Emerging Trends and Issues

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• Emerging Trends and Issues
• in Health Information Exchange
• Organizational Approaches to Establishing
  Community-Wide Networks
• Capitol Hill Steering Committee on
• Telehealth and Healthcare Informatics
• Select Findings from eHealth Initiative
  Foundations
• Second Annual Survey of State, Regional and
  Community-Based Health Information Initiatives
  and Organizations
• 2005
• www.ehealthinitiative.org

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Why Health Information Exchange?

• U.S. healthcare system highly fragmented.data is
  stored often in paper formin silos, across
  hospitals, labs, physician offices, pharmacies,
  and insurers
• Public health agencies forced to utilize phone,
  fax and mail to conduct public health
  surveillance, detection, management and response
• Physicians spend 20 - 30 of their time searching
  for information10 - 81 of the time, physicians
  dont find the information they need in the
  patient record
• Clinical research hindered by paper-based,
  fragmented systems costly and slow processes

Health information exchange (HIE) is defined as
the mobilization of healthcare information
electronically across organizations within a
region or community.  
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What is Health Information Exchange (HIE)?

• HIE provides the capability to electronically
  move clinical information between disparate
  healthcare information systems while maintaining
  the meaning of the information being exchanged.
• The goal of HIE is to facilitate access to and
  retrieval of clinical data to provide safer, more
  timely, efficient, effective, equitable,
  patient-centered care.

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What is an HIE Initiative?

• Formal organizations are now emerging to provide
  both form and function for HIE efforts.
• These organizations are geographically-defined
  entities (sometimes called RHIOs) which develop
  and manage a set of contractual conventions and
  terms, arrange for the means of electronic
  exchange of information, and develop and maintain
  HIE standards.
• Although HIE initiatives differ in many ways,
  those that experience the most success share
  common characteristics.

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Characteristics of Successful Health Information
Exchange Initiatives

• Governed by a diverse and broad set of
  stakeholders within the region or community
• Develop and assure adherence to a common set of
  principles and standards for the technical and
  policy aspects of information sharing -
  addressing the needs of every stakeholder
• Develop and maintain a model for sustainability
  that aligns the costs with the benefits of HIE
  and
• Use metrics to measure performance from the
  perspective of patient care, public health,
  provider value, and economic value.

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Research to Support the Value of Health
Information Exchange

• Standardized, encoded, electronic HIE would
• Net Benefits to Stakeholders
• Providers - 34B
• Payers - 22B
• Labs - 13B
• Radiology Centers - 8B
• Pharmacies 1B
• Reduces administrative burden of manual exchange
• Decreases unnecessary duplicative tests
• Center for Information Technology Leadership
  2004

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Findings from eHealth Initiative Foundations
2005 Survey of State, Regional and
Community-Based Health Information Exchange
Initiative and Organizations Released August 29,
2005
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Survey of Over 100 State, Regional and
Community-Based Initiatives

• 109 respondents from 45 states and the District
  of Columbia
• Covered aspects related to goals, functionality,
  organization and governance models, information
  sharing policies, technical aspects, funding and
  sustainability

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eHI Foundations 2005 Study 8 Key Findings

• 1. Health information exchange is on the rise
• 2. The key driver moving states, regions and
  communities
• toward health information exchange is
  perceived
• provider inefficiencies with rising
  healthcare cost also
• seen as an important driver
• 3. Health information exchange efforts recognize
  the
• importance of privacy and security
• 4. Health information exchange efforts are
  maturing
• organization and governance structures are
  shifting
• towards multi-stakeholder models with
  involvement of
• providers, purchasers and payers.

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eHI Foundations 2005 Study8 Key Findings

• 5. Advancements in functionality to support
  improvements in quality and safety are evident
• 6. HIE efforts are delivering more information
  and increasingly using standards for data
  delivery
• 7. Securing funding to support start-up costs and
  ongoing operations is still recognized as the
  greatest challenge for all HIE efforts
• 8. Funding sources for both upfront and ongoing
  operational costs still rely heavily upon
  government funds but alternative sources for
  ongoing sustainability are beginning to emerge.

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What Stage Are They In?
Stages of HIE Development
Stage 1 12 (23)
Stage 2 14 (27)
Stage 3 15 (25)
Stage 4 37 (16)
Stage 5 12 (9)
Stage 6 11 (N/A)

• Recognition of the need for HIE among multiple
  stakeholders in your state, region, or community

• Getting organized
• Defining shared vision, goals, objectives
• Identifying funding sources
• Setting up legal governance structures

• Transferring vision, goals, objectives to
  tactics and business plan
• Defining needs and requirements
• Securing funding

• Well underway with implementation - technical,
  financial, and legal

• Fully operational health information
  organization
• Transmitting data that is being used by
  healthcare stakeholders
• Sustainable business model

• Demonstration of expansion of organization to
  encompass a broader coalition of stakeholders
  than present in the initial operational model

Second Annual Survey of State, Regional and
Community-Based Health Information Exchange
Initiatives and Organizations
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Key Drivers for Health Information Exchange

• Provider inefficiency due to lack of data to
  support patient care
• Rising health care cost
• Public health surveillance needs
• Ability to facilitate performance reporting and
  improvement
• The ability to improve patient safety and quality
• Supporting clinical care
• Improving health outcomes
• Improving speed and quality of information
• Facilitating EHR implementation
• Improving access to care

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Key Drivers for Health Information Exchange
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HIE Initiatives What Are They Doing?
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Growing Focus on Disease Management, Quality
Reporting
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Who is Involved in HIE Initiatives?
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Who is Leading These Efforts?
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How are HIE Efforts Organized?
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HIE Efforts are Forming Legal Structures
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Greatest Challenges Among HIE Efforts

• Securing upfront funding- 91 of all respondents
  cited securing upfront funding as either a very
  difficult or moderately difficult challenge.
• Developing a sustainable business model- 84 of
  all respondents cited developing a sustainable
  business model as a very difficult or moderately
  difficult challenge.

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Greatest Challenges Among HIE Efforts

• 3. Engaging health plans- 74 of respondents
  perceived the engagement of health plans as a
  very difficult or moderately difficult challenge.
  
• Accurately linking patient data- 80 of
  respondents indicated that accurately linking
  patient data was a very or moderately difficult
  challenge.
• 5. Other challenges....

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HIE Efforts Greatest Challenges
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Federal Government Still Key Funding Source
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Federal Government Still Key Funding Source
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New Models for Sustainability Emerging
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Where Do We Go From Here?

• Work to align financial and other incentives for
  electronic health information exchange to quality
  and efficiency goals.
• Support innovative programs designed to
  facilitate public and private sector seed funding
  of emerging health information exchange efforts
  as a means of supporting widespread
  interoperability.

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Where Do We Go From Here?

• Continue to work to engage multiple and diverse
  stakeholders within healthcare in health
  information exchange efforts - including
  laboratories, health plans, purchasers, and
  consumers.
• Work to expand and clarify the role of states.
• Support national efforts designed to achieve
  consensus on and promotion of adoption of
  standards.they could not be more timely!

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For More Information

• To join eHI Foundations Connecting Communities
  Working Group go to www.ehealthinitiative.org
• To download the report Emerging
• Trends and Issues in Health Information
• Exchange go to www.ehealthinitiative.org