While many regional health data exchanges struggle to snare start-up funds, Indiana Health Information Exchange Inc. is already building a set of IT services based on a mature electronic medical record system used by five health care operators here.
In fact, the Indianapolis-based IHIE is part of a consortium that was awarded a contract this month by the U.S. Department of Health and Human Services to develop a prototype for a national IT infrastructure for exchanging health information.
The IHIE was created in February 2004 by the five health care providers that are using its network as well as a physician-led IT group and a public/private partnership that included local universities, the combined government of Indianapolis and Marion County, and several businesses.
Since late last year, the exchange has been rolling out a clinical messaging service to provide its membership, which includes community physicians at 18 hospitals, with electronic access to pathology, laboratory, radiology and electrocardiogram reports.
Two of the health care operators went live with the service in November 2004. A third went live this October, and the other two are expected to go live in December and January, officials said.
So far, between 2,400 and 2,500 of the 3,000-plus doctors in the system are receiving reports from the clinical messaging service.
The new, fee-based service replaces paper-based reports that were delivered to physicians by fax, postal mail or courier, said J. Marc Overhage, IHIE’s CEO and president.
Using the electronic system, it costs 17 to 37 cents to send a message, compared with about 81 cents per message using the old system, he said.
All of the participating hospitals notified physicians in mid-2004 of their plans to transmit all patient data using the IHIE system by the end of this year. As of early this month, about 90 percent of messages were being sent electronically, and the rest were being sent via fax, Overhage said.
The clinical messaging service uses data gathered by Indianapolis hospitals and labs to populate the city’s Indiana Network for Patient Care electronic medical records system. The service converts the data into a consistent report format for delivery to physicians through a portal.
Test Run
James Ehlich Jr., a private-practice physician in Indianapolis, began receiving test results from IHIE via fax in April. By summer, he was downloading reports electronically from IHIE’s portal.
Ehlich said the electronic system delivers reports a day earlier than the fax-based system, and it has enabled him to stop receiving some duplicates. In addition, the consistency of the reports has improved, he noted.
Ehlich did cite one drawback of the new system: He can retrieve only tests that were ordered by him or his partner. And since 95 percent of his patients are referred by other physicians, he often needs to see the results of tests requested by those doctors, he said.
Those regulations can force him to retest patients or postpone appointments while waiting for results to be sent by other doctors, Ehlich said.
Overhage said the fees generated by the clinical messaging service are critical to the “long-term financial viability” of IHIE. Those funds will be used to bolster the not-for-profit IHIE to a cash-positive position in the first quarter of next year and will provide a foundation to pay for building additional services.
The information exchange is planning to launch additional data-exchange services over the next few months, officials said. For example, on Jan. 1, it will begin offering electronic access to medication history. On the same date, a federal regulation takes effect requiring that hospitals obtain a medication history for all patients when they are admitted.
Two of the city’s five health care operators have signed up for the service; the others have expressed interest, Overhage said.
During the first half of next year, IHIE plans to launch a new “pay for performance” service to be built using the EMR system.
The IHIE’s IT development arm, Indiana University’s Regenstrief Institute Inc., is building decision-support software to run on top of the EMR database to add claims data from local insurance companies for specific doctors.
Subsequently, the system will be updated to measure the diagnoses and prescriptions physicians make against national standards. Physicians who meet those standards can be eligible to receive a higher level of reimbursement from the insurance companies that have agreed to participate in the program, Overhage said. Insurance companies covering 80 percent of the population in the Indianapolis market have agreed to participate, he added.
Wes Rishel, an analyst in the health care provider practice at Gartner Inc., described IHIE as the most advanced regional health care information organization in the country right now in terms of exchanging clinical data.
“[IHIE] has been smart in terms of picking the right early applications that are easy for people to sign up [for] and using that as a starting point to build out a broader group of functions,” he said.
SIDEBAR
11-Year-Old EMR System Key to National E-health Project INDIANAPOLIS — Just before noon on Nov. 18, 78 patients were undergoing treatment in the emergency room at Wishard Memorial Hospital here.
The treatment and medication records of many of them — those who had previously been treated in one of 18 hospitals in the city — were immediately available to physicians via a citywide electronic medical records system.
The 11-year-old EMR system is called the Indiana Network for Patient Care, or INPC. It has become a key element in a proj-ect to build a prototype system for a national movement away from paper-based medical records.
The 2-year-old Indiana Health Information Exchange is using the system with other regional health information organizations (RHIO) in California and Massachusetts. The RHIOs won the contract for the project from the U.S. Department of Health and Human Services.
J. Marc Overhage, IHIE’s president and CEO, said the organizations are using the INPC’s matching algorithm for integrating patient history information from different hospitals and clinics in the HHS prototype. In addition, working with the regional health networks in California and Massachusetts will help validate some of the work IHIE has done to foster data exchange, he noted.
John Finnell, an emergency room physician at Wishard who trained in California and spent several years practicing in Minnesota, said the INPC system is ahead of those in other states. In both states where he worked previously, Finnell said, he rarely had immediate access to the clinical histories of ER patients like he does in Indianapolis.
The INPC system provides ER doctors in Indianapolis with an abstract containing treatment history and test results that they can refer to before embarking on a treatment path, he said.
“The abstract speaks for the patient — especially when they can’t speak or if they are unconscious,” Finnell said.
The RHIO is now in the midst of several more projects to extend the EMR system.
For instance, Wishard’s emergency room this month began testing rules-based software with the EMR system that can alert staff of patients who need a flu shot. A full-time paramedic mans the system and offers inoculations to patients in high-risk categories, Finnell said. The data from that effort is being compiled to determine whether the program helps to reduce the number of reported flu cases, Finnell added.
The hospital’s emergency department is also testing a new interface that can be used to add information on a patient’s temperature, blood pressure and other vital signs to detect patterns that might indicate the outbreak of a disease like avian flu.
Scott Tiazkun, an analyst at IDC, said such proactive efforts get to the heart of the reason why organizations are spending millions of dollars to automate patient records.
“This is doing exactly what an [electronic medical records system] is designed to do — be proactive,” he said. Such proactive efforts are “ahead of what 90 percent of hospitals are doing now.”
