Stimulus Funds Can Lead to Health Information Exchange Networks

With the announcement that the federal government's plans to spend $19 billion to spur the use of computerized patient records, the industry has a renewed interest in how and when hospitals should begin to adopt electronic health records.

But what about hospitals already entrenched in EHR? What's next for them?

Physicians at the Medical Clinic of North Texas have been using an EHR for nearly 10 years, says CIO Mike Yerrid. He will be focusing on expanding into the health information exchange arena, to connect other physicians within the Dallas-Fort Worth region, with the eventual goal of establishing a medical home model.

"We are a large primary care medical group, and there's value to exchanging our electronic information with other groups in the area," says Yerrid. "We're hoping people will join the game. We're trying to sell the benefits and create an attractive package for specialists and primary care groups."

States and counties throughout the country have experienced varying levels of success when it comes to getting HIEs and RHIOs off the ground. Respondents to the HealthLeaders Media Industry Survey 2009 were split fairly evenly on the topic. We asked them, "Which of the following best describes your thoughts about regional data sharing projects, known as RHIOs?" About 37% of CIOs said they expect RHIOs to take hold over the next decade, another 35% said they expect them to fizzle due to lack of funding or management issues, and the remaining 28% said it's too early to be concentrating on RHIOs and the industry should first focus on automation efforts.

Yerrid says he expects the medical group to face interoperability issues. "It will be a challenge. It's one of those situations where if you had the only phone in the world, what value is the phone? And in the past one of the main problems with creating an HIE has been finding a revenue model that works. Our plan is to use the stimulus money to invest in the future, rather than pay ourselves back," he says.

Despite the challenges (interoperability, revenue, funding) that surround launching an HIE, the number of operational health information exchange initiatives increased considerably between 2007 and 2008, according to the eHealth Initiative. eHealth's eHealth's latest survey results indicate 42 operational HIE initiatives, up from the 32 in 2007 (a 31% increase). All 32 operational health information exchange initiatives that responded in 2007 continued to be in operation in 2008.

Yerrid says he expects that number will grow once the stimulus money begins to flow. "I think people are starting to see the real value that can be had from exchanging information this way. The creation of medical homes, by connecting specialists and hospitals, and the rest, is really the way we are going to expand coverage and improve healthcare," he says.

Since many hospitals are hunkering down and putting projects off to ride out the bad economy, Yerrid says now is the time to be performing due diligence to ensure all of the government's available incentives are being maximized. Once things get better, he says, that will be the time to begin to ramp up HIE efforts again.

"From an IT perspective, we don't always have to be running at full throttle, and this is one area where I think we can just tap the breaks a little bit. With that said, we're maximizing our e-prescibing incentives, our PQRI incentives, and working with pay-for-performance objectives to max those revenues so that when things do get better, we'll be ready to move forward quickly," he says.

There have been some small wins when it comes to advancing HIEs. And though 31% growth is incremental and not momentous, it's important to remember that increase came about before the stimulus plan was announced. Once that money starts coming in, more healthcare organizations will follow in the footsteps of Medical Clinic of North Texas.

—Kathryn Mackenzie