How To Keep Health Data Exchanges Going

Financial sustainability has been the hardest nut to crack for many health information exchanges. And even with the feds providing $564 million in stimulus funding for states to build and expand HIEs, the sustainability issue will likely remain one of the toughest challenges.Under the American Recovery and Reinvestment Act, the Department of Health and Human Services awarded grants to states ranging from $4.6 million to $38.8 million. However, that money is designated for establishing or advancing the HIEs, including infrastructure, software, hardware costs. The grant money can't be used for operations.

So once the HIE is running, there'd better be a well thought-out, solid plan to keep it going. The recent past is littered with promising health data exchange efforts that didn't last after public or private grant money ran out.

In Iowa, IT consulting and services company Hielix, along with a partner firm MedNet, were recently awarded a contract to devise a strategic business and financial sustainability plan for the statewide health information exchange that's being developed by Iowa e-Health, a collaboration created by Iowa's department of public health. Earlier this year, HHS awarded a nearly $8.4 million ARRA grant to Iowa to develop a statewide HIE.

Meanwhile, in creating a sustainability plan for the HIE, Hielix has begun talking to the various Iowa stakeholders, including healthcare providers, medical centers and medical schools, about how they intend to use the exchange and the value they hope to get from it, said Hielix CEO Patti Dodgen.

Those discussions include how the exchange can help clinicians provide safer, better quality of care to patients as well as make their own processes more cost efficient, she said.

For instance, the value of the HIE for ambulatory care offices includes doctors being able to electronically exchange information about patient referrals, such as those involving medical specialists or inpatient hospitalizations. It's also about doctors being able to quickly access patient info at the point of care, not waiting for the postman, FedEx or faxes to come through with important test results or radiology reports, she said.

But the job of trying to explain to stakeholders the potential value of an HIE before the exchange is actually up and running can be a delicate task. Nonetheless, getting the buy-in from stakeholders big and small is vital to the sustainability of the HIE later.

Working to get HIE buy-in from healthcare providers who are hesitant about sharing patient information with competing organizations in the first place-and hoping they'll pay to help sustain the health information exchange later-requires "certain facilitator skills," Dodgen concedes.

How difficult do you think it is to convince doctor offices about paying a monthly or yearly subscription fee to use a health information exchange in the future-- if those same doctor offices claim they can't even afford buying fax paper today, necessitating that radiology reports get hand-delivered to the physicians by the imaging centers where those doctor sends patients for tests?

That's the kind of situation that Dodgen has seen firsthand while working with potential stakeholders of HIEs in other states, including Florida.

In those situations, Dodgen said part of the HIE's sustainability planning involves convincing the diagnostic imaging center that exchanging data, including sending reports to doctors via the HIE, has more value than the courier method used today.

To contribute to the sustainability of the HIE, the imaging center could be asked to pay a fee that's a fraction-say 25%-- of what the facility is paying yearly to maintain the courier service, including vehicle expenses, salaries, gas, mileage and more. So, the use of the HIE could reduce the imaging center's previous courier expenses by 75%, she said.

For doctors used to having the reports delivered to their offices, the goal is to help them understand that "having access to information as soon as it's available [from the imaging center or others] is critical in care" of patients, she said.

"The best sustainability plan takes into consideration when those benefits will accrue and who'll be getting them" first, she said. Stakeholders likely to see the biggest or earliest boost in process efficiencies or reduction in costs could be expected to "subsidize" the HIE until smaller stakeholders realize value in the HIE, she said. That could include phasing in subscription fees for different groups of stakeholders over time.

The imaging centers might be expected to kick in financial support for the HIE earlier, while small doctor offices could pay a subscription fee later, once they too are benefiting from the use of the exchange, she said.

"There's a share-the-wealth philosophy, where those who are getting the biggest benefits earlier help subsidize the HIE until the benefits begin accruing for those subscribers that can't afford it right away," she said. That's a sustainability plan that's worked for other HIEs so far, including HealthBridge, a non-profit that facilitates health data exchange services for doctors in the Cincinnati, Ohio area.

"It helps those on the ragged edge of viability," she said.

Once the use of a HIE gains enough steam in a region-with a large and important array of patient information being exchanged among healthcare providers- those clinicians not participating become the competitive disadvantaged, she said.

"Patients vote with their feet," she said.

Patients' responsibilities include being informed about their health and involved in their healthcare decision making, she said. HIEs can help facilitate that by ensuring that clinicians have access to critical medical information to discuss with patients before treatment choices are made, wellness programs planned, and so on.

Everyone-from HIE stakeholders to patients-can play a part in the success of HIEs, she said. That's vital to keep in mind when planning how you'll sustain your HIE.

The latest issue of InformationWeek Healthcare shows how four health information exchanges are getting doctors to finally share information. Also in this issue: Eight often overlooked data protection pitfalls and how you can prevent problems. Download it now (registration required).