Implementing electronic health records (EHRs) in hospitals and physicians offices is difficult enough. Getting the systems to talk to each other—for coordinated care, patient safety, and to improve quality—seems even more daunting.
The inter-facility chatter is called a health information exchange (HIE). A North Texas HIE cooperative is fighting the clock, among other things, to get one established before the federal funding runs out.
Texas received funding from the 2009 federal economic-stimulus legislation to help develop HIE. However, those monies will run out by the end of 2013.
The Texas Health Services Authority and Texas Health and Human Services Commission coordinate the development of 10 regional HIE networks throughout Texas. Ideally, a statewide HIE would connect hospitals, physicians, payers, pharmacies, and labs and follow the patient to wherever healthcare is provided.
Texas is taking a market-based approach, relying on health plans, hospitals and physicians to finance HIE after the funding expires—which may be a true test of its value to stakeholders. Many other states have relied on government entities to create and coordinate HIEs.
The local version is the North Texas Accountable Healthcare Partnership (NTAHP). The organization’s pilot project, which will run until the end of the year, includes about 1,000 physicians and nine hospitals. The partnership’s region includes 13 North Texas counties, including Dallas-Fort Worth. NTAHP and the Houston partnership Greater Houston Healthconnect are the state’s largest.
Joe Lastinger, NTAHP chief executive officer, said the it plans to offer the HIE to most North Texas healthcare organizations by September. He noted there are several private HIEs in DFW, and NTAHP’s goal is to “become an HIE for HIEs.”
Lastinger said there’s no shortage of challenges to creating a self-sustaining HIE. Among them: time, attention, trust, and funding.
He said the greatest risk is the Affordable Care Act, which creates a lot of strategic uncertainty for local healthcare firms. Many are struggling to meet internal meaningful-use deadlines to qualify for federal incentives.
“Everybody has a lot on their plate. Every stakeholder has similar stresses,” Lasting said. “Their IT teams are being pushed to the max. No one has pushed back (against the HIE). They are trying to figure out, ‘How does this fit in with the other 10 things we want to accomplish?’ ”
According to Lastinger, healthcare organizations are much more price-sensitive than they were several years ago. He estimated it would cost $5 million-$6 million annually to operate the HIE. That represents only about $1 out of every $100,000 of patient revenue. However, organizations are scrutinizing every expense dollar because of declining reimbursement, and they want to know that all participants are paying their fair share.
Lastinger said the 45-page agreement companies must sign will be a barrier. “I shudder to deliver that to a solo physician, and I can’t afford to spend six months with (hospital) legal departments.”
The competitiveness of the DFW healthcare market is also a huge issue. Lastinger said it was important that NTAHP be a trusted, neutral organization that can trusted with sensitive information. Organizations would not be able to download competitors’ patient data for analytic purposes, he added.
Meanwhile, the clock is ticking. The grant money has funded the pilot and the HIE’s infrastructure. It is nearly ready for market.
“This is a perishable opportunity,” Lastinger said. “If we don’t connect by 2014, it becomes a lost opportunity.”
