Competition and lost revenue are keeping communities from participating in health information exchanges, panelists told attendees at the Regional Healthcare Stimulus Exchange Conference.

Group Health Cooperative, Integrated Healthcare Association (IHA) and NAMMCAL have implemented electronic health records and developed community connect strategies, but are meeting resistance.

Group Health Cooperative, a Washington State patient-owned cooperative comprising 900 physicians, payers, labs and pharmacies, implemented Epic's EHR in 2003. One hundred percent of its physician order entries are computerized, said Ernie Hood, vice president and CIO.

Its patient-centered medical home, EHR and patient portal are all connected. "The fly in the ointment is getting the other guys to come on board," he said. "Information exchange needs to happen. It's a terrible waste if we can't share."

"A lot of fear is the barrier," Hood said. He wants to dispel the myth of lost revenues: If the data is fluid, I'll lose my patient. "We haven't done a good job of demonstrating that they're not real," he said. When one lab test is done, patients want more done, he said.

North American Medical Management California (NAMMCAL) develops and manages provider networks comprising independent solo practitioners in three southern California counties. Its 1,600 physicians don't have the financial resources or human capital to invest in health IT, so NAMMCAL subsidizes the rollout of EHRs. Approximately 20 percent of the physicians are live on EHRs, said Leigh Hutchins, president and COO.

NAMMCAL is on a dual path of implementing an EHR and HIE, but it has bumped up against the different motivations of and strategies for governance and funding from stakeholders, she said. Providers are trying to figure out whether to become an HIE or be a participant. "We're ready to go, but will the community catch up?" Hutchins said.

An audience member argued that workflow issues were miniscule compared to the politics among providers. Seattle has its share of internal competition among hospitals, Hood said. "Can we change motivation through incentives, pay for performance?" he asked.

Integrated Healthcare Association, a statewide, multi-stakeholder nonprofit promoting quality improvement, accountability and affordability, implemented its pay-for-performance program in 2003 and has documented quality improvement. It incorporates 10 clinical IT measures, including patient registries for population management and point of care technology.

Tom Williams, executive director of IHA, pointed out that "a lot of collaboration and some kind of organizing force" is needed to move the community to participate in HIEs. "I hope state-designated entities (SDEs) can get people to the table," he said. "It's more important than actual incentives."

"Financial incentives aren't enough," Hood agreed. With the SDE, the state has a bully pulpit to "twist some arms" and apply a stronger hand, Williams said.

For more information about the Healthcare Stimulus Exchange, visit www.healthstimulusx.com.