Working as one rather than as separate entities IEHIE makes strides

RIVERSIDE, CA – At a time when the value and sustainability of public health information exchanges are being questioned, Inland Empire Health Information Exchange (IEHIE), which was slated to go live on April 1, is making a case for both.

IEHIE, comprising 48 healthcare organizations in Riverside and San Bernardino counties including hospitals, physicians and payers, boasts an operational self-funded business model and a collaborative spirit. These two critical components make IEHIE unique, according to Executive Director Richard Swafford.

Collaboration, sustainability critical

The exchange is a culmination of a three-year effort that began at the grassroots level when Riverside County Medical Association, the San Bernadino County Medical Society and the Hospital Association of Southern California partnered to determine how to deliver better, safer patient care. “That’s what it’s all about,” said Richard Gagnon, director of information systems at Redlands Hospital, which is one of the 14 participants in IEHIE’s pilot.

“We are one of a group of hospitals that has broken a lot of barriers,” said Gagnon, who is also chair of IEHIE’s governing council. The willingness to share information and work together for the common good of the community has been the most rewarding aspect of the collaboration, Gagnon said. “We’re working together as a community – not as independent organizations – to achieve this goal,” he said.

“We have been impressed with the collaborative manner in which the key stakeholders in the Inland Empire region have worked to create collective buy-in, a sustainable funding structure and a strategic plan for long-term growth,” said Paul Viskovich, president of Orion Health North America, IEHIE’s technology partner.

“Their measured approach to creating this infrastructure takes into account the specific needs of different providers and healthcare facilities in the community regardless of size, specialty and patient population and allows for growth and maturation over time.”

“They (the hospitals) set aside competitive concerns,” added Swafford. “At the end of the day, this (HIE) is going to benefit the 4.1 million people in the Inland Empire by providing them better care.”

IEHIE benefited from learning from failed HIEs. “You have to get county government involved,” said Swafford. San Bernardino and Riverside counties signed participatory agreements and their respective public health agencies are actively involved. A large portion of the counties’ population is on public plans. Therefore, it was critical to get participation from Inland Empire Health Plan, a Medi-Cal managed care plan that covers some 600,000 lives.

Creating the right business model

The collaborative spirit carried over to the business model. All stakeholders agreed to pay for value-added services via a fee structure determined by participant type – payers by number of lives, medical groups per physician and hospitals by bed size.

IEHIE was formed as a 501(c)3 organization, with the goal of breaking even, not making a profit, Swafford explained. Although the HIE infrastructure contract with Orion Health, whose Orion Health HIE platform is powering the exchange, was completed some six months ago, it wasn’t signed until the current 14 pilot participants paid their fees in advance. “We aren’t relying on grants as a mechanism for sustainability,” he emphasized.

The Case for public HIEs

Collaboration and sustainability will carry IEHIE far, but Swafford says public HIEs have a greater role to fulfill.

“Our future is the PHR (personal health record),” he said. In order to have a complete PHR, however, health information must be captured at every point the patient comes into contact in the healthcare system,” he said.

While direct interoperability will provide some connectivity channels, it won’t deliver the full patient record, he added. Public or community HIEs – connected to regional HIEs and then eventually to the statewide HIE and later to the Nationwide Health Information Network – will be able to deliver broader patient information access and thus the full picture.

IEHIE’s strategy is also to be the utility for entities that want to leverage other programs and capabilities. The accountable care organization (ACO) model, for example, requires the ability to share patient information in order to effectively participate in an ACO environment. “We rely on our participants to tell us what their requirements are so we can integrate them into our overall strategy,” Swafford said.

Defining success

The effective use of the HIE in the clinical setting and the integration of the HIE into the clinical workflow will be the earmarks of success, according to Swafford. Authorized users will be able to view patient information, which Orion Health HIE aggregates into a central data repository, via a secure web-based clinical portal.

Primary care physicians are notified within 24 hours if their patients present to an ED via alerts for 10 different events. The platform will pre-populate the PHRs by all care providers that patients can access via a patient portal, Gagnon said.

“Our model is built on as much communication and interaction between the patient and their circle of care as possible,” Swafford said.

Participating in an HIE is aligned with Redland Hospital’s mission – to provide top-quality healthcare to patients. HIE is another tool to provide better care and knowledge to their patients, said Gagnon. The level of physician satisfaction, especially in the emergency department, will determine the success of IEHIE. Gagnon said physicians are “ecstatic” about the ability to provide them with guidance and knowledge in how to treat presenting patients.

“The HIE provides a good foundation for the expansion for continuity of care, and helps develop a tighter relationship between hospital and physicians,” he said.

When the community-based HIE goes live, Gagnon predicted, “We’re going to knock everybody’s socks off.”