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Feuding HIEs Pit Cerner vs. Epic Loyalists in Missouri

   May 17, 2016

Vetoed by the Governor

I put the LACIE conversation out of mind until an hour after Boyce and I talked, when I saw the news that Gov. Jay Nixon (D- Missouri) had just made a line-item veto of $500,000 from the state budget that would have funded connections between the state's Department of Social Services and MHC.

"The language added places conditions on health information exchange services that would unfairly exempt [some] providers from the requirement to pay for such services as called for under existing contracts," Nixon was quoted as saying by St. Louis Public Radio.

The veto was quickly followed by a statement of support from MHC with some eyebrow-raising language.

"The budget was inappropriately and unconstitutionally manipulated as a result of special interests that are working to hinder and fragment the adoption of health information exchange (HIE) in Missouri," MHC's statement says in part.

"The impact of the budget language would have compromised the free market system by eliminating hospitals' and providers' ability to choose the HIE that best suits their needs."

Since I was not able to get further clarification, or any comment at all out of MHC in time for this column, presumably one of those special interests is LACIE.

Monopoly Pricing?

Boyce suggested I call Mike Dittemore, executive director of LACIE, for more background on the governor's veto.

"We were live at least two years before Missouri Health Connection was even trading their first piece of data, and that was really in Direct messages, not in query-based exchange," Dittemore says.

LACIE even began exchanging data with another HIE in the state run by the Tiger Institute for Health Innovation out of the University of Missouri in Columbia, Missouri.

"MHC doesn't feel it's fair that we're able to provide services at less than half the cost that they can provide services at," Dittemore says. "They're trying to form a monopoly."

I was unable to determine how many messages MHC carries between its members.

But it's worth noting that many Epic-powered health systems, such as those which make up the bulk of MHC's member organizations, bypass regional HIEs entirely and instead use the Epic-provided CareEverywhere mechanism as an EHR vendor-powered HIE.

So it seems unlikely that Dittemore's monopoly fears will come true any time soon.

At this point, Boyce emailed me to add his thoughts to my conversation with Dittemore:

"The legislature passed a law stating HIEs couldn't charge each other to connect and share data, and established a separate panel to oversee the HIEs in Missouri. MHC, which has gotten over $14 million in federal dollars to provide a state coordinating body, flipped and tried to create a monopoly for Medicaid data they will charge others to connect with—exactly the opposite of the intent of the HIE funding. Then they get Nixon to veto when his buddies lose their monopoly."

"Cerner," he wrote, "has nothing to do with this. You have [St. Louis-based] Barnes Jewish Hospital with St. Luke's on MHC (haemorrhaging [sic] tax $ and blocking exchange) and two self-funded regional HIEs in LACIE and Tiger institute on the other. The only 'special interests' are federally-supported HIEs blocking data sharing."

It seems clear to me that something in this Missouri HIE controversy doesn't add up.

I hope this column brings a response from MHC and its defenders, and we can more fully understand why Missouri's two biggest HIEs cannot connect to each other.

If the matter cannot be sorted out in the public arena, I suspect that those policy makers in Washington trying to eliminate information blocking will take a more active interest in what's going on in Missouri.

How ironic would it be if information blocking were being facilitated with the help of federal funding?

Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.

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