Mature HIEs build trust to share data, IT

By Mary Mosquera
03:23 PM

Oklahoma health information exchange SMRTNET has managed to build a network of seven networks and has attracted a broad range of 3,000 providers in 2011 that share data between hospitals, Native American tribes, community health centers, labs, universities and private physicians.

The individual networks exchange data statewide using a shared set of common resources and privacy policies. 

The Secure Medical Records Transfer Network (SMRTNET), a statewide non-profit organization, is one of the examples that the National eHealth Collaborative (NeHC) highlighted in its report of case studies of 12 sustainable and mature health information exchange (HIE) organizations across a variety of geographic regions. 

The HIEs follow a number of business and marketing models, according to NeHC, which is a public/private partnership that promotes secure health information exchange, in “Secrets of HIE Success Revealed: Lessons from the Leaders,” released Aug. 2.

Exchange efforts are emerging around the country in order to meet requirements for meaningful use of electronic health records (EHRs) and to improve care coordination.

“While every HIE project is unique, they all share the same problems of participation, value, security, growth and especially sustainability,” said Mark Jones, COO and principal investigator of SMRTNET.

The report extracts critical characteristics that are common to all of the exchanges and offers real-world success stories that may “contribute to a cohesive national roadmap for nationwide HIE” so others can learn from them, said Kate Berry, CEO of NeHC, in an announcement.

For SMRTNET, broad representation in the HIE planning in the beginning was important for future expansion. “Then every potential participant knows that there has been ‘someone like you’ at the table from the beginning,” Jones said in the report.

Among steps the report listed as important for an HIE’s success:

• Bring together many interested organizations that represent industry, health care, technology, consumers and public sectors and other local interests who will agree on shared objectives to foster trust and learning.
• Establish and maintain a consistent set of policies and procedures for data use and data integrity so that “no stakeholder gains a competitive advantage at the expense of others.”

• Sharing IT infrastructure and patient information benefits outweigh risks for HIE provider participants who compete with each other in service area markets, especially in rural areas, where health IT resources are often sparse.

• To identify revenue streams, many HIEs are evolving from just data exchange to application solution providers. SMRTNET offers a master patient index and access to a community record through an online portal. The community record includes demographics, diagnoses visits, medications, provider, labs and data to support meaningful use, such as electronic prescribing and secure messaging, such as the ability to forward reports.

• HIE technical and training personnel work with physicians and office staff to understand and even integrate exchange applications into their workflow to get them online quickly and improve operations.

Many of the profiled HIEs participate or plan to with the nationwide health information network (NwHIN), a set of standards and protocols that enables providers to share information securely over the Internet. The same group of HIEs is establishing the Direct Project, which is a streamlined version of the standards and services of NwHIN, similar to secure email, for simple exchanges.

[See also: HIEs expand to 255 to meet health system changes. ]

The Veterans Affairs Department shares health information with the Defense Department and some private healthcare providers that treat veterans as part of its single Virtual Lifetime Electronic Record effort.

Providers that share data through NwHIN Exchange see patient summary data in a view-only mode from within the Web-based version of VA’s VistA electronic health records system. They also supplement VA information in major components of the VistA EHR. Providers can access medication and problem lists, allergies, immunization, vital signs, lab test results, and encounters.

VA has five VLER pilots underway around the country and six more planned by September in which providers share a subset of information from the continuity of care summary record.

VA also is incorporating Direct in a pilot in Tennessee in which a VA physician transmits a referral for mammography to a radiology group, which sends back a consultation report via Direct to the VA ordering physician.

HIEs face barriers, however. Establishing policies and methods to meet complex privacy requirements slow growth of the critical mass of patient records needed to accelerate adoption. And gaps in interoperability standards and a lack of rigorous adherence to existing standards continue to consume HIE resources to make data and presentation consistent, the report said.