office of the National Coordinator for Health IT -- has become an important on-ramp to the health information superhighway.
But just as state and local governments alone could not build and maintain the Interstate Highway system, the federal government has stepped in to provide funding and a policy framework to develop the NwHIN. As part of the HITECH Act -- most famous for its incentives for the meaningful use of electronic health records -- 56 states and territories received $548 million to build out HIE capabilities at the state level, with a requirement that nearly a third of their budget be allocated toward interstate exchange.
Many of these efforts also include incorporating Direct Project services into their planning. While states are thinking strategically about how the simple push mechanisms of Direct can be used in a statewide context, many HIOs already have launched Direct pilots, and more are in the works.
HIE Success Stories
Twelve sustainable and mature HIOs were highlighted in a recently released National eHealth Collaborative report -- titled, "Secrets of HIE Success Revealed: Lessons from the Leaders." NeHC CEO Kate Berry said, "Roughly two-thirds of these organizations are connecting to the NwHIN and they are also doing some interesting things with the Direct Project. Direct is an important part of many of their strategies, and they're using it very efficiently to support primarily care coordination."
These leaders have developed strong and varied business models for financial sustainability and should do well under new payment models. Berry said, "I would say they are cautiously optimistic that as rules on ACOs are finalized, these organizations will be well poised with the infrastructure in place for exchange. But not only do they have the technology, they have already done the difficult work of building trust among the stakeholders."
One of the innovators highlighted in the report is MedVirginia, an HIO that serves central Virginia. "As a provider-owned enterprise, MedVirginia's primary focus has been establishing trust with, and bringing value to, physicians and hospitals," Michael Matthews, MedVirginia's CEO, said, adding, "Our organization is built on a foundation of trust."
MedVirginia has partnered with Verizon and MEDfx on a Direct Project pilot. The pilot uses the MEDfx Lifescape provider portal to facilitate the secure exchange of referrals using Direct and CONNECT protocols, while message routing and security is enabled by Verizon's health care provider registry and certificate authority. The MedVirginia pilot also is demonstrating connectivity through its NwHIN gateway to provide higher levels of exchange. MedVirginia became the first organization to connect to NwHIN with the SSA MEGAHIT project. "Part of providing good health care is being able to connect to all the other people in the system involved in the care processes," Matthews said.
The Taconic Health Information Network and Community in the Hudson Valley region of New York was another HIO profiled in the NeHC report. THINC has a very good business model that provides sustainability going forward. THINC joined MedAllies in a Direct Project pilot to push clinical information across EHR systems to support care coordination and transitions of care, in a manner consistent with clinicians' established EHR workflows.
"Over the last several years, with increased physician adoption and usage of EHRs, our providers have increasingly asked for interoperability between their respective systems for care transitions," said John Blair, president and CEO of Taconic IPA. Providing Direct exchange is important in improving clinical care coordination, but only augments physicians' work and is not viewed as a threat to their existing services. "Direct for us fills the gap in vendor to vendor connectivity for transitions in care. It does not threaten the current business model because the current offerings do not traipse in that space," he said.
Another Direct pilot is our own Gorge Health Connect in the Columbia River Gorge area of Oregon. GHC is partnering with Medicity on a pilot that will be demonstrated Sept. 14 at the "AIM 2011: Innovating for Healthy Oregonians" conference.
The GHC pilot focuses on routing referrals, summary care records and results between primary care providers, hospitals and specialists. Through Health Information Service Provider services provided by Medicity, GHC will assign and administer a secure health domain address (similar to an email address) for each provider in the network. Using an app running on Medicity's iNexx platform, providers then can exchange Direct Project referrals and clinical documentation with any other provider registered with an HISP.
Looking Forward
When Mitch Kapor -- senior adviser on health IT at the Center for American Progress -- introduced the term "Health Internet" at the ITdotHealth forum in 2009, he highlighted the catalytic role that government played in defining common protocols that enabled the Internet to be created from open source and proprietary software.
The health information superhighway is being built, rules of the road are being developed through a policy framework and standards are continuing to be refined. HIE is recognized as one of the keys to improving care coordination, lowering costs and providing higher quality care. We are on the threshold of a new era, and the Health Internet will be an important part of our future.