Mark J. Jacobs, MHA, CPHIMS, FHIMSS
Most CIOs /CMIOs that I know focus efforts everyday on strategies, planning, building or maintaining complicated information exchanges within their own enterprises by developing and deploying transformational information technology that improves the delivery of care and streamlines administrative services. Most recognize the need for a strong partnership between the Health Information Technology (HIT) team and leadership. They are acutely aware that transformation is a fundamental change in the way a health system or community delivers and/or administers healthcare, enabled by health information technology, with documented improvement in quality and efficiency.
Some CIOs/CMIOs that I know have devoted countless hours to community HIT collaboration efforts by educating, promoting standards and providing expertise that might someday lead to Health Information Exchange (HIE) beyond the community. However, they understand the costs, the technology costs and the industry limitations of the HIT that they purchase and contract.
A 2009 eHealth Initiative survey found that “meaningful use” will redefine how HIT will be used and place strong emphasis on the ability of providers to exchange information through Medicare and Medicaid payments. Those CIO’s that have been involved and who have pioneered HIEs and can envision the capabilities that can support care as clinicians become meaningful users of electronic health records (EHRs).
Now the States are active in HIEs and are forging ahead with their plans to create Statewide Exchanges. I often ask, “Where are the CIO’s and CMIO’s at the table?”
Community, governmental and non-government policy makers who are at the design table say that CIO’s/ CMIO’s are not the only decision makers in how funds are budgeted. I can buy that, but wait!
They tell me that the work that CIO’s/CMIO’s are doing should be part a larger plan that the hospital and health systems executives support. I can buy that too!
Finally I hear, if CIO’s/CMIO’s had the level of understanding of technology and the
capabilities that HIEs offer then they might have an entirely different conversation at the drawing table.
Then comes the question, “Who will pay for the Statewide HIE ?” Repeatedly, I am told that the costs should be paid by those that benefit the most and the Feds have not provided much guidance in working this out other than stating that HIEs can “pioneer” in this area. States are definitely struggling in finding a revenue model that accomplishes HIE sustainability goals.
I would like to excite your thoughts here…..and any ideas would benefit the cause!
ChuckChristian says
Mark, thanks for your timely comments and insights. I was reminded today that connecting the community is hard work and requires a great deal of resolve to continue to move the ball forward. Trying to get some folks (including vendors) to understand that HL7 is not a plug-n-play widget, at times takes more resolve than I can muster.
On the topic of “paying the freight”, I too have heard that those that benefit the most would be paying the lion’s share of the cost. Having heard/said that, I’m hoping that the ones that will benefit the most will be our patients and the communities that we have the opportunity to serve. However, for now, most of the models that I’ve seen that provide a level of substainable revenue for the HIE, call for the costs to be shouldered by the providers. As more models appear, I’m hoping that some (if not all) of the costs will be shared among all the stakeholders a little more evenly. Well at least that’s my fantasy for the day.
Steve Huffman says
Great comments Mark! As a current participant to a sustainable HIE in northern Indiana (MHIN) I have to throw my $.02 in. While we are not owners of the regional HIE we do “pay our freight” as Chuck points out, but this freight model quickly fizzles after the initial push of fax reduction wears off with physician groups. The key is finding out how to move to the next level of utilization with the HIE and get additional benefit out of the information. An HIE that allows collaboration around the data that is sent and new and innovative ways to leverage the data to show ongoing CONTINUALLY DIFFERENTIATED value will be sustainable.
All too often we hear about HIE’s that ride out the fax reduction train to find out that it is a short trip.
Rich says
In our corner of the world in New Jersey, we have actually been very successful in getting heavy CIO input into the HIE evolution/revolution that is taking place here. Somewhat less so, CMIOs, and this is a key challenge area because without direct physician input, we may wind up building a giant system that doesn’t fit nicely into a primarily constituency’s workflow, and thus does not get properly utilized. What we are building right now is going to reflect the both the stated needs of health IT leaders as well as the “facts on the ground” that need to be navigated through. Clinicians can, will, and must play a vital role in all aspects of the system design, as well, most certainly.
Yes, that is all good (with the “physician” caveats duly noted). But the closing paragraph raises a question that continues to haunt all current and prospective HIEs. What kind of a financial model does the HIE need to have in order to be truly self-sustaining after all the initial grant money runs dry? Intuitively, it would make sense to assess the bulk of the costs on the stakeholders who stand to derive the most benefit from an HIE (many say that payers are the ones who stand to benefit the most). A surcharge on payors for each claim processed, perhaps? I have heard that idea. In order to appropriately assess providers, the cost would need to be allocated in such a way as to not obviate the compelling value proposition of “buying into” an HIE, no small task in today’s tight financial environment. I lose sleep over this and, frankly, we all should. Self-sustainability needs to be front-and-center of all discussions going on within HIEs, as without that, all our noble efforts will ultimately wind up being for naught.
Brian Ahier says
In Oregon the Health Information Technology Oversight Council (HITOC) Strategic Workgroup was created to make recommendations and provide expert advice to the HITOC on the content of a state HIE strategic and operational plans. These plans are required by the ONC to receive federal funding for implementing a statewide HIE.
The roster of the group (http://www.oregon.gov/OHPPR/HITOC/docs/StrategicWorkgroup/HITOC_SWG_Web_roster.pdf) does include some CIO representation. The five domains we are working to make recommendations on are Governance, Technology Infrastructure, Business and Technical Operations, Finance, and Legal and Policy. But Federal start-up funds will be insufficient long-term and we must find a to create a sustainable funding stream.
We are considering a hybrid model which combines elements of Minnesota’s Health Information Organization (HIO) structure and New York’s examples.
Minnesota uses State certified HIO’s with an Oversight Board within Minnesota Dept. of Health.
New York has a State HIT sub-cabinet office. They have created a 501(c)3 governance body that uses State certified HIOs which are partially State funded and controlled through contractual arrangements.
Since governance and financial sustainability are so intertwined these are the first areas we will focus on. I will soon write a post on our progress and also give some local examples from our Gorge Health Connect HIE we have been working on in our region.