Look inside some of the most established HIEs and how they help U.S. health organizations share data, in the name of lower costs and better patient care.
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The Indiana Health Information Exchange, the U.S.'s largest HIE and one of the oldest, serves more than 19,000 doctors and 80 hospitals, with data on more than 7 million patients. IHIE, created by the Regenstrief Institute, a medical informatics think tank, runs the Indiana Network for Patient Care (INPC), a secure network that provides a "virtual patient record" to participating doctors. That record includes information from encounters covering more than 80% of care provided at hospitals within Indiana. For instance, when a patient is admitted to a hospital or emergency department, the INPC provides a clinical abstract of the patient's medical history even if the individual has never been treated at that particular facility. "INPC speaks for patients when they may not be able to speak for themselves," said an IHIE spokeswoman. The INPC also contains radiology images, discharge summaries, operative notes, pathology reports, and medication records. Clinicians can access information in the INPC ony when a triggering event occurs, such as a visit to an emergency department.
The INPC Management Committee, which is made up of various healthcare community stakeholders, strictly governs the amount of time a physician has access to patient records. Access varies by patient class including Emergency Department, inpatient, and outpatient encounters, with the duration of access varying depending on the care being delivered. These security restrictions and limitations ensure that only healthcare providers responsible for treatment gain access to patient data. IHIE also offers a clinical messaging service called Docs4Docs. It delivers real-time patient results securely from 49 Indiana hospitals and specialty facilities to over 19,000 physicians across the state and beyond. Docs4Docs offers a single source for providers to find lab, radiology and transcription reports from multiple locations.
Clinicians, who are estimated to receive over a million clinical messages daily, get their Docs4Docs results in their practice's E-medical record system, in a Web-based inbox, or by fax. An IHIE spokeswoman said IHIE staff work closely with EMR vendors to ensure connectivity and accuracy. The Web inbox logins are maintained and vetted by the IHIE Client Services department. IHIE also says that all physician office fax numbers are researched and verified before any results are delivered.
As for IHIE's business model, individual providers do not pay anything to participate. The exchange contracts with hospitals and health systems on INPC and Docs4Docs. IHIE also has received federal and state investments and grants. In 2010 it received $16 million in ARRA investments as part of the Beacon Community Collaboration Program. This investment established the Central Indiana Beacon Community and IHIE is the lead organization in that program, said an IHIE spokeswoman. "Our focus for the future is on sustainability by developing and delivering services that the market needs and wants to pay for and reducing dependency on grants and government investments," she said. "We are still interested in opportunities such as the Healthcare Innovation Challenge posed by CMS earlier this year. We applied for another sizable funding opportunity and are waiting to hear on whether it will be awarded to us."