Competitors collaborate to make HIE work

Anthony Brino, Editor, HIEWatch

Anthony Brino is the Editor of Healthcare Payer News, covering a range of health policy and insurance issues, and also the Editor of HIEWatch. Follow Anthony on Twitter @AnthonyBrino. 

 

If the HIE succeeds, it will be a model for payers and providers in other regions to join forces for everyone's benefit.

In a densely-populated region with dozens of competing health systems, how can a health information exchange work for everyone?

The greater Philadelphia area might have an answer. Health organizations are taking a historic opportunity for a major metropolitan experiment with HealthShare Exchange of Southeastern Pennsylvania. Led by executive director Martin Lupinetti, HSX is bringing together a membership of more than 50 hospitals, medical practices, clinics and insurers to share patient health records and claims data — and make it all accessible to inpatient, outpatient and clinic settings at the point of care.

HSX went live with clinical data exchange in 2013, but it is very much a work in progress that others can learn from, with Lupinetti as well as Richard Snyder, MD, chief medical officer at Independence Blue Cross, slated to detail the project and its implications at HIMSS15.

HSX is built on an architecture “that makes it special among HIEs nationwide,” serving one of the largest population’s through a single integrated platform, using the Direct protocol and offering encounter notifications and query-based services.

Through 2016, the HIE has the goal of connecting 15,000 providers representing 100 percent of practitioners and 90 percent of hospitals in greater Philadelphia, as well as community health centers, City of Philadelphia health clinics and participating health plans.

“I’ve been thankful to be able to take advantage of discharge information facilitated by HSX, which gathers all of the hospital results, including tests, and sends it straight into our inbox,” said John Potts, DO, a primary care physician with Clinical Care Associates of the University of Pennsylvania, when the HIE rolled out to more providers mid-way through last year.

“We can’t wait days or weeks for this kind of information, as we used to in the past, because it helps us right away to adjust the patient’s transitional and follow-up care,” Plotts explained. “I see us using this a lot more in the future.”

Among other providers linked to the HIE and exchanging data are Plott’s parent organization, the University of Pennsylvania Health System, Aria Health, Crozer-Keystone Health System and Doylestown Hospital.

There are “significant opportunities for the Commonwealth of Pennsylvania to use health information exchange to produce meaningful benefits for the healthcare system,” as HealthShare Exchange leaders note. “Due to the sheer size of the market and it demographics, dollars invested in regional health information exchange in Southeastern Pennsylvania have the potential for significantly greater return on investment than in other regions of the state.”

If the HIE succeeds, it will be a model for other regions to tackle such a large collaborative effort with both payers and providers. HSX still has work ahead of it — namely, figuring out financing.

In 2012, HSX received a $1.5 million grant from Pennsylvania for startup costs and implementation, and support is also coming from acute care hospitals and insurance companies.

Physicians and primary care providers are “not expected to provide a financial contribution during the initial phase,” the HIE said in its sustainability plan. But participation expands with clinics and health plans — along with the service of claims-translated clinical data — “those entities would be included in the financial sustainability model and would be expected to contribute.”

A test of the HSX’s success will be how well it serves the region’s payers and providers as they work in accountable care — such as the Delaware Valley ACO, serving 32,000 Medicare beneficiaries already.

Lupinetti and Snyder’s session, “Payers and providers build an HIE: A major metro experiment,” is scheduled for Monday, April 13 at 10 a.m. in Room S404.