Like lumbering dinosaurs, they appeared and became massive and multiplied. Then they just died out.
Or so it seemed.
Community health information networks, which had a brief heyday in the mid-1990s, are largely a thing of the past. But a CHIN in Dayton, Ohio, has survived by reinventing itself twice -- hanging on until the World Wide Web gave the effort new life.
The Greater Dayton Area Health Information Network now operates as an Internet-style private network, called an intranet, that's available to each of eight participating hospitals and their practicing physicians.
It's a long way from the primitive first efforts to develop a data-sharing capability. But having something to show early was crucial to keeping the effort going through technological obstacles, says Joseph Krella, president of the Greater Dayton Area Hospital Association, sponsor of the initiative.
"We never really reinvented what our purpose was" while adapting to changes in technology, Krella says. But he adds, "We would not have been able to continue unless we had a product to show and a story to tell."
The CHIN concept was propelled by a lofty premise that patient information should be shared by competitors in a market for the common good. One of the first CHINs took form in Dayton, and Ohio became a hotbed with additional initiatives in Cleveland and Cincinnati.
As it turns out, CHINs were ill-suited to the healthcare business climate and generally unable to adapt. The technology they had to use to forge regional connective networks was costly and inflexible, and CHINs generally didn't get to the point of offering a usable product.
Beginnings. A group of Dayton-area hospitals in 1993 began planning to exchange patient encounter summaries across an electronic network to emergency departments and medical-record departments, Krella says.
Aware of the time and expense required to dispatch couriers among hospitals, executives of area facilities concluded that "there had to be a better way," he says.
Two giant companies seeking to get into the CHIN business, IBM Corp. and Ameritech Corp., heard about the project and offered to develop and sell computer software, hardware and network improvements tailored to the data-exchange objectives.
A two-year demonstration processed 3 million patient encounters and created 1 million hospital records over a high-speed, high-capacity communications network.
But in the span of two years, the focus of healthcare delivery -- and its data -- had begun to move outside hospitals to physician offices and labs, Krella says. The scope of data exchange had to broaden to meet the expanded focus, the association concluded.
With help from Deloitte & Touche, the health network explored a plan to integrate demographic, clinical and financial data and direct all the information to one PC in a doctor's office.
IBM developed software to access and display clinical information, while an Atlanta-based company called ActaMed Corp. handled financial data and claims processing.
The prevailing technology was based on forging point-to-point connections with physician offices, which confines access to predetermined PCs and involves phone-line leases and switching that adds to the cost.
Intranet advance. But in healthcare, Krella says, technology "was beginning to develop more rapidly than we anticipated" toward the use of Internet protocols, making information available to any authorized person with a Web browser and eliminating the need to set up each connection individually.
Instead of continuing as planned, the Dayton network gradually moved to Internet-based technology.
Rollout of IBM's Health Data Network integration software is complete at one hospital so far -- 410-bed Kettering (Ohio) Medical Center -- and is scheduled to be operational by late May at 320-bed Grandview Hospital and Medical Center in Dayton.
Interfaces to information systems at two Dayton facilities, 714-bed Miami Valley Hospital and 324-bed Good Samaritan Hospital and Health Center, are in the early stages; the two hospitals are expected to be running the patient-data application by late summer, Krella says.
ActaMed was acquired last year by Healtheon/WebMD, an Atlanta-based healthcare Internet company.
The Dayton health network's partnership with ActaMed evolved into an agreement for additional services such as medical content and claims-transaction processing. Those services are now supplied to the Dayton intranet through WebMD Practice. And the intranet's technical professionals have transferred other existing services to the central hub, such as access to area inpatient databases, Krella says.
The Dayton network also worked with Anthem, the Blue Cross and Blue Shield company serving the region, to add a connection that supplies patient eligibility information.
From Anthem's mainframe computer center in Louisville, physician office employees can determine whether a patient has coverage and what the components are -- drug or wellness coverage, for example -- and whether a second surgical opinion is required, says Lisa Rindler, the association's director of professional affairs. The Anthem link also includes a directory of providers and a drug formulary.
Broader appeal. Other eligibility verification services are available through WebMD for patients of Aetna U.S. Healthcare, Cigna HealthCare and United HealthCare.
With the intranet transition completed and new services broadening its appeal, the Greater Dayton Area Health Information Network is in the midst of an enrollment boom. Nearly 1,900 users are signed on, including 900 physicians and 200 residents at Wright State University School of Medicine, Dayton. A year ago, the network had fewer than 400 users.
The network has a $2.3 million budget for 2000, fully funded by the participating hospitals and by Anthem, Krella says. Officially the usage fee for doctors is $500 a year, but the association board has waived the fee for now to encourage participation. There are 2,200 physicians in the 10-county area served by the hospital association.
Among the roster of services available, a prime lure for physicians is the secure e-mail network and free access to a medical reference and information service, MD Consult, which usually charges a per-physician fee, says Robert Barker, M.D., who practices critical-care medicine at Miami Valley and Kettering.
"It's a $35-a-month subscription if you were to purchase it separately, so that's a big savings for us," Barker says. The practice includes six hospitalists, four critical-care specialists and three infectious-disease specialists.
The online connections supply demographic and billing information on demand, but for now those details have to be re-entered in the physician office because the electronic data can't go directly into the physician practice management system.
Still, it's better than when offices had to dial in via modem to each hospital information system. Instead of getting back to a home page where a keystroke or click could access the next hospital, staffers had to disconnect and then re-dial, Barker says. "It was so labor-intensive that it wasn't practical."
Among the next expansions planned is an initiative with Merck-Medco Managed Care, a giant pharmacy benefits manager, initially involving about 75 physicians, Rindler says. A pilot project will give them access to electronic refill services for prescriptions as well as drug formularies by health plan, she says.