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Health Information Exchanges 5 lessons learned

How to build a successful and sustainable HIE. By Brent Dover

a public or private health information exchange (HIE). Why? Because the level of care collaboration driven by HIE solutions is essential for success in these emerging care-delivery models. Establishing an HIE initiative may seem an intimidating


task. For a guide on how to build a successful and sustainable HIE, providers need look only at Delaware Health Information Network (DHIN) and Michigan Health Connect (MHC). In 2007, DHIN became the first operational statewide HIE in the nation. Today, 100 percent of acute-care hospitals and skilled nursing facilities and 93 percent of physician practices in Delaware are using and securely exchanging patient data through DHIN. Meanwhile, MHC has been embraced by ap- proximately 1,125 primary care and specialty physicians since it was launched in 2010.

A major reason these initiatives have succeeded is that health systems and other stakeholders in the community understood the value of a community asset for patient care. They chose to collaborate in order to put patient care first. This cooperation created the opportunity to deliver solutions that support more efficient patient care designed around col- laborative clinical workflows.

Another factor behind the success of these initiatives is that they focus on addressing the workflow problems of providers who use the HIE. MHC, for example, has reduced workflow inefficiencies arising from paper, fax and telephone com- munications and fostered collaboration among physicians by automating and stream- lining the referral pro- cess. Aiming at these low-hanging fruit – the inefficiencies and pain

Brent Dover is president, Medicity. For more on Medicity:

points that affect providers daily – is a key strategy for generat- ing immediate value and buy-in from participants. The following are key lessons learned about how to demon- strate value, kick off HIE success and drive provider adoption of the HIE solution:

1. Define expected benefits from the start. It is essential that HIEs define the goal of their project and the benefits they hope to achieve. To accomplish this, they can form a team of clinicians, information technology experts and others

14 October 2012

s the healthcare industry transitions from fee-for- service to fee-for-value payment models – such as shared savings and pay for performance – care providers will need to form, join or connect to

to research and create a baseline of measureable and relevant benchmarks. While they need to begin the project with the end in mind, they also need to create strategies for incremental deployment of the solution – resulting in quick wins and rapidly demonstrable value. 2. Measure benefits regularly. HIEs should measure their performance against the baseline benchmarks on an ongoing basis to determine whether they are hitting the mark. This will help them make a business case to potential backers and participants, enable them to secure new members, grow more quickly and obtain actionable data to address areas that are performing poorly.

3. Set a deadline for providers to transition to electronic ex-

change. To ease the transition from paper to electronic records, physicians often are given the option of receiving information in both formats. In the short term, this is an excellent strategy to secure buy-in, but it should not be allowed to continue in- definitely because it defeats the purpose of automation. HIEs should set a reasonable deadline – three to six months – to get providers completely transitioned to electronic data exchange. To incentivize practices to drop paper, HIEs can charge a fee for dual delivery.

4. Establish accountability for participants to provide clean

data. When an HIE is aggregating data to create a community health record, ensuring the integrity of its community master person index (MPI) is key to success. In the world of EHRs, it is common for a patient to have multiple medical record numbers or identifiers. By ensuring data sources resolve iden- tity conflicts before their data are included in the community HIE, the HIE will avoid having to divert valuable resources to address this issue after the fact. It will also avoid incurring potential delays and unnecessary costs, particularly as the number of participants, patients and data transactions grows. 5. Interface with physician EHRs. Physicians have invested significant resources in implementing EHR systems in their practices. For these physicians to adopt an HIE solution, it is important that the HIE interface with their EHR. At the same time, it is essential to provide flexible solutions that enable providers who don’t have a full EHR to participate in the HIE. Providers need to implement HIE capabilities rapidly to adapt to the emerging healthcare business model. Those that follow the path blazed by successful pioneers will be better positioned to navigate challenging market forces and gain a competitive advantage.


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