Amid continuing concerns over the sustainability of public health information exchanges (HIEs), the Metropolitan Chicago Healthcare Council (MCHC) is preparing to launch what is expected to be one of the largest regional HIEs in the US. Thirty-four of the Chicago area's 89 hospitals will participate in the launch of MCHC's MetroChicago HIE, slated for the first quarter. Between 20 and 30 additional institutions are expected to join the exchange by next summer, according to the Chicago Tribune.

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A membership organization that provides services to 170 healthcare entities, MCHC began to develop MetroChicago HIE in April 2011. Among the pieces it has put in place so far are systems integration, a governance agreement, policies and procedures, and implementation guidelines, said Daniel Yunker, senior vice president of MCHC, in an interview with InformationWeek Healthcare.

MCHC recently chose Sandlot Solutions to provide the HIE's infrastructure. The Fort Worth, Tex.-based HIE vendor previously built a large HIE in the Dallas-Fort Worth area. That exchange encompasses 30 hospitals -- among them the facilities of Texas Health Resources and Baylor Health Care System -- plus North Texas Specialty Physicians, a network that includes about 750 physicians in 20 practices.

Santa Rosa Holdings owns the majority of Sandlot's shares, and its subsidiary, Santa Rosa Consulting, is supporting the launch of MetroChicago HIE. The reputation of that consulting firm is one reason MCHC and its CIO advisory council selected Sandlot as its HIE vendor, according to Yunker.

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Another reason for choosing Sandlot was its flexibility. "Building a regional HIE isn't like buying something off the shelf," Yunker explained. "It's a lot more complex than that. We and the advisory council felt that Sandlot, with the support of Santa Rosa, could deliver the expectations we have and accomplish the goals for our HIE."

Yunker acknowledges that the healthcare organizations involved in MetroChicago HIE will have to support it financially because there are no longer any government grants available for HIEs. However, MCHC believes that its venture will be financially sustainable, especially if more providers join it. "The more they participate, the better the expense structure for those who are sharing that resource."

The major organizations in ChicagoMetro HIE, including the Advocate and Rush healthcare systems, have already made big investments in data exchange across their enterprises, Yunker says. But as they start taking financial risk and managing population health, they recognize that they need patient data that originates outside their organizations -- even if it comes from competitors.

They also need to analyze their data, and Sandlot, like some other HIE vendors, can provide some of that capability. Sandlot has returned to the centralized model of health information exchange, using a data warehouse that aggregates all the clinical data it receives, along with claims data made available to organizations that take financial risk. As a result, the vendor can perform population management functions such as identifying the care gaps of individual patients and categorizing an organization's patients by their health risks.

The federated model that many HIEs have used to avoid data aggregation and the associated privacy issues has not proved workable because it can't support analytics in real time, Sandlot CEO Joe Casper told InformationWeek Healthcare. The HIEs that used the federated approach, he said, "couldn't build a sustainable model. As soon as you moved to a centralized model with a data warehouse, all of a sudden you had the information that someone was willing to pay for."

Some of the value-added features that Sandlot is supplying to MetroChicago HIE include:

In addition, Sandlot will provide direct messaging to MetroChicago HIE by the end of this year. The HIE itself will enable its participants to exchange care summaries and meet the requirements of Meaningful Use Stage 2 without using the secure messaging protocol, Casper told us. But direct messaging will be valuable for exchanging data with providers -- especially in rural areas -- that are not part of the HIE, and it will be helpful as the HIE is in the process of expansion.

Yunker believes that more Chicago-area providers will join the HIE as it shows what it can do. "We're doing this in a phased approach so we can demonstrate value to the launch group, and demonstrate value to those in the next wave."

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