Dale Sanders, CIO, Cayman Island Health Authority
In a previous post, I ranted a bit about the generally dismal track record of health information exchanges to find a sustainable economic model, and in particular, criticized the false analogy that we often draw between health and financial information exchanges. In this post, we’ll take a more positive, “How do we solve the problem?” approach by exploring the characteristics of the minority but notable HIE’s that are successful. Although I’m fairly familiar with the Utah exchange, I’m not an inside expert with any of these HIE’s so the value of this post won’t come from me…it will come from those with firsthand knowledge who are willing to contribute. The best I can do is plant the seed. Hopefully, with contributions from all of us, we’ll have enough information to compile a succinct and valuable paper that we can widely share.
The HIE’s we’ll focus on are those that have been in existence for several years and appear to have a self-sustaining economic model.
• New England Health Exchange Network www.nehen.org
• Indiana Health Information Exchange www.ihie.com
• Utah Health Information Network www.uhin.org
• Cincinnati Healthbridge www.healthbridge.org
I think we will see a strong similarity between the Utah and New England models which I would describe as having their origins in processing claims and eligibility data, and that remains their core business. Indiana and Cincinnati have roots in the exchange of clinical results. Below are the questions that seem salient to me, but I encourage others to offer their thoughts.
- How long has the HIE been in existence?
- What are its sources of operating revenue?
- Did it ever or does it now receive State or Federal funding? If so, how much?
- What was last fiscal year’s operating budget?
- What was last fiscal year’s operating profit and/or loss?
- What type of data passes through the exchange?
- Is any of the data processed by the exchange used by clinicians to treat patients?
- How many organizations process data through the exchange?
- How many transactions were processed by the exchange last year?
- What business and/or clinical processes are supported by the exchange?
Brian Ahier says
These are some excellent questions. I look forward to us finding some of the answers…
Steve Huffman says
One of the misconceptions with the Indiana HIE story is that we actually have 4 regional exchanges. iHIE, that you reference in your writeup, is the regional exchange for central Indiana. HealthBridge, MIE and MHIN are also exchanges that currently have a solid business model and are fully functional. I can speak specifically to MHIN (Michiana Health Information Network). While my hospital is not an owner of MHIN we are a very heavy contributor and I sit on the Board of Managers (full disclosure). The answers below come straight from the management of MHIN.
Per your questions above here are short answers that can spur additional questions:
1. How long has the HIE been in existence?
Established in 1999, the Michiana Health Information Network (MHIN) has been operational for over 10 years.
2. What are its sources of operating revenue?
MHIN’s sustainable business model derives revenue from the following products and services:
MHIN Data – A community-wide clinical data repository and delivery service which securely stores clinical information from all sources into one longitudinal patient record and electronically delivers results to physician offices
MHIN Messenger – Web-based clinical messaging and results communication platform for sending, receiving, and managing clinical information
MHIN Integration Services – A single interface that delivers discrete digitized results from all participating institutions to any physician office or institutional EHR. Additionally services include the connect disparate systems within a physician practice or institution.
MHIN Quality – Sophisticated analytics, patient registries, case management, and system generated alerts to help providers identify and manage patients and healthcare populations.
3. Did it ever or does it now receive State or Federal funding? If so, how much?
To date MHIN has not been the beneficiary of any State or Federal Funding.
4. What was last fiscal year’s operating budget?
This is only subject to release if all other participating organizations share their respective operating budgets as well.
5. What was last fiscal year’s operating profit and/or loss?
As a private organization we do not generally share our profit and/or loss, but the company has a 10 year track record of sustainability.
6. What type of data passes through the exchange?
Patient Demographics, ADT (Admission, Discharge Transfer), Scheduling Information, Hospital Transcription, Laboratory Results, Radiology Reports, Physician Office Notes, Referrals, CCR/CCD, Medications, Allergies, Known Problems, Immunization Records, vital signs, and more.
7. Is any of the data processed by the exchange used by clinicians to treat patients?
Yes. The health exchanges is the primary platform for delivery and integration of health results across the community and particularly in ambulatory care settings.
8. How many organizations process data through the exchange?
6 hospitals, 4 laboratories, 4 diagnostic imaging centers, and hundreds of physician offices and other providers such as hospice, skilled nursing facilities, surgery centers, home health agencies and health departments.
9. How many transactions were processed by the exchange last year?
Over 15 million.
10. What business and/or clinical processes are supported by the exchange?
The exchange supports any business or clinical process that involves sharing, transferring, storing, or accessing any type of medical information.
Dale Sanders says
Wonderful contributions, Steve. Thanks for getting things moving. I’m wondering (and assuming) if the other HIE’s will also be concerned about openly sharing their financials, and thus if we should find a way to uncover the metrics but retain privacy and anonymity. I think it would be particularly helpful to understand the details behind the sources of revenue– i.e., the pie charts and fees. We’ll see how far we get on this path, first. BTW, very impressive long-term accomplishments with no Federal or State funding. The organizations who are paying for the services are clearly seeing the ROI.
Steve Huffman says
I’ll leave a little more information, from a contributor and funding source (taking my board hat off for a minute or two).
It will be difficult to get to the bottom line of the financial’s of the HIE. This isn’t because they won’t share it (many won’t), but because the models vary wildly. MHIN happens to have a centralized repository model, while other models use a decentralized approach, or a federated approach.
While historically my Health System has questioned the payment to MHIN, after careful consideration and evaulation a few years ago, we know understand that it is well worth the expense. For MHIN and other HIE’s in the state of Indiana this goes beyond just limited faxing.
From a hospital perspective the lesson, in my opinion, is that there is benefit to the HIE and you have to continue to leverage the investment and create new and innovative ways within your own health system to continually make the HIE beneficial for the patient / community.
I don’t see a model where patients pay, the government pays, or only insurance companies pay. You have to create the solution, communicate the benefit and match the cost with the benefit received.
Dale Sanders says
Steve’s third paragraph(“While historically…”)is where the wisdom and commitment reside… that’s the heart of the story. As mentioned, the models vary wildly, but the appreciation and belief in the ROI is key. I really wish we could find a way to peel some of the mystery away from the financials and utilization fees, though. I’m holding onto hope. :-)
Anthony Guerra says
KLAS just released a report on HIEs. A news item can be found here: https://healthsystemcio.com/2010/02/08/klas-most-hie-vendors-long-on-talk-short-on-results/
I did an interview with the author – Jason Hess – yesterday. I will have the first part online today and will add the link here.
Anthony Guerra says
here you go: https://healthsystemcio.com/2010/02/09/one-on-one-wklas-clinical-research-gm-jason-hess-i/
Dale Sanders says
This following was sent to me via email by Keith Hepp, VP of Business Development at HealthBridge:
>>>>>>>>>>>>>>>>>
Dale
My response
– We’ve been operating since 1997
– 35 million transactions last year
– all clinical results for care
– 5M budget
– less than 1p from government but that’s changing quickly
– fee for service model
– profit of 5p of revenue
– 28 hospitals 5 labs 750 physician groups
– lab rad trans card micro path prescription public health
Brian Ahier says
WOW!!!! This is such an incredible help. Thanks guys :-D
dmmorreale says
well Dale these are the right questions. We as leaders in Healthcare IT have to do more to help the clinicians use the data to treat patients/ For Me, I think it is one of the imperatives, dare I say, moral imperative to move the data to the point of care in a format that is meaningful, easy and thus valuable.