Indiana Health Information Exchange Blazes a Trail Worth Following

The need to exchange health information is widely recognized as a goal worthy of pursuit – but one fraught with many challenges, according to many healthcare industry leaders. Fortunately, the trailblazing Indiana Health Information Exchange (IHIE) is providing a model worthy of replication. 

"Over the last decade, people have come to recognize that capturing data on a person's health and well-being is very important," said Harold Apple, CEO of IHIE. "When you have data, you can take quick action at the point of care. You can also analyze the aggregate data to see trends in larger populations and then implement best practices that can lead to improved overall outcomes."

But according to a viewpoint article published in the Journal of the American Medical Association in April 2012, the HIE "vision is deceptively simple" and "there are enormous challenges to enabling clinical data to flow across organizations."

Indeed, HIEs are likely to struggle with business and policy issues when connecting with their healthcare community, including: defining the return on investment; getting stakeholders to agree on governance and policies; and determining how to exchange health information with competing organizations to successfully participate in accountable care organizations (ACOs) and meaningful use initiatives. In addition to these challenges, maintaining financial sustainability is frequently cited as an HIE obstacle.

IHIE, however, has found a way to get and keep the exchange on solid financial footing. More specifically, leaders have realized that financial success hinges largely on the volume of providers participating in the HIE – and have hit upon a means to quickly get organizations into the fold. 

To streamline the HIE "on-boarding" process, IHIE now uses AT&T Healthcare Community Online, a cloud-based HIE and care collaboration platform, to displace its  existing messaging system, making IHIE more accessible in a highly secure and scalable environment. AT&T Healthcare Community Online utilizes the AT&T network and best-in-breed ecosystem to increase the number of hospitals participating in the exchange and to decrease the time spent on implementations and integrations.

After a provider enters into a contract, IHIE leaders work with the hospital to plan a "readiness assessment" with the facility to identify timing preferences and any risks to the project from the hospital's side. IHIE provides the hospital with standard interface specifications including an AT&T-developed tool that enables the hospital to identify general issues with their messages before attempting to create an interface. As such, IHIE can address the more complicated interface challenges earlier in the process, so all of the basic issues are quickly resolved.

"Now, we are on-boarding hospitals into the exchange in waves of 10 and 15 at a time," Apple says. "Before we had a severe backlog of some 30 or 40 hospitals that we had contracted with and that were not exchanging data with our other members. It would have taken us years to get to this point without the help of AT&T."

The hospital on-boarding process now takes, on average, four to five months, as opposed to nine to 12 months previously.

The end result: IHIE now operates the nation's largest health information exchange, one that connects more than 90 hospitals, long-term care facilities, rehabilitation centers, community health clinics and other healthcare providers in Indiana. This network serves an area with a population of about 6.5 million people and more than 25,000 physicians. IHIE provides information and medical records in a highly secure, standardized and electronic format, enabling information to follow the patient, rather than being limited to one physician office or a single hospital system.

To build on the success forged in Indiana, IHIE launched a for-profit subsidiary in 2013 to offer its technical and operational expertise to customers across the nation. Under the name Thrive Health Data Solutions, or Thrive HDS, IHIE can now offer proven, scalable solutions to any health organization looking to aggregate data across disparate IT systems and create meaningful inferences through predictive and retrospective analytics.

"The fact that we can get data to the right point in the care process within seconds to help that EMT, physician or that nurse who is providing care is something we are all very proud of," says Jim Hill, executive vice president for Thrive HDS. What's more, IHIE also is using the data to examine trends in population health – and identify and implement best practices to improve overall healthcare delivery. 

Perhaps best of all, though, IHIE and Thrive HDS are making it possible for other health information organizations to follow in its footsteps. IHIE and Thrive HDS are collaborating with AT&T to offer professional services designed to assist organizations with successfully setting up and running their HIE. Professional services available through this collaborative arrangement can help health systems, ACOs, and public or private HIEs advance business, policy and technology initiatives to support organizational goals. These planning and advisory services, available as part of the AT&T Healthcare Community Online portfolio for care collaboration and HIE, help organizations assess, identify and prioritize opportunities. They also can help address governance, stakeholder engagement, sustainability and other business issues. In addition, technology advisory services are available to address vendor performance concerns.