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HIEs Deliver Savings to Rural Hospitals

 |  By Alexandra Wilson Pecci  
   August 10, 2011

Although there are definite challenges to forming health information exchanges in rural areas—a lack of broadband access being chief among them—one advantage that rural stakeholders may have over their urban counterparts is a greater willingness to collaborate.

According to a report from the National eHealth Collaborative, "HIEs serving rural markets seem to have a natural advantage over urban HIEs in their ability to attract otherwise competing providers to participate in health information exchange."

The report also finds that rural communities' lack of health IT infrastructure is actually the reason that when rural HIEs do get up and running, they share information efficiently and are more likely to attract members based on the exchanges' real business value.

The report, "Secrets of HIE Success Revealed: Lessons From the Leaders," profiles 12 mature and fully operational HIEs across the country, including ones in rural areas, to identify critical success factors and challenges.

According to Kate Berry, CEO of the National eHealth Collaborative, participating organizations are not only driven by a desire to improve healthcare, but also by the fact that HIEs make sense financially.

"One thing that came through loud and clear with these folks is while they have a strong mission…they also have very serious business acumen and business discipline that guides the decisions they make," Berry said in an interview. "As they develop the services, they're focused on: 'where's the value?' and 'who's going to pay?' There has to be a business case."

She pointed to the Spokane, Washington-based HIE Inland Northwest Health Services, which has an HIT network that connects 38 hospitals and 450 ambulatory organizations. It also provides 47,000 end users with secure access to a community-wide EHR system that contains records for 3.5 million patients. Berry said Inland Northwest hosts the technology for many rural hospitals and physician practices through a shared services model.

"They're saving lots of money for the hospitals because they've consolidated the data centers," Berry said. "Essentially all the connected providers pay subscription fees, but they're saving so much money by not having to develop the infrastructure themselves, that they're really much, much better off."

In fact, according to the report, hospitals that participate in this particular HIE spend approximately 2% of their budget on health IT infrastructure compared to the national average of 3% or more. The Inland Northwest infrastructure also includes "advanced applications not always factored into the national average spend, including computerized physician order entry, clinical documentation, bedside charting, bar-coded medication verification, and medication reconciliation," the report said.

Another example that Berry highlighted is SMRTNET, which she calls "a network of networks" that connects Indian tribes and other providers. After first operating with grant funding and in-kind resources from partner organizations, the SMRTNET HIE framework has been replicated in additional counties in Oklahoma and now consists of "seven self-governed networks that exchange data statewide" on more than 80% of the population of Oklahoma across 115 sites from 64 towns and cities.

According the report, successful HIEs have several things in common: strong leadership; continually aligning stakeholders with the HIE's priorities; becoming a trusted, neutral entity; and having competing businesses or entities partnering with one another. Berry also highlighted the "balance of mission and business" and a focus on making decisions based on real value.

"There's lots of good news in this report that shows that this can be done," Berry said. "And it can be done in a way that really makes healthcare better and is not terribly disruptive to the provider."

 

Alexandra Wilson Pecci is an editor for HealthLeaders.

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