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Hospitals building health information exchange, brick by brick

Hospitals are building a de facto national health information exchange infrastructure as they try to connect ambulatory practices and other hospitals in their regions.

A national, interconnected network of health information exchanges might be the dream of federal health IT leaders — who are pouring billions into building state, regional and local HIEs, with HIE grants announced last week. But where are we, really, two years after the Health Information Technology for Economic and Clinical Health (HITECH) Act?

Judging from's conversations with leaders of two early-adopter private health information exchanges serving regions in Ohio and Pennsylvania, the ad hoc network is slowly building itself. While they feel the nationally connected HIE network will be years in the making, they can see the path.

"We're very excited about where this is going to take our community. The doctors are excited because they see this as a means to become more efficient," said Carla Fonte, Wooster Community Hospital CIO and chairman of the board of eLINCx, a central Ohio health information exchange under construction.

"They're making phone calls, they're faxing, they don't always have the information. When you come into a hospital's emergency room, if you've been here before, we know what we know about you in our [electronic medical record], but we don't see your primary care, your cardiologist or the other doctors you may have," Fonte said.

One of the most basic HIE models involves a local hospital reaching out to its satellite facilities and unaffiliated ambulatory physicians in the region to enable health information exchange. These regional HIEs have three basic problems to solve — interoperability of the different electronic health record applications used by participating providers; recruiting all the local physicians using EHR systems; and of course, paying to implement and maintain the network.

ELINCx connects two main hospitals — Wooster, plus the Dunlap Community Hospital — and 17 other facilities including clinics, individual physicians and group practices. the health information exchange took several years of committee discussions with representatives from the two hospitals, which fund it and offer the HIE service free to the other participants.

ELINCx is implementing its network: designing interfaces; educating providers and assessing EHR software upgrades needed for the providers, who are using about six different EHR systems, Fonte said.

One of the biggest challenges is interoperability. Overcoming EHR-to-EHR disparities was one jigsaw puzzle. An even bigger one will be harmonizing terminology among lab providers. They all will need to use Logical Observation Identifiers Names and Codes, or LOINC, for ordering test results from the various EHR systems.

When information flows one way from lab to provider, harmonizing terminology is not as big an issue, but it is key to the eventual smooth, back-and-forth exchange of information that eLINCx wants to enable and sustain, Fonte said.

ELINCx chose to contract with General Electric Co. to host a hybrid model, in which each provider's data resides separately but is centralized at GE's hosted site. (This is different from a centralized model, where the data resides in one location.) GE eHealth Information Exchange hosts data indexes in its private cloud; manages access privileges; and passes information between providers — porting labs, radiology data, continuity of care documents (CCDs) and referrals from one EHR to the next. GE also hosts the electronic master patient index for eLINCx.

The idea is for all patient records, from any participant in the health information exchange, to show up in each facility's EHR system.

All but two physicians in the using EHR systems have signed up to participate in the HIE, and the last two have been invited. "We would expect the other two to be forthcoming," Fonte said.

A handful of practices are still using paper workflows, but that will likely change, Fonte said, because federal meaningful use incentives are helping fund the switch to EHR systems. "In our community, we have a more saturated market of [EHRs] than other areas," she said. "We felt we had enough participants that it was worth moving forward."

Eventually, eLINCx will plug into Ohio's statewide HIE and fire CCDs, labs and radiology reports across its network.

Meanwhile, Vantage Health Group Telecommunications Inc., a health care communications provider, recently started a regional health information organization, or RHIO, to facilitate health information exchange among six rural northwestern Pennsylvania hospitals — Corry Hospital, The Ellwood City Hospital, Meadville Medical Center, Millcreek Community Hospital, Saint Vincent Health System and Titusville Hospital.

Vantage Health Group also chose a cloud model — hosted by Verizon Business — based on the example of MedVirginia, which similarly connects central Virginia hospitals, said Jay Long, the organization's executive director. He sees a lot of work ahead for his organization as it tries to get the independent hospitals to share patient information, but eventually the national HIE network envisioned by federal authorities will come together. In his opinion, it will take more prodding from Washington.

"You take small steps. We started with two of our hospitals," Long said. "The same thing is going to happen [nationally] when people realize the benefits. You have to start at the regional level. It's going to be real hard, unless it's federally mandated — which it probably will be — to do anything at the national level."

Let us know what you think about the story; email Don Fluckinger, Features Writer.

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