Indiana has a long history of health information exchange, shaped with the help of the Regenstrief Institute and the Indiana Health Information Exchange.

This history began in the 1970s, when the Regenstrief Institute created the first electronic health record system. In 1993, Regenstrief created the Indiana Network for Patient Care to enable data sharing between emergency departments of hospitals serving Indianapolis – perhaps the first "health information exchange" in the country.

This data-sharing clinical repository was formed from the alliance of the five largest hospital groups in Indianapolis and supported by the Regenstrief Institute.

A neutral steward of data

"As the value of the INPC became apparent and EHRs became more common, Indiana researchers, business owners and hospitals met and determined the INPC needed a neutral steward of the data with a business focus," explained John Kansky, president and CEO of the Indiana Health Information Exchange.

"In 2004, the IHIE was founded as a separate 501(c)(3) not-for-profit organization to securely manage and grow the INPC," he continued. "To this day, the INPC remains at the core of how to fulfill our mission – to improve health and healthcare through information exchange."

The INPC is the largest inter-organizational clinical data repository in the nation, according to Kansky. IHIE, as its data steward, is vendor- and customer-agnostic and does not own any of the data in the INPC.

"IHIE manages the data and ensures that it is protected on behalf of our customers," he said. "We have a customer-based governance committee to ensure data is used in the way in which customers approve. IHIE is responsible for the development and maintenance of products and services derived from the unique INPC data asset.

"While we are working intentionally to build and expand our relationship with state government, we believe many HIEs would benefit from expanding their service offerings to the market and building their base of revenue from fees paid in exchange for value."

John Kansky, Indiana Health Information Exchange

"As the statewide health information exchange and health data utility for Indiana, IHIE leverages the INPC's data, governance processes and fabric of trust among its participants to meet as many of the health data needs of the state as possible," he continued.

This means developing and delivering services to healthcare providers, but also to multiple state government agencies, federal government agencies, health insurance companies and other stakeholders in the health of citizens, he added.

More than 30 years of data

The INPC includes more than 30 years of data, which IHIE manages within a dynamic yet production-oriented HIE environment. The HIE's domain expertise in acute and ambulatory EHR integration (including lab systems, health plan administrative claims systems, medication data, public health) positions the IHIE as one of the largest and most mature health information exchanges in the U.S., Kansky said.

"We have been able to amass more than 13 billion elements of clinical and claims data including public health data and payer information and patient data for things such as lab results, radiology reports, CCDs, transcriptions, cardiology reports and more," he explained.

"IHIE creates products and services to help customers leverage the data in ways that will be beneficial to them," he continued. "IHIE's services are organized into three product suites: OneCare, PopCare and GovCare."

OneCare, PopCare, GovCare

OneCare offers systems to improve the health of the individual patient. The products provide interoperability and seamless delivery with EHRs and technologies that organize information around patients when and where they seek care.

PopCare includes systems that offer insight into population health. The technologies are designed to support population health efforts that serve to strengthen the community. The data and products ensure health information follows the patient, regardless of treatment location, and help providers identify patients needing testing, screenings and other care interventions.

GovCare services provide a complete, coordinated effort to connect healthcare professionals to the state through communicable disease reporting, immunization registry programs, making clinical data available to Medicaid providers and supporting statewide data analysis.

"At IHIE's inception, we started with two products: CareWeb, a secure application that displays patient information from the INPC; and Docs4Docs, a clinical results delivery service that sends reports to providers around the country via a no-cost web inbox or EHR interface," Kansky noted.

"Since then, we have expanded our offerings and now provide six products in our OneCare suite, four products in our PopCare suite and four products/services in our GovCare suite," he continued. "We are intentional about only developing those products and services that our customers need or specifically request."

IHIE makes information available to approximately 50,000 healthcare providers in Indiana and neighboring states.

Joining forces

In 2020, IHIE consolidated with the Michiana Health Information Network (MHIN). Unifying under IHIE created a single, statewide health information exchange serving the entire population of the state.

"Also in 2020, IHIE joined the fervent response to COVID-19," Kansky recalled. "We worked, and continue to work, closely with the Indiana Department of Health and Indiana Family and Social Services Administration to support COVID surveillance activities, processing and sharing testing results with clinicians and the state, and supporting dashboards for public consumption of COVID data.

"The work continued into 2021 as IHIE added vaccine data to the dashboards," he added. "We received a grant from HHS for an ONC STAR project to make vaccination data more readily available to local health and community leaders."

Through this initiative, IHIE provided county-level COVID-19 vaccination data on its website in seven different languages. The data reflects not only the number of vaccinated individuals in each geographic area, but also the social vulnerability index of those census tracts.

Generating revenue via products and services

"As an independent HIE that is not directly funded by the state, IHIE focuses on delivering value to its participants," Kansky said. "For the past 18 years, IHIE has been a self-sustaining, not-for-profit health information exchange. We generate revenue by offering products and services our participants value and will pay to use.

"While we are working intentionally to build and expand our relationship with state government, we believe many HIEs would benefit from expanding their service offerings to the market and building their base of revenue from fees paid in exchange for value," he advised.

IHIE takes its data custodian role and data security very seriously.

"We currently are going through HITRUST recertification," Kansky noted. "We spend a lot of time and effort making sure that our staff is up to date on privacy and security policies and that we follow strong and secure processes and procedures.

"We work closely with legal and the INPC governance committee to make sure we are using and sharing data in ways that are both legally and organizationally acceptable," he continued.

Rapidly changing technology

Technology to collect and share data changes rapidly.

"IHIE always is seeking to understand and adapt to new and different data standards and technologies, such as APIs, including but not limited to FHIR," he concluded. "The ability to take, store and share data is the lifeblood of our organization, so we always need to be ready and able to do so in the manner and timing that makes sense for our customers."

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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