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Health Information Exchange

director and chief applications offi cer, Boston Medical Center (BMC). “If certifi cation can address the EHR market and broaden to other areas of clinical information types soon, then this translator period may be short. If certifi cation doesn’t take hold immediately, then middle- ware companies will be in high demand for a bit longer,” he says. “I would predict that most of the major vendors are going to look at more open architecture and services and thus enable communication through the HIE over the next several years. My organization is using translators in the meantime while our vendors catch up.” Mary Anne Leach, vice president and

CIO, The Children’s Hospital, Aurora, Col., says, “Absent widely adopted clini- cal content and data standards, transla- tors (or ETL-type functions) may be required in the interim to facilitate data exchange, data aggregation, trending/analytics, and to support the most effective use of the system by clinician end-users.” According to William A. Spooner, senior vice president and CIO at San Diego’s Sharp Healthcare, “Numerous vendors are developing translator or gateway toolsets, based on the emerging standards (CCD/CDA/XDS).” Daniel Morreale, CIO

ytics and to Mary Anne Leach

s s


and president, Infoshare, AtlantiCare Health System, Atlantic City, agrees that translators, in relation to normalizing codes, will be a signifi cant endeavor. Says John Reifenberger, vice president of RHIO development, Axolotl: “Transla- tors may start to emerge in the market; however, part of the service provided by Axolotl is to enable proprietary systems to com- municate with Elysium Exchange. We have 15 years of experience doing this, and so far, though we have created templates and acquired knowledge that simplifi es the process, each proprietary system is still somewhat unique. Until proprietary systems begin utilizing standards, a universal translator, a product that requires minimal manual confi guration, seems unlikely.” Organizations, such as ISO and IHE,

did t William Spooner

Daniel Morreale t

ex w kn ea un ut a

are leading thew John Reifenberger


are leading the way, relates Mary Kasal, executive direc- tor, Franciscan Health System (an Axolotl customer). “The great increase of other standards bodies has now developed the base knowledge to allow the development of extensible translation tools,” she says. “I believe this is fundamental infrastructure that, as of yet, lacks an orga-

12 July 2010

D v g s

nizational platform to support the use of the translations. I see that area as the next natural place for development. Metaphor is the banking industry’s conversion from paper to electronic over a 20-year span.” Michelle Blackmer, senior director of healthcare mar- keting for Initiate (an IBM company), sees integration as a primary objective of HIE; her product has established adapters for most EMR/EHR systems, and she expects to do the same for PACS and LIS. “We also see document sharing and exchange playing an increas- ingly [important role],” she relates.

ROI and patient benefi ts

Many IT systems are infamous for their soft return on investment. But Vengco has some hard facts to share regarding HIEs: Since implementing the Carefx portal solution in May 2009, BMC has improved the rate of scheduled referrals from 30 to 60 percent, reduced no-shows from 30 percent to less than 5 percent, and increased total number of incoming referrals by 100 a day (about 10 percent). When fully functional, Vengco estimates the portal system will generate an estimated additional $6.5 million each year for the client. Reifenberger says that “ROI largely will depend on the

Mary Kasal

customer’s situation and environment. Much of the ROI might be affected by the decisions made on the topics in the fi rst question,” he says. “Typically, tens of thousands are saved immediately in reduction of the administrative and material costs of paper records exchange. Patients benefi t from a reduction in tests, easier care coordination, less time spent fi lling out forms and easy availability of their medical records.” Kasal estimates her annual ROI is approximately $2 million – in paper handling alone. According to Tabatabaie, redundant radiological exams account for $15-20 billion annually. “It will probably cost somewhere around $1 billion per year to operate a nation-wide system for access to prior imaging exams everywhere,” he says. “The ROI is pretty impressive.” Focusing back on the big picture, Arlotto reminds us about the transformational nature of HIEs: “Goals for care coordination across disparate providers and clinical integration between hospitals and doctors cannot hap- pen without HIE,” she says. “Quality measurement and improvement across provider entities is enabled through HIE. Ideally, patients will see improved effi ciency and elimination of redundant provider services; they will have an improved patient experience; their providers should have more knowledge about their past health issues and problems; and they should enjoy more access to their own health information.”


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