News related to the exchange of health information and the entities that facilitate that exchange continue to dominate the headlines. And for good reason. Access to a comprehensive view of a patient’s health information across encounters and providers is widely seen as one of the most important contributors to the Obama administration’s goals of improving the quality and reducing the cost of US healthcare.
Health information exchanges come in many shapes, styles and colors. Today there are literally hundreds of efforts in various stages of implementation and operation throughout the US. Many are what I term “proprietary exchanges”, in that their constituencies are limited to care delivery organizations that are either owned or tightly coupled to the key sponsoring entity, typically a hospital or IDN. The evolution of proprietary exchanges has outpaced that of multi-constituent, community-based and regional exchanges. While theoretically of greater value to patients and the broader “provider community”, the heterogeneous nature of such entities burdens them with competitive, operational, governance and, particularly, financial challenges that proprietary exchanges are not (or at least less) subject to.
Recognizing this, the HIT funding in ARRA made provisions for federal seed money to accelerate the development of community-based exchanges under the aegis of each state. On February 12th, DHHS Secretary Kathleen Sebelius awarded $386 million in HITECH grants to 40 states under the State Health Information Exchange Cooperative Agreement Program (SHIECAP). On March 15th, Secretary Sebelius, along with the National Health IT Coordinator, Dr. David Blumenthal, announced an additional $162 million in 16 additional SHIECAP awards to the remaining 10 states and other, qualified state designated entities.
So now that all of the states and eligible territories have all received their funding, the next challenge for these entities will be developing a sustainable operating model. Keep in mind that this federal funding is intended to serve only as a “pump primer”, an initial catalyst that will rapidly dwindle, based on the expectation that government largesse will be replaced by a sustainable, cash flow neutral business model.
So what constitutes a sustainable business model? In part, it must offer subscribers access to information that they find of value, deliver it in a manner that is efficient and compatible with their workflows and at a cost that is affordable and priced at a level consistent with the information’s perceived value. And they must do so quickly, before the federal money runs out.
OK, then it seems reasonable to ask the next question:”what constitutes information of value” and how do these entities set their initial priorities? Surely the experiences of the more mature exchanges are a good place to start. Let’s look at some recent survey data. Arguably, the most consistent and comprehensive of the publicly available surveys is the annual survey conducted by the e-Health Initiative (eHI), the most recent of which was published in September 2009. Those interested in obtaining a complete copy of the results can download them at http://www.ehealthinitiative.org/HIESurvey/. Almost 150 exchange entities responded to the survey, including some of the most mature and highly evolved in the country. Although some requested anonymity, 140 are listed in the survey’s appendix. Of the total, 57 were in full operation at the time of the survey (mid-2009), while another 36 were well underway, with some of those in initial pilot operations.
So if we assume that those who have been at it the longest and have the scars to prove it are a good bellwether, what data types are most commonly being exchanged? Number 1 is lab data and #2, prescription data. It’s these facts that made me sit up and take notice of two recent stories in the trade press, both involving potential contributors to the ongoing evolution of health information exchanges which, to date, had generally remained on the sidelines. On February 16th, Health Data Management carried a story that Surescripts, which operates the country’s largest electronic prescribing network, announced the formation of an HIE Advisory Committee “to help the company develop a standardized prescription history service for health information exchanges and other entities.” Named to the advisory committee were five high-profile executives from five of the of the most successful and visible health information exchanges in the US, including:
• Laura Adams, president and CEO at the Rhode Island Quality Institute in Providence;
• Michael Matthews, CEO of MedVirginia in Richmond;
• Marc Overhage, M.D., CEO of the Indiana Health Information Exchange in Indianapolis;
• Robert Steffel, CEO at HealthBridge in Cincinnati; and
• Dick Thompson, executive director and CEO of Quality Health Network in Grand Junction, Colo.
In its press release, Surescripts said that it intends to connect to multiple data sources to acquire information needed to create and provide access to a patient’s a prescription history. These actions potentially open up access to prescription data for more than 90% of the insured individuals in the US. Moreover, since Surescripts data reflects the actual fulfillment of the medications prescribed, it is far more clinically useful data than merely knowing that a prescription was written.
About a month later, on March 9th, Health IT News carried a story that Surescripts, in conjunction with Quest Diagnostics, will collaborate on an integrated electronic delivery service that will make lab and pharmacy data more easily accessible to doctors and other clinicians. Admittedly (see my prior blog post) Quest is not a major factor in many regions of the country, where the local hospital serves as the dominant laboratory service provider, but in many areas it holds a substantial market share.
The information that could be collectively supplied by both Surescripts and Quest represents a rich source of data and immediate value to both the mature and nascent HIEs — data that is essential to the long term viability and acceptance of HIE and key components of coordinated, collaborative patient care delivery. In addition, this prescription history data would also serve as a foundational component of the medication reconciliation processes so vital to meeting the meaningful use criteria.
When key players who have been conspicuous by their absence finally decide to get into the game, I think it’s a sure sign that “this dog can hunt”. If we have not yet hit the tipping point, I think it’s well within sight. What do you think?