Health information exchange (HIE) sustainability and the future of these networks generally depend on their ability to create a useful and meaningful use value proposition for healthcare providers. In turn, this value proposition is dependent on the needs of a provider community, which must see the HIE as a helpful and effective tool that supports the delivery of high-quality care at an acceptable cost.
It is this understanding of creating value that has led the Colorado Regional Health Information Organization (CORHIO) to get all of the state’s large hospitals participating in HIE. According to Larry Wolk, MD, CEO of CORHIO, hospital HIE adoption is key because of the effect it has on getting others on to the network. EHRintelligence.com caught up with Wolk to discuss the domino effect of HIE adoption and how a hospital’s decision to join an HIE should lead to further connections down the road.
As a physician, when and why do you see the value of HIE?
I drank the Kool-Aid probably as early as anyone here in Colorado with regard to adoption and implementation of electronic health record systems. I still practice part-time as a pediatrician and we went to an electronic health record system six or seven years ago. I saw the benefit of practicing with an EHR system as compared to paper, both financially and from a quality standpoint. I was involved in a kind of advisory capacity on an initial CORHIO or COHIE planning grant almost ten years ago. For me it was easy because I saw the practice of medicine moving to a place where using technology to assist in providing better care made perfect sense.
What was the tipping point for CORHIO getting participants sign up and connect?
There was probably a wait-and-see attitude by the hospitals. The hospitals were wondering what CORHIO’s sustainability looked like before they made an investment in it. Their decision had a domino effect. The docs were waiting to see what the hospitals would do before they made a decision. That’s now followed by the health plans that are now seeing that if the hospitals and doctors are in and they now have a critical mass of their network that they can utilize for the same purpose as what they were using paper records and information for, then maybe this is something they should get behind, too.
When I came in, I made a priority of building trust and making sure we had a sound sustainability plan that looked beyond the ONC money that we originally received to get this thing started. The Centura Health Care System had just gone live a few months prior to my coming on, so it was utilizing them as advocate relative to the other major systems to help bring them on which we just completed a couple weeks ago with Exempla Healthcare.
Where will your organization be focusing its energies going forward?
We already have more than a thousand docs who are live. Now it’s looking at this queue of physicians who now want to come in to be data receivers now that we have all the hospital systems, either live or signed up. One, we have to keep our heads down and make sure we get these hospitals signed up and get the physicians signed up to receive the data. Two, it’s to make that data flow bidirectional so that the information can be shared back and forth and not just hospitals sending ADT,* lab, and rad and physician offices just receiving those, but developing and supporting the CCD or clinical information delivery from the provider practices to hospital systems or ACOs or health plans.
[ADT: admission, discharge, transfer]
How has meaningful use and healthcare reform helped HIE adoption in Colorado?
Meaningful use helped, one, at least it was a set of standards whether you appreciated them or not. But practically speaking, if nothing else the money is meaningful to providers. Using my own experience for my practice — I’ve got a safety net clinic system that’s a non-federally qualified health center that sees predominantly Medicaid-insured kids — we were able to get meaningful use certified and get the meaningful use incentive payments from Medicaid. We’re about $6- or $7-million a year in revenue organization, and the meaningful use payment because of the number of providers that we have in the first year we were just over $300,000. That’s significant because then it allowed us to plan for the capital investment required to have the computers, the software, the programming — everything necessary in order to attain meaningful use, which arguably should help you provide better care and more cost-effective care.
Then there are patient-centered medical homes, even though there’s no money tied to it per se. Physicians are forward-looking and in pediatrics it’s been in place for number of years here prior to the ACOs and developing almost around the patient-centered medical home model and certification in Colorado. Physicians don’t want to be left behind, especially if there’s going to be payment reform that then gets tied to having a certified patient-centered medical home.
What does the future of HIE look like?
Hopefully, there will be and there are other successful either large regional or state HIEs that can be the patches of the quilt for the national health information network. We just want to continue to establish CORHIO as the footprint for this part of the country, so we’re starting to look at our neighboring states and how we pull something together that really is the representative HIE for this part of the country because at some point there will be national HIE and national health information network strategy. What makes the most sense is to connect to those folks that have the footprint for that particular part of the country. Source
