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Competition among health information exchanges slows development of Michigan system


By Jay Greene, Crain's Detroit Business
Posted: October 8, 2012 - 1:00 pm ET
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A plan intended to foster interconnected health information exchanges across the state has gone awry as companies providing the services compete for hospitals, physicians and market share.

The health information exchanges -- not to be confused with the health insurance exchanges under health care reform -- are intended to help make it easier for hospitals and physicians to exchange patient information, thereby achieving lower costs and higher quality by better coordinating care and reducing service duplication.

The problem is the two exchanges with the biggest market share, Okemos-based Great Lakes HIE and Grand Rapids-based Michigan Health Connect, use different information systems that cannot exchange data with providers that select other exchanges.

The executive directors of the two HIEs, Carol Parker of Great Lakes and Doug Dietzman of Michigan Health, say the goals of their organizations are to become statewide exchanges.

But while each HIE is highly competitive in seeking to add hospitals and physicians, Parker and Dietzman say they have been talking the past several months over ways to share data.

An agreement between the two HIEs could be reached within a year to integrate their patient data systems, the two executives say.

Parker said she also has discussed patient data sharing using patient queries and Great Lakes' master patient index with several other HIEs in Michigan, including two in metropolitan Detroit: Southeast Michigan HIE and Ingenium LLC, formerly My1HIE.

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Lee said the hospital association board voted in September to encourage hospitals to select either Great Lakes or Michigan Connect as their HIE, which could reduce data exchange fragmentation.

But he added that the MHA board decided not to lobby the state to fund or push for a statewide HIE, although it believes that is the best long-term goal.

"The hospital association is clearly trying to broker better coordination with the HIEs and, where feasible, more collaboration," said Andrew Rosenberg, M.D., chief medical information officer with the University of Michigan Health System in Ann Arbor.

"The debate is a single HIE or interrelated HIEs. I argue that a single HIE is a better model," said Rosenberg.

Parker and Dietzman said their organizations are not contemplating a merger. They say collaboration to share data is a more realistic goal, at least for now.

"We are working with our vendor on this now," Parker said. "A lot of hospitals and physicians indicate to me they would like to see the (regional) HIEs share data. From a public health, quality and cost standpoint, it doesn't make sense not to share data."

Dietzman said he believes ultimately there will be information exchange among all the HIEs in Michigan. The question is just when, he said.

"I don't have any providers coming to me and saying that this is something I need you to do. That is part of the issue. When they start saying that, then maybe we will move faster," he said.

In 2006, Gov. Jennifer Granholm approved a plan to create nine substate health information exchanges -- online databases that allow competing medical providers to instantly share patient information in a secure format -- and encourage the HIEs over the next five years to grow. As it turned out, there are six.

Many experts say that initial plan is partially successful. But Granholm's plan called for the regional HIEs to become interconnected by this year through the Michigan Health Information Network.

Now some believe it could take several more years for that goal to be reached.

In the meantime, the six surviving substate HIEs in Michigan are signing up dozens of hospitals and physicians, developing different information technology approaches and starting to exchange patient data within their own organizations.

But last year, a study by Harvard University researchers in the Annals of Internal Medicine found states that have promoted the use of a single HIE, including Indiana, Maryland and Massachusetts, have not only moved more quickly ahead in the goal of exchanging patient information, but those HIEs also are more financially stable.

Dietzman said states that have set up single HIEs are smaller and less complicated than Michigan and have state financial support.

Nationally there are more than 250 HIEs, including 160 private HIEs, but less than 60 are exchanging data, and only 40 percent of those receive sufficient revenue to cover expenses, studies show.

To address patient data fragmentation by having separate regional HIEs, the Michigan Health and Hospital Association's HIE task force concluded in June that the best solution for Michigan is to have a single, statewide HIE, said Jim Lee, the association's vice president for data policy.

"As the state moves forward with HIEs, we are asking if it makes sense to continue doing what we are doing" or if a new approach is needed, Lee said. "We have asynchronous growth with some HIEs doing well and the others not showing any sustainability."

Brian Connolly, CEO of Dearborn-based Oakwood Healthcare, said the four-hospital system, which is installing an Epic Systems electronic medical record system, is one of a few health care organizations in Southeast Michigan that have not selected an HIE. He said Oakwood prefers to wait until there is a single, statewide HIE. "I would like to see it structured so all hospitals, doctors and systems are in (one HIE) so we don't need to have interfaces and compete" with each other, Connolly said. "We don't want to invest in an HIE that gets absorbed or discontinued. We can wait for a single one."

Oakwood, like all hospital-based systems and most physicians in Southeast Michigan, is spending millions of dollars on internal electronic medical record systems to connect its hospitals and affiliated physicians.

Parker said she understands concerns like those expressed by Oakwood. But she said she would prefer more hospitals to be the table to help push the HIEs to collaborate and develop internal systems.

"Last year we decided to expand statewide to be (financially) sustainable. We don't want to overwhelm participants with costs because it is expensive to develop the infrastructure for an HIE," Parker said.

Subra Sripada, chief administrative and information officer for Beaumont Health System, said Michigan Health will eventually help Beaumont electronically connect with private practice physicians that are not on its Epic EMR.

But Sripada said a single HIE eventually is needed in Michigan.

"There is lots of fragmentation, with some HIEs doing a good job and the others not so," Sripada said. "The state needs to get more involved. I believe there will be more urgency when health care reform kicks in because we need to exchange information" to improve quality and lower costs.

Over the next several years, Michigan Health, Great Lakes and Southeast Michigan HIE and other private HIEs are expected to connect with the Michigan Health Information Network, said Executive Director Tim Pletcher.

MiHIN, the statewide organizer of the regional networks, also could connect into a nationwide HIE network, he said.

Pletcher views the multiple HIE projects under way in Michigan like the work done in the early years of the Internet.

"We had lots of innovation, creativity, experimenting and techie work to form the computer networks. It all came together to what we have now as the Internet," he said. "Like where we are now with the HIEs, it wasn't pretty in the beginning. We will get there."

But Dietzman said he believes natural market forces will lead to a consolidation of HIEs and greater collaboration to exchange data between Great Lakes and Michigan Health.

"There is nothing in place to structurally force everything into a single exchange," he said. "The problem is you have two independent boards that do not feel overly compelled to give up what they are doing. Both are progressing. We know we have to interact eventually in Michigan and with northern Ohio and Indiana."


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