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6/8/2012
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California HIE Sails Uncharted Waters

Inland Empire Health Information Exchange combines public and private exchanges, which appeals to participants worried about competition.

8 Health Information Exchanges Lead The Way
8 Health Information Exchanges Lead The Way
(click image for larger for slideshow)
The Inland Empire Health Information Exchange (IEHIE), which recently went live in southern California, stands the debate over public vs. private HIEs on its head: Although it's a regional HIE--one of the largest in the country, in fact--it also serves as an enterprise HIE for some of its participants. Coupled with the fact that the exchange is already financially self-sustaining, this hybrid model carries some lessons for struggling community HIEs elsewhere in the nation.

IEHE was founded in 2009 by the county medical societies of San Bernardino and Riverside counties and the Hospital Association of Southern California. That's an uncommon way to start a regional HIE, but it gave IEHIE considerable traction in its efforts to woo providers in the Inland Empire region of California, said Richard Swafford, executive director of IEHIE, in an interview with InformationWeek Healthcare. "The associations brought together the primary players in both counties," he recalled.

Swafford pointed out that he still found it difficult to enroll the 53 hospitals, medical groups, independent practice associations (IPAs), management services organizations (MSOs), and public hospitals and clinics--serving over 4 million people--that now belong to IEHIE. "It took three years to get the stakeholders actively engaged, to do product selection, to build out the governance, and to evaluate the financial models so we could be self-sufficient without relying on grants. It was difficult but the participants really saw the value and supported it and continue to support it."

The competitive environment posed one of the greatest challenges. Although the Inland Empire covers a vast territory, the hospitals in the two counties are "clumped together" in certain areas, noted Swafford. "So they do compete directly for patients, and they compete for contracts. On the medical group side, we have some very large IPAs and MSOs that directly compete with other each, too."

[ Practice management software keeps the medical office running smoothly. For a closer look at KLAS' top-ranked systems, see 10 Top Medical Practice Management Software Systems . ]

In other parts of the country, this type of competition has motivated many healthcare systems to form their own private HIEs, consisting of hospitals and their affiliated providers, rather than trying to work with other systems to build community HIEs that could provide more comprehensive data on their patients. In fact, a recent survey by Chilmark Research showed that most of the estimated 40% growth in HIEs over the past year has been on the enterprise HIE side.

IEHIE adroitly sidestepped that problem by offering to build enterprise HIEs for organizations that don't yet have them. At the same time, the exchange supplies these organizations, such as Loma Linda University Medical Center and SynerMed, an IPA/MSO, with connectivity to the larger community. This argument has been convincing, he said, because IEHIE can create a private HIE for a small fraction of what it would cost these entities to do it on their own.

Healthcare systems and groups that are forming accountable care organizations (ACOs), he added, also want to connect to IEHIE even if they have their own enterprise exchanges. He cited the Prime Care IPA as an example. "The idea is that we can provide patient information to the ACO component that they don't have internally. Because their IPA really captures only data related to their Prime Care patients."

In January, IEHIE launched a pilot with 14 participants that had 2,200 hospital beds and 800 doctors, and it went live with its clinical and patient portals in April. So far, 21 of its 53 members have signed participation agreements and paid full annual fees, on a per-bed or a per-doctor basis, to IEHIE. In addition, the Inland Empire Health Plan, the dominant MediCal managed care plan in the area, is providing financial support, and Swafford said he's in discussions with several other health plans that would like to join IEHIE.

With technical support from HIE vendor Orion, which is building the infrastructure of the exchange, IEHIE is rolling out a care management program that provides software-as-a-service tools to its members. In addition, Swafford said, IEHIE soon will provide lab and radiology ordering and results capabilities. Later in the year, IEHIE also plans to offer Orion's image viewer and its "EHR lite" for practices that don't yet have an electronic health record.

Despite the potential savings that the exchange offers from more efficient communications and fewer redundant tests, IEHIE's participants don't expect to recoup their investment in the first three years, Swafford said. "But they see a long-term value related to healthcare reform, the adoption of EHR, and the use of electronic data to meet federal and state mandates. Also, many are motivated by a desire to provide better care for the community."

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GLEV
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GLEV,
User Rank: Apprentice
6/12/2012 | 8:40:06 PM
re: California HIE Sails Uncharted Waters
The IHIE concept dated back to 2004 ( 8 years ago ) It's current success was taking a wait and see attitude and careful historical review of RHIOs which failed at that time. IHIE did not apply for or get any government funding, other than public health care entitities which are non-profit (Inland Empire Health Information Exchange) who pay a normal startup fee and subscription. The Inland Empire is one of the most competitive health care markets, with hospitals competing with each other. Privacy is guarded between competing institutions, one of which is a tertiary care center. Judging from my experience and knowledge base it is unique with good sustainability, unless one of the anchor groups drops out. It is well ahead of other California HIEs. Driving forces will continue to be local and community interest. Peer influence will become greater as more and more EHRs are used. Call back in five years.
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