A plan intended to foster interconnected health information exchanges across Michigan has gone awry as companies providing the services compete for hospitals, physicians and market share.

The health information exchanges 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, Mich.-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, formerly My1HIE.

Nationally there are more than 250 HIEs, including 160 private HIEs, but fewer than 60 are exchanging data, and only 40% 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.

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 Dr. Andrew Rosenberg, chief medical information officer with the University of Michigan Health System in Ann Arbor. “The debate is a single HIE or interrelated HIEs,” Rosenberg said. “I argue that a single HIE is a better model.”

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,” he said. “That is part of the issue. When they start saying that, then maybe we will move faster.”

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 healthcare 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.”

—Crain's Detroit Business