At Indiana Health Information Exchange (IHIE), Chuck Christian has found what could possibly be a dream situation. Not just because he gets to catch up with the many “old friends” he made while serving as CIO at Good Samaritan for 20-plus years, but also because he’s at an organization with an outsourced data center — something he’s been looking for throughout his career. In this installment of our quarterly chat, Christian talks about what he hopes to bring to the table as VP of technology and engagement, how IHIE is working to achieve a long-term plan without losing sight of its main priority, what he thinks of the 21st Century Cures Act, and the importance of sharing best practices.
- Tackling pop health — “There’s really not a one size fits all.”
- IHIE’s joint replacement program
- Exchanging data with MHIN & HealthBridge
- Illinois’ foggy HIE landscape
- Creating a patient-centered data home — “Healthcare happens regionally.”
- The Indy 500 care challenge
- Heartland pilot — “We’re going to stress-test the standards.”
- ONC grant funding
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What we’ve found in having a lot of conversations with our members around population health is there’s really not a one size fits all. It depends on their care models, the size of the organization, and if they’ve decided to go at-risk for certain parts of their business.
You read about all these very complex and complicated ways of moving data around, but I think we’ve found that healthcare happens regionally. You’re always going to have patients who are going to go to Mayo, Cleveland, or MD Anderson or some large health center — you’re always going to have those patients, but that’s not the norm. The norm is going to be around regional referral centers.
The treating physician only has the benefit of the information that the patient has with them in their head, or that their family member has. Wouldn’t it be great if that physician had access to the information that’s sitting wherever their HIE is?
That’s why we call it the patient centered data home; the data actually follows the patient in a pretty simple manner and it uses all the standard protocols.
We really appreciate them giving us that funding to move this forward. It’ll take some of the pressure off these very small, non-profit organizations.
Christian: That was one of the components of the strategic plan. The other one was around population health. We have several ACOs in the area that we are working with and several clinically integrated networks as well where we’re helping them manage their patient population. They’re responsible for the care of that patient if they’re in one of the Medicare/Medicaid advantage plans, so they need to know pretty quickly where that patient is getting service — particularly if the patient is getting care outside of their network — so they can bring them back in and control those costs. And so what we’ve found in having a lot of conversations with our members around this thing called population health is there’s really not a one size fits all. It depends on their care models, the size of the organization, and if they’ve decided to go at-risk for certain parts of their business. Many have, and I think others will as well.
The other topic we’re having some conversations about is the joint replacement program, which actually started in April of this year. It was one of the CMMI demonstration projects. They call them voluntary, but you don’t get a chance to volunteer — you’re ‘volun-told.’ Indianapolis was one of those demonstration areas, and so if the patient has a joint replacement, that facility is responsible for all the patient’s care and cost of their care, because they’re going to get paid in a bundle for 90 days post-surgery, and so they need to know where that patient goes. We haven’t done a lot of work with this because I think everybody’s still trying to get up to speed on what is the impact? How are we going to do this? And then there’s another one that’s supposed to start after the first of the year around cardiac care; we’re still waiting for details on that. So because we have access to the information of wherever that patient may have care within Indiana, we can provide good information to help manage that cost.
The third one was around what we call interstate HIE connectivity. We’ve had a great relationship with the other HIEs in this area. We have one in South Bend called MHIN, which is the Michiana HIE. We’ve been exchanging certain data with them for some time. We have another relationship with a health collaborative called HealthBridge, which is one of their business units. We’ve been exchanging lots of data with them between the Indiana and Ohio markets that they cover for some time now, and we’ll continue to do that.
The other thing we wanted to do is, the hospital where I was in southwest Indiana is what I call a border facility. It was right on the border of Illinois, and we had quite a few patients who would come from Illinois for care at Good Samaritan. Unfortunately, because of the way the SHIECAP (State Health Information Exchange Cooperative Agreement Program) grants were done, a lot of the money was spent on the exchange of data within the state’s borders. The state was going to spend the money on itself, even though a percentage of that money was around exchanging data with a nearby state. But if you take Illinois, they don’t have a state-wide health information exchange. They had one a Chicago metro HIE. It just shut down because their vendor, which is Sandlot Solutions, went bankrupt. And then ILHIEA, which was the Illinois HIE, could not find a sustainable business model, and so they went out of business as well. So there’s nobody in Illinois for us to exchange data with. There is one over in Champaign-Urbana, but it’s only about six facilities. It’s very regionalized and it’s a pretty good distance from the Indiana border, so it’s rare that a patient would come to Indiana to do that.
And so we’re working with SHIEC, which stands for the Strategic Health Information Exchange Collaborative. It’s about 50-some-odd HIEs in the country that are working together for common things and one of these things is what we’ve called the patient centered data home. The concept of this thing is so simple it’s kind of silly. You read about all these very complex and complicated ways of moving data around, but I think we’ve found that healthcare happens regionally. You’re always going to have patients who are going to go to Mayo or Cleveland or MD Anderson or some large health center because they have something that’s extremely rare or critical or can’t be diagnosed or defies diagnosis in the usual, customary way. You’re always going to have those patients, but that’s not really the norm. The norm is going to be around regional referral centers.
I’ll use IU Health as an exchange. Since it was where they cured Lance Armstrong of testicular cancer, we have a lot of people that come up to IU Health from all over the state for their cancer treatment, to their transplant center, and for a variety of other things. Moving that data with the patients is not that difficult in the state of Indiana, but we have this little thing called The Indianapolis 500 every year. So we’ve got 400,000 to 500,000 of our closest friends descend upon Indianapolis for about 30 days. They’re not all here for 30 days, but there’s a large contingent of folks that come in with the racing teams, and then you have the fans on the carburetion days, and of course race day. Inevitably you’re going to have one of those patients show up at an emergency room somewhere in Indianapolis. And so the ER physician or the treating physician only has the benefit of the information that the patient has with them in their head, or that their family member has. Wouldn’t it be great if that physician had access to the information that’s sitting wherever their HIE is? I’ll use Michigan as an example. You have a patient that comes down from Michigan to Indianapolis and winds up in the emergency room of Eskenazi Health. So what we’re doing with the patient centered data home is when we get the registration transaction into our HIE, we’re going to look at it and notice that patient’s zip code is in Michigan, and so we’re going to fire off a transaction to Michigan and say, do you know this patient? They’ll say yes, and then they’ll send us back a clinical summary out of their repository. And then we’ll present that to the ER physician, and all that happens in real time. So in theory, the physician could actually have that clinical summary before he ever saw the patient, and have a lot of information about the patient — past medical history, allergies, medications, and a whole bunch of other stuff depending on how it’s crafted. And then when the patient’s treatment is finished in Indianapolis, we’ll bundle up a clinical summary of that visit and send it home so that when that patient gets back home, their attending physician will have access of this care down here. And so that’s kind of why we call it the patient centered data home; the data actually follows the patient in a pretty simple manner and it uses all the standard protocols.
We’ve stood up what we call the Heartland pilot. We have seven different health information exchanges that run on five different technology platforms using national standards to transmit data and hopefully by the middle of December, if everything stays on schedule, three or four of those HIA’s will have started to exchange data in that manner. And the reason the others aren’t participating yet is they’re changing out their technology or their vendor stacks right now for how they manage and the technology they use for their exchange.
The really interesting thing is SHIEC put together a grant application to ONC for this and two other pilots: one in Oklahoma and Arkansas, and the other in Utah, Arizona, and Colorado. The one in Oklahoma is using the same technology, and the one in Utah, Arizona, and Colorado are all using the same technology. The Heartland project is using different technology, so we’re going to stress-test the standards a little bit more than the others are. And so ONC actually awarded Heartland a grant. It wasn’t a whole lot of money, but it sure beats nothing, and we really appreciate them giving us that funding to move this forward. It’ll take some of the pressure off these very small, non-profit organizations. ONC is also very interested in what we’re going to be able to discover in this pilot project that we’re going to kick off here very shortly.
So those are the three tenants of our strategic plan, but the other thing is we continue to have conversations with our members. They’re going to national conferences; they’re smart people and they’re coming up with really great ways of utilizing the technology.