8 Health Information Exchanges Lead The Way

Look inside some of the most established HIEs and how they help U.S. health organizations share data, in the name of lower costs and better patient care.




The HITECH Act's Meaningful Use program raises the bar for data sharing among doctors, hospitals, clinics, and other providers, with the goal of improving patient care coordination and quality. That's driving more healthcare organizations to join formal health information exchanges. But not all HIEs are alike.

Some healthcare providers are joining public health data exchanges, including statewide initiatives that have received funding from the HITECH Act or other sources. Other providers are collaborating with healthcare organizations in their region to form private efforts among hospitals and affiliated doctors and medical groups.

Although the Meaningful Use program has been fueling renewed HIE activity over the last couple of years, health data exchange efforts have been going on for more than a decade, with mixed success. After burning through seed money, some HIEs have run out of funds. Also, convincing healthcare providers to share information with competitors about their patients has been a tough sell, as has the notion of hospitals and doctors paying subscription fees to participate in--and financially support--these data exchange efforts. But the Meaningful Use criteria demanding more patient information sharing are slowly but surely changing minds.

Many of the HIEs operating today--both private and public--include participants such as hospitals, doctor groups, labs, pharmacies, and payers. And increasingly, more-specialized caregivers are beginning to join HIEs, including rehabilitation and long-term care facilities. Among the most common data currently shared include lab results, clinical summaries, medication lists, and medical image reports. Some exchanges also assist payers and providers in administrative transactions such as eligibility verification.

The proposed Meaningful Use Stage 2 agenda demands medical image sharing, with some HIEs already planning to incorporate this service. In fact, Maine's state-designated HIE, HealthInfoNet, recently announced that it had kicked off a pilot for healthcare providers to share patient medical images, including mammograms, MRIs, x-rays, and CT scans, statewide for the first time in the U.S.

"More people are doing health data exchange; it's definitely picking up," said Jennifer Covich Bodenick, CEO of the eHealth Initiative, a national organization representing 200 healthcare stakeholders ranging from public health agencies to private healthcare providers and consumer groups. About 234 HIEs currently operate in the U.S., including private and publicly funded exchanges, according to eHealth Initiative, which has been tracking HIE activities and progress for nearly a decade. Despite an interest in HIEs, providers have to divide their attention among many different IT initiatives, including Meaningful Use compliance and transitioning from ICD-9 to ICD-10, said Bodenick. "The biggest issue facing the healthcare industry right now is competing priorities," she said. Healthcare organizations figuring out their strategies for sharing patient data need to examine whether that includes participating in HIEs.

Here's a sampling of several HIEs in operation today, along with an overview of the kinds of services they offer to healthcare organizations seeking to securely share patient data.


The Indiana Health Information Exchange, the U.S.'s largest HIE and one of the oldest, serves more than 19,000 doctors and 80 hospitals, with data on more than 7 million patients. IHIE, created by the Regenstrief Institute, a medical informatics think tank, runs the Indiana Network for Patient Care (INPC), a secure network that provides a "virtual patient record" to participating doctors. That record includes information from encounters covering more than 80% of care provided at hospitals within Indiana. For instance, when a patient is admitted to a hospital or emergency department, the INPC provides a clinical abstract of the patient's medical history even if the individual has never been treated at that particular facility. "INPC speaks for patients when they may not be able to speak for themselves," said an IHIE spokeswoman. The INPC also contains radiology images, discharge summaries, operative notes, pathology reports, and medication records. Clinicians can access information in the INPC ony when a triggering event occurs, such as a visit to an emergency department.

The INPC Management Committee, which is made up of various healthcare community stakeholders, strictly governs the amount of time a physician has access to patient records. Access varies by patient class including Emergency Department, inpatient, and outpatient encounters, with the duration of access varying depending on the care being delivered. These security restrictions and limitations ensure that only healthcare providers responsible for treatment gain access to patient data. IHIE also offers a clinical messaging service called Docs4Docs. It delivers real-time patient results securely from 49 Indiana hospitals and specialty facilities to over 19,000 physicians across the state and beyond. Docs4Docs offers a single source for providers to find lab, radiology and transcription reports from multiple locations.

Clinicians, who are estimated to receive over a million clinical messages daily, get their Docs4Docs results in their practice's E-medical record system, in a Web-based inbox, or by fax. An IHIE spokeswoman said IHIE staff work closely with EMR vendors to ensure connectivity and accuracy. The Web inbox logins are maintained and vetted by the IHIE Client Services department. IHIE also says that all physician office fax numbers are researched and verified before any results are delivered.

As for IHIE's business model, individual providers do not pay anything to participate. The exchange contracts with hospitals and health systems on INPC and Docs4Docs. IHIE also has received federal and state investments and grants. In 2010 it received $16 million in ARRA investments as part of the Beacon Community Collaboration Program. This investment established the Central Indiana Beacon Community and IHIE is the lead organization in that program, said an IHIE spokeswoman. "Our focus for the future is on sustainability by developing and delivering services that the market needs and wants to pay for and reducing dependency on grants and government investments," she said. "We are still interested in opportunities such as the Healthcare Innovation Challenge posed by CMS earlier this year. We applied for another sizable funding opportunity and are waiting to hear on whether it will be awarded to us."

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Like Indiana's HIE, the New England Health Exchange Network has a long history. NEHEN was launched in the late 1990s by a group of New England healthcare organizations to share data with payers in an effort to streamline administrative transactions, including insurance eligibility checks. In recent years, NEHEN has been extending its services to support clinical data exchange. In 2009, NEHEN strengthened that strategy by acquiring MA-Share, which was an initiative of the Massachusetts Health Data Consortium to help New England healthcare providers share clinical data.

Among the services offered by NEHEN is NEHENClinical, a set of software tools that allow health information systems, including EMRs, to send and receive clinical information with other providers and payers. Built on a flexible framework, NEHENClinical can accept any clinical transaction that uses the HL7 2.5.1 or Continuity of Care Document (CCD) specification, route it securely and reliably, and deliver it to another exchange partner, including providers, payers, and government agenies. NEHEN members have open access to NEHEN's underlying database and transaction routing engine so that participating organzations can integrate the tools into the rest of their health information technology workflow and architecture.

NEHEN uses a tiered subscription model based on organization size. NEHEN has "no grant funding, we are a member-funded, member-directed organization," said Sira Cormier, NEHEN program director.

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The Michiana Health Information Network, now in its twelfth year of service, offers healthcare providers across the Midwest advanced integration and communication tools for exchanging clinical data. Based in South Bend, Ind., MHIN offers immediate access to patient information in a single longitudinal record that integrates data from thousands of providers and health systems. MHIN's latest tool--cross document sharing (XDS)--lets participants in MHIN generate or accept an inquiry from any healthcare entity, facilitating Continuity of Care Document (CCD) delivery and ultimately a more complete picture of a patient's health through an aggregate summary of medical information. Clinicians can access this care summary (pictured above) through any EHR, reflecting MHIN's HIE interoperability. Providers and facilities across the healthcare spectrum--ranging from hospitals and laboratories to extended care facilities and public health departments--generate 10 million MHIN transactions a month. MHIN is subscription based. It offers annual and monthly subscriptions, depending on the size and needs of the healthcare organization.

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CORHIO is the nonprofit, state-designated entity for health information exchange in Colorado. This HIE focuses on improving provider productivity through the exchange of clinical information through connected EHRs. CORHIO also offers HIE services to paper-based provider offices through Web-based programs. Using CORHIO's secure, Web-based "community health record" application on a desktop, laptop, or tablet computer, an authorized clinician or caregiver can search for a patient and access a longitudinal view of that patient's medical history.

The exchange aggregates patient information in the community health record from all of the HIE's participating providers. That's especially helpful in emergency situations, or when providers see a new patient for the first time. The image above shows the search box on the left side, along with some sample search results on the right. Patient information is neatly organized by tabs at the top of the page, including patient demographics, fact sheets, reports, and tests.

CORHIO has received two grants focused on building capacity for statewide health information exchange and launching HIE by community. Those include a grant from the Colorado Health Foundation and nearly $10.9 million in HITECH funding. CORHIO used these funds to alleviate a portion of its one-time set-up cost, as well as the cost of linking CORHIO to Quality Health Network (QHN), a fully functioning regional HIE in the Western Slope of Colorado. However, CORHIO says its long-term sustainability will depend on a fee-based subscription model.

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Greater Houston's Healthconnect, launched in 2010, is an independent, community-based organization responsible for enabling information exchange among healthcare providers in a 20-county region of Houston that has 7 million people. Healthconnect's goal is to mobilize healthcare information electronically across organizations to enhance the safety, quality, and efficiency of care and improve information access throughout the region. Still under development, Healthconnect envisions eventually providing an array of services, including secure provider-to-provider communication; a community health record--a clinical summary for a patient from all participating organizations; and a referral exchange. Other services being planned include electronic results delivery; surveillance and state reporting; integration into EHR platforms; and HIE-to-HIE data exchange.

Healthconnect's tiered pricing structure reflects the number of physicians in the practice group, and net patient revenue and discharges for major hospital systems. "We have Medicaid managed care plans and commercial payers paying per member per month for their number of covered lives," said a Healthconnect spokeswoman. "The model was created based upon benchmarking with all successful, sustainable HIEs in the U.S." In addition, Healthconnect "also anticipates local philanthropy to subsidize the connection costs for some of safety net clinics and charity care," she said.

Recommended Reading:

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HealthBridge began in 1997 as a private regional effort to improve health care quality by sharing health information electronically in the Cincinnati, Ohio, tri-state area. But over the years, its services and membership have grown, and its success and financial sustainability has drawn the attention of other HIE efforts and government leaders. For instance, HealthBridge currently is providing technology services and consulting to help run several other HIEs, including HealthLinc in Bloomington, Ind., and the Northeast Kentucky Regional Health Information Organization in Morehead, Ky. Over the last three years, HealthBridge has been helped lead projects funded by the Office of National Coordinator for Health IT, including the Greater Cincinnati Beacon Collaboration (GCBC), an effort to use health IT to improve emergency and other patient care. HealthBridge also is the lead organization in the Tri-State Regional Extension Center, which serves healthcare providers in southwestern Ohio, northeastern Kentucky, and south-central Indiana. HealthBridge's HIE network encompass more than 50 hospitals, 800 physician practices, 7,500 physicians, and six different communities in four states. In 2011, its secure electronic network sent more than 60 million electronic messages, including clinical lab tests, radiology reports, discharge summaries, and other information.

Recently, HealthBridge announced that 66 practices in Cincinnati went live with a new Emergency Department Admit Alert System developed through HealthBridge and a group of community partners and providers involved with GCBC. The real-time ED Admit Alert System informs practices when patients are admitted into emergency departments or hospitals so they can offer follow-up care. HealthBridge's HIE receives messages from 21 hospitals when an inpatient admission or ED visit occurs. Under the new ED Admit Alert System, ED or admit messages are matched against patient panels from participating practices to check if any patients with diabetes or asthma are present. If the system finds a match, it immediately sends out an electronic alert to the patient's primary care practice.

HealthBridge gets its funding from "a hybrid model--mostly subscription based but also some transaction fees and some grant funding," said a spokeswoman.

Recommended Reading:

Grow Your Own Health Information Exchange
Private Health Information Exchanges Take Over
Direct Project Rapidly Advancing Health IT Interoperability
Cloud-Based EHRs, Telemed Come To Rural Colorado
3 Traits Shared By Successful HIEs
New York Moves To Protect Health Data Privacy
Covisint Cloud Hosting Michigan HIE
$564 Million Later, Little Health Information Exchange Happening
Doctors, Patients Can Spur HIE Progress, Feds Say
How To Achieve Better Patient Engagement



Maine's state-designated health information exchange, HealthInfoNet, recently launched a new medical image pilot that will make the HIE the first in the nation to support statewide sharing of X-rays, CT scans, MRIs, mammograms, and other medical images. HealthInfoNet went live in 2009 and currently supports the exchange of health records for 1 million of the 1.3 million people who live in the state. Until now, HealthInfoNet provided access to medical image reports, but with the pilot, physicians also will have instant access to the actual medical images themselves, rather than wait for copies of patients' MRIs and other diagnostic imaging to be sent on disks. HealthInfoNet will be able to link each image with a single patient identifier through its HIE Master Person Index, allowing clinicians to search for a patient's prior images when needed, to track changes over time. The HealthInfoNet medical image archive is made possible with a cloud-based architecture and services provided by Dell, which in December 2010 acquired medical image archiving vendor InSite One. HealthInfoNet operates on subscription fees from participating healthcare organizations, and the HIE also has received HITECH funding.

Recommended Reading:

Grow Your Own Health Information Exchange
Private Health Information Exchanges Take Over
Direct Project Rapidly Advancing Health IT Interoperability
Cloud-Based EHRs, Telemed Come To Rural Colorado
3 Traits Shared By Successful HIEs
New York Moves To Protect Health Data Privacy
Covisint Cloud Hosting Michigan HIE
$564 Million Later, Little Health Information Exchange Happening
Doctors, Patients Can Spur HIE Progress, Feds Say
How To Achieve Better Patient Engagement



Launched in April 2011, the Care Continuity Consortium brought together several private, innovative healthcare organizations who individually also were EHR early adopters. CCC members include Geisinger Health System in Pennsylvania, Kaiser Permanente in California, Mayo Clinic in Minnesota, Intermountain Healthcare in Utah, and Group Health Cooperative in Washington state. The consortium's aims to demonstrate to other organizations how the use of national health IT standards can help them securely share patient health data among disparate EHR systems, across disparate geographic regions. For instance, if a patient from one system gets sick or has an accident while traveling and seeks healthcare from another organization--or if any healthcare provider sends patients to another--clinicians at each of the consortium systems can easily and quickly access important information about the patient's medications, allergies, and health conditions. The goal is to provide clinicians with key information so they can quickly choose the best treatment while avoiding unintended consequences such as adverse medication interactions. KP, Mayo, Geisinger, Intermountain, and Group Health currently fund the exchange.

Recommended Reading:

Grow Your Own Health Information Exchange
Private Health Information Exchanges Take Over
Direct Project Rapidly Advancing Health IT Interoperability
Cloud-Based EHRs, Telemed Come To Rural Colorado
3 Traits Shared By Successful HIEs
New York Moves To Protect Health Data Privacy
Covisint Cloud Hosting Michigan HIE
$564 Million Later, Little Health Information Exchange Happening
Doctors, Patients Can Spur HIE Progress, Feds Say
How To Achieve Better Patient Engagement

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