A proposed community health information network in northern Ohio has attracted the official interest of nearly half the hospitals belonging to the Greater Cleveland Hospital Association, the CHIN's initiator.
Twenty-four of the association's 52 members submitted a letter expressing interest in connecting to a regional electronic data-transfer network that would be built, owned and operated by Chicago-based Ameritech Corp.
Though the hospitals expressing interest make up less than a majority, they account for 75% to 80% of the total beds in the 70-mile radius of Cleveland covered by the association, said Philip Mazanec, its senior vice president.
The letters aren't commitments, though. They just demonstrate a willingness by the hospitals to take further steps, such as assessing their computers' readiness to give and take information from the CHIN, Mazanec said.
Proponents of the organization effort are banking that hospitals and other health-data users will support the utility-style structure of upfront fees and usage charges that will compensate Ameritech for shouldering the CHIN's development (Jan. 2, p. 16).
So far, one area provider, Akron-based Summa Health System, is under contract. That early decision stemmed from independent discussions the system had conducted with Ameritech for a smaller network in the Akron area before momentum swung to a single network covering up to a 100-mile radius of Cleveland, Mazanec said.
Across a band of Midwest metropolitan areas, the balance between getting a CHIN started and getting broad support for it has been handled a number of ways during the past few years.
The utility arrangement took hold first in a Milwaukee-based venture between Ameritech and Aurora Health Care, a four-hospital system that's since expanded to six. Formed in 1992, the Wisconsin Health Information Network now has 13 hospitals under contract as well as a range of ancillary health services and payers, including Wisconsin's Medicare fiscal intermediary (May 9, 1994, p. 52).
Ninety miles south, in Chicago, a provider coalition was formed in 1993 partly as a defensive move against allowing a vendor of CHIN technology such as Ameritech to gain a foothold. The Metro-Chicago Community Health Information Network first got the backing of 77 hospitals and the state medical society, then went in search of vendors (See related story, this page).
Chicago's CHIN organizers said they didn't want to cede control of the CHIN structure to a nonhealthcare corporation with a profit motive. A not-for-profit CHIN operating company will have final say on business and operational issues, contracting with a vendor group to build and run the CHIN.
Initiatives in Cleveland and Cincinnati are moving away from the extremes of vendor and community control.
In Cincinnati, a coalition of 31 hospitals and other healthcare stakeholders is planning a not-for-profit operating company akin to Chicago's-but the eventual vendor will have an ownership interest (Feb. 6, p. 10). Ameritech is one of three vendor finalists.
The Cleveland hospital association's vendor tilt is tempered by its aim to establish communitywide control of the governance structure. Ameritech and the association each would have a seat on a CHIN board, along with other medical interests and representatives of payers, business and the general public, Mazanec said.
The board, however, will recognize Ameritech as the owner/operator and the final authority on technical issues, such as the way data will be transmitted throughout the network, he said.
But that's the cornerstone of the association's vendor-owner approach. Ameritech's technical ability to quickly make the CHIN operational, combined with its financial ability to foot the investment up front, will help spare the market the time and money involved in gathering backers and raising capital, Mazanec said.
The profit motive is part of the deal. "Certainly Ameritech is making a significant investment in infrastructure," he said. "They're not in the business to lose money."
But when it's time for Ameritech to get the investment back in fees and usage charges, CHIN subscribers will benefit from tiered pricing based on organization size, volume discounts on connection expenses and the ability to amortize their expenses over time, Mazanec said.