Once upon a time, many health IT stakeholders hoped to develop a massive, public health information exchange (HIE) that would eventually let hospitals and practices share patient data nationwide. That hope is beginning to look more like a pipe dream.

A recent report from Chilmark Research for instance, shows that while the HIE market grew more than 40% in the past year, most of that growth came in privately sponsored, enterprise health information exchanges, rather than in public health information exchanges that seek to connect providers across regions and states.

Chilmark CEO John Moore offered his take on the growth in private HIEs in a recent InformationWeek Healthcare interview: "Everybody realizes they're going to have to tie their systems together with their affiliates if they're going to have any hope of surviving payment reform."

The main reasons for the rapid health information exchange growth, according to Chilmark, are the Meaningful Use criteria that will require interoperability between systems as patients are moved from one care setting to another, and the impending changes in reimbursement methods that will necessitate greater care coordination.

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While public health information exchanges could help providers meet these challenges, healthcare organizations tend to approach information exchange in the context of their own positions in the marketplace. In addition, many don't want to wait for public health information exchanges to reach their areas. So it's not surprising that the bulk of health information exchange growth is now in the private sector.

However while many providers are turning to HIE vendors, some are taking a grassroots approach, cooking up their own brands of information exchange. One example of this build-your-own model is Huntington Memorial Hospital in Pasadena, Calif., a 625-bed facility that works with about 3,000 physicians in 1,500 practices.

Most of the physicians affiliated with the hospital have electronic health record (EHR) systems, but few have fully optimized their use. Rebecca Armato, executive director of physician and interoperability services at Huntington, says her goal is to help them fully use these systems by creating what she calls a "connected, collaborative care community."

The Huntington HIE connects the hospital and the community of private medical practices. It selectively pushes patient data back and forth among providers. It sends data about a patient's hospital stay or hospital-based outpatient clinic visit, for instance, into a physician portal, and to a community physician's EHR system, depending on each clinician's needs.

One of the keys to convincing community physicians of the value of the HIE is to show them that the exchange won't disrupt their workflow or overwhelm them with a barrage of data, said Joel Diamond, MD, at this year's HIMSS national conference in Las Vegas. Diamond is a partner at Handelsman Family Practice and chief medical officer for dbMotion, a vendor that provides an interoperability platform capable of integrating patient data across various IT applications.

That education process involved seven seminars in 2010 and 2011, hands-on training at the hospital's "physician innovation center," and training in individual physician's offices to explain how to use various software and hardware tools.

As Armato and Diamond explained in their HIMSS12 presentation, the HIE generates four interacting screens for clinicians to work with.

First there's a virtual patient record, which contains vital data on each patient. Second, it's viewable within the hospital's EHR (Huntington is currently a Meditech shop but will soon switch to Cerner). The third component in the HIE is the community doctor's office EMR, and finally there's the collaborative care portal.

The portal is the "game changer" for doctors, said Diamond, because it lets clinicians in diverse practice settings see summaries of all their patients' hospital care by date and then drill down to see, in real time, the specific care they're getting.

So if Dr. Jones is about to see Mr. Smith in her office, she can log onto the collaborative care portal to find out that he had a CT scan while he was in the hospital a week ago and that he was referred to Dr. Silver for a pulmonary consult that took place two days earlier. The portal also serves as a communication tool among physicians, giving them the ability to create new referrals or send quick notes to other members of the care team without disrupting their workflows.

Armato said she's received lots of positive feedback from physicians using this homegrown HIE, including comments about how it's saving them time and money normally expended on mail and faxes to other providers. Others appreciate the fact that the system has sped up the admission process, improved communication among clinicians, and made billing quicker.

While many policymakers continue to work toward that holy grail of a national HIE, hospitals like Huntington Memorial deserve a round of applause for making information exchange a reality in their communities.

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