Healthcare organizations and providers have a number of motivations for connecting to a health information exchange (HIE). Those forming or participating in accountable care organizations (ACOs) or patient-centered medical homes (PCMHs) require a mechanism for exchanging health information between care providers and settings. Meaningful use is another driver of HIE adoption as eligible professionals and hospitals move forward with Stage 2 and Stage 3 Meaningful Use.
As John Kansky, VP of Strategy & Planning at the Indiana Health Information Exchange (IHIE) explains, the challenge for his and other HIE organizations of increasing clinician buy-in centers on identifying providers’ pain points and ways HIE can mitigate those sources of discomfort. In this Q&A, Kansky shares what one of the nation’s top exchanges is doing to increase the adoption and meaningful use of HIE.
What factors have enabled IHIE’s growth and success as an organization?
There are a couple of key factors. One is that we’ve been connected to, partnered with an organization called the Regenstrief Institute, which is here in Central Indiana and they’re internationally renowned for their work in health information technology — one of the pioneers in health information exchange from a research perspective. Thanks to their pioneering work in the nineties, we got about a ten-year head start on the rest of the country.
The other is understanding and never losing perspective of being business-like and focusing on customer value. Many HIEs especially three to five years ago were focused on being not-for-profit, societal-benefit do-gooders, which is not meant to be pejorative. But to sustain any organization you really need to focus on customer value and execute like a business.
The combination of Regenstrief’s head start and their understanding of this space as well as the intellectual provided us in terms of software and then our execution over the last ten years — those are the two big factors.
What have the EHR Incentive Programs and meaningful use done for HIE?
Meaningful use has had its benefits and its distractions. The biggest benefit is that it has moved the nation forward a huge leap in terms of its awareness of electronic health records and health information exchange. It has taken a lot of fence-sitters and galvanized them into action, and action includes going out and implementing EHR but it also at the hospital and physician level has meant getting to know their health information exchange and ringing our phones. Organizations that were not compelled to participate in our network through the government’s policies around meaningful use have been compelled to participate. The biggest net good is not the specifics — not that Direct is fabulous or it’s gotten doctors to do this one specific thing — it’s been that it has significantly increased the attention to EHR and HIE, and we’ve benefited from that.
Now we were well established and had a customer-value proposition before that came along, so I don’t want to give the impression that we haven’t utterly steered our strategy or changed our proposition because of meaningful use. We just added to it.
How do you get healthcare organizations and providers to buy in to HIE?
I don’t mean to be flip, but you treat them like customers. You listen very intently to what they’re telling you their needs are and you try to respond to them. Basically, it boils down to we’re in the business of aggregating and making available clinical data. You do that and you have many things you can do that provide value across the healthcare system to not only doctors’ offices and hospitals but also potentially payers, employers and labs. You sit around thinking about what else you could do that you think would have value for your customers and then validating whether they want you to do that and be willing to pay for it. Many ideas come from their pain points that they brought to us.
What are some of those pain points?
They range from the mundane to the most sophisticated. For example, there are accountable care organizations and clinically integrated networks needing to be able to analyze data across patient populations and getting access to data beyond their enterprise. That’s a key one that not that many health information exchanges nationally can deliver on, but we absolutely can and are. Any healthcare organization participating in our exchange that is going down this pathway of payment reform models, they know that we have the data on the care of their patients from the majority of enterprises, including all those that aren’t them. Inasmuch as they need to know about their patient, there are a number of value propositions around helping them understand the care of the patient and the population using data that is beyond their enterprise.
Now, if we go in the way-back machine to 2004 and 2005, there is a much more mundane but still very valid old garden-variety tried and true HIE value proposition: We deliver electronically lab and radiology results. Guess what? As a growing percentage of healthcare providers put in EHRs and want those in progressively more electronic and automated structured data kind of ways, that grisly old value proposition just gets better and better.
How should providers go about connecting to IHIE or other HIEs?
It’s great if they are thinking about the connection to the health information exchange before they consummate their purchase to the EHR vendor because they are going to need some interfaces and it’s great to negotiate those interface costs with your vendor before you sign the contract instead of after. We have a fairly standard normal set of interfaces, so it’s nothing crazy that we’re going to be asking the EHR vendors to build with us. The physician practice will want to talk with us about the capabilities we have and engage us in conversation about which of these they want to use the HIE for. For example, are they very focused on meaningful use and that’s their first priority? This would drive certain ways of connecting and capabilities.