4 reasons HIEs make 'cents'

At the recent HIMSS Virtual Conference and Expo, David Kendrick, MD, CEO of MyHealth Access Network, a Beacon Community, spoke on his experiences not just implementing a community HIE, but also streamlining costs and improving quality of care for the state of Oklahoma. 

In his presentation, "A Community HIE that Makes Cents while Improving Health," Kendrick said, "The challenges facing providers are how to afford increasing costs and how do we shift from the fee-for-service curve to the risk curve without incurring significant losses, and how do we contain risks when we can't contain the patients." 

"(Those are) the big questions on providers' minds, especially when they look to the ACO model," he added. "But no matter what payment model we have, we have to figure out how to deliver a higher quality product to more people for fewer dollars per person."

Kendrick outlined four keys to having an HIE make 'cents.'

1. Its ability to streamline and connect. Kendrick explained how Oklahoma ranked near the bottom of almost every healthcare quality report in the country. In fact, according to a report from The Commonwealth Fund, the state was considered to be in the "high cost, low quality" part of the spectrum, showing that the average Medicare patient in Oklahoma doesn't get as high quality care as other Medicare patients in the country, he said. Kendrick added the state had a dramatic shortage of primary care doctors, making it difficult to talk about high quality when the state was "fragmented… patient see doctors in separate health systems and clinicians are left out of communications entirely," he said. Kendrick explained how the basic concept of an HIE was to help pull together the system and, essentially, put everyone on the same page. "We don't deliver care or services," he said, when talking specifically of the role of the HIE. "We provide the wires to connect everyone, and so to do the things no one can do on their own. That's been an important concept, and we're always testing the boundaries of that."

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2. Its ability to promote the use of IT. Kendrick likened the state's use of EHRs, prior to the HIE, to that of a PC in the 80s. "We took it home, we'd plug it in, we'd install a piece of software, but it wasn't that compelling," he said. "So the HIE is that day in 1991, where I picked up a disk and was connected to the Internet for the first time, and suddenly, my computer knew a lot more…when you get health information exchange in place and start to use it to do business, then we can do community wide care coordination more effectively." In his community, Kendrick continued, five EHR systems - none of which connect to each other - are brought together through the HIE, allowing physicians, through their EHRs, to see how a patient is progressing if they choose to bounce from doctor to doctor. "A core piece of what we're doing is, we expanded that beyond population levels to provide individual provider organizations with their own sandbox to do analytics," he said. "And then provide them with the patient portal. We're changing the way they train physicians, nurses and social workers so they can make use of this new environment where the HIE is available."

3. Its ability to reduce cost-related waste. Prior to beginning their project, Kendrick said, the system turned to the Center for IT Leadership in Boston to determine the potential value of the HIE for the community. "We wanted to know what was the value for our region," he said. "This was the construct: basically with providers and hospitals, and then the provided electronic connections between them. Within those connections, they estimated the value of different things like electronic prescriptions or electronic referrals." When the system quantified everything, Kendrick said they saw more than $200 million a year is waste. "It shows who's getting that value as well, not just what the value was, but more importantly, what can this do for the quality of healthcare, since these interconnected networks haven't existed before," he said. "It's been hard to quantify," Kendrick noted, yet the benefits of an HIE stood to address major issues that existed in the community, like adverse drug events, etc.  

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4. It's ability to produce ROI for all involved. The return on investment for the entire project, Kendrick said, depends on the perspective of the participant in the system. "So we have stakeholders who are providers, some of who are payers, employers…labs, radiology, public health," he said. "Providers benefit from more efficient health information exchanges, saving them clerical time and effort; they identify patients who need care and get revenue from people who need screenings and so on." Payers and employers, he continued, get the resulting higher quality of care and less adverse events, duplicate testing, etc. Labs and radiology feel benefits as well, which public health "gets many of the boxes checked," said Kendrick. "These are tangible ROI for the community, right down to the point of care where the patients and doctors meet."