At the 2012 Government Health IT Conference & Exhibition, BG Jones, vice president, alliances and federal Government, Orion Health, will discuss Orion’s role in building and sustaining HealthInfoNet — the state of Maine’s independent, not-for-profit health information exchange — and what lessons others can take from this example. Mr. Jones will discuss this topic — “Maine: Building a Statewide HIE” — on Tuesday, June 12.  

HIMSS: Can you provide a brief overview of what you plan to discuss during your education track at the Government Health IT Conference & Exhibition?

Jones: I’ll be highlighting Orion Health’s work with Maine’s HealthInfoNet, an independent, non-profit health information exchange (HIE) that was first incorporated in 2006 to use health information technology to improve and transform health care quality and safety across the state of Maine.

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Orion Health provides the technology backbone of the exchange by unifying data across all participant sites with the Rhapsody Integration Engine and making this information accessible to participants through a centralized clinical data repository and clinical portal.

HIMSS: So much is happening in Washington that will affect health reform efforts in 2012—including continued efforts to implement health reform, a presidential election and the Supreme Court’s ruling on the Affordable Care Act. What do you see as the primary challenges affecting HIEs for the rest of the year and beyond?

Jones: The number one challenge we have seen and will continue to see for HIEs is governance and funding. Now, with such uncertainty in Washington, it is more important than ever for HIEs—whether in the planning stages, or already live and exchanging data—to have a solid governance model and a strategic plan for funding in place. We’ve learned through our work with HIEs domestically and abroad that there’s no “one size fits all” approach to setting up these organizations. 

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It takes a strong governing body to have the discipline to come up with a strategic plan or roadmap, identify those key stakeholders that should have a voice in the HIE from the beginning, gain buy-in from those stakeholders, collectively agree on how the HIE will be funded in the short and long term, and how this might need to change over time (due to reductions in grant monies, for example). The more planning and collective agreement that can be achieved in the front end, before any vendors are even considered, the easier it will be to find the right technology partners and move forward with implementation and go-live of the HIE.

HIMSS: Maine is a coastal state with a few mid-sized cities and large rural areas and populations. What are some of the unique challenges and opportunities of building and maintaining an HIE in this area?

Jones: Maine actually has more unique advantages than challenges. While in many states provider systems are very competitive and for-profit, Maine's hospitals are all non-profit and there is a great sense of collegiality among them. They agreed at the very beginning they didn't need to compete on patient data and agreed to co-mingle their information in one central repository. As a small state (population-wise), Maine has been able to bring together and build a strong stakeholder coalition that has been the foundation for a robust trust framework that has enabled a concept in 2005 to grow in to a solid working operation with strong credibility within both the provider and consumer communities. 

Maine's providers were already ahead of the curve with EMR adoption when the HIE came into being, meaning both patients and providers had more familiarity and acceptance of electronic information sharing.  Being a small, rural state (the population is only 1.3 million) that old saying, "everybody knows everybody" comes into play. Particularly among the hospitals, awareness about the HIE was spread by word of mouth. Also, the HIE’s CEO, Dev Culver, had been a CIO at one of the largest health systems in the state for close to 20 years and was highly respected and widely known. 

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Two most prominent challenges would be first, funding. HealthInfoNet got off the ground before stimulus money became available through the Office of the National Coordinator, so they had to spend a lot of time fundraising before building out the technology. Second, many parts of Maine still do not have access to broadband internet, meaning many of the smaller rural physician practices won't be able to connect. This is rapidly changing however, and should be resolved in the near future. 

HIMSS: What impact has the Maine HIE had on the residents on the state?

Jones: HealthInfoNet has collected a number of stories from providers about how the HIE has helped them provide better care for their patients. Providers say they've avoided potential medical errors, reduced duplicate testing, and better coordinated the patient's care through the HIE. HealthInfoNet also has a collection of stories on their website and YouTube page. They also have a video of a patient  talking about what she sees as the benefit of the HIE. They are also planning to do a formal impact study related to care in the emergency department later this year. 

HIMSS: What are the most important lessons learned in growing and sustaining your statewide initiative?

Jones: HealthInfoNet focused most on building and sustaining the trust framework to support stakeholder engagement and commitment, and a big part of this is patient awareness and education. Regardless of whether an individual opts-in or opts-out of the HIE, it's best to make sure patients are well aware that the HIE exists and understand their choices regarding participation. This builds trust and helps HIEs maximize participation among patients and their providers.

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Another lesson learned was to start with a large community and continue to expand. HealthInfoNet initially connected many providers around the state, but none initially in the same town or community. This resulted in a failure to gain impact in high areas of patient cross-over between corporately unaligned provider organizations and ultimately reduced the speed to HIE adoption and use in the early years. Now, working with the Bangor Beacon Community, HealthInfoNet is rapidly connecting all the providers in the Bangor region. HealthInfoNet has learned that a community-based strategy may be a better approach so that clinical users will have more instant value and relevant data available when they log on for the first time. This will boost usage from the beginning.   

Lastly, HealthInfoNet learned not to underestimate the time and money needed to meet and sustain the legal requirements for setting up and running an exchange.

HIMSS: What are you most looking forward to at the Government Health IT Conference & Exhibition?

Jones: I’m looking forward to the opportunity to network with others, exchange lessons learned and get a better sense of other organizations’ successes – and their challenges – so we can continue to evolve our business to best meet the needs of HIEs across the country.

The 2012 Government Health IT Conference & Exhibition will be held June 11-12, Washington DC. Register for the conference here. This article originally published on the HIMSS.org News page.