The Ann Arbor (Mich.) Area Health Information Exchange is accomplishing what many voluntary consortiums of independent medical groups have only dreamed of doing: earning pay-for-performance dollars and improving patient outcomes by sharing clinical and administrative data in electronic medical-record systems.
While the 4-year-old A3 HIE is still in its formative stages, one of the four participating group practices, 110-physician Integrated Health Associates, already has collected $1.2 million since June 2006 from Blue Cross and Blue Shield of Michigan under its Physician Group Incentive Program, says Carlotta Gabard, IHA’s vice president of administrative services and executive director of A3 HIE.
The A3 HIE consortium also includes three specialty groups in the Ann Arbor area—Michigan Heart, Huron Gastroenterology and Michigan Multispecialty Physicians. These groups also have earned hundreds of thousands of dollars through other pay-for-performance programs in Michigan, Gabard says. For example, since 2005 the four groups have collected about $350,000 from the Southeast Michigan e-Prescribing Initiative.
“The doctors are very excited about what we are doing,” says Gabard, adding: “We are at the point now where we are seeing major benefits from the system.”
Some 250 physicians and 50 nurse practitioners share four data sets on nearly 500,000 patients through a single Internet-based health portal. The sets are patient demographic information, medications, allergies, and current problem and diagnoses lists.
It saves physicians time this way: When a patient is referred to a specialist or sees another doctor within the system, staff does not have to re-register the patient. Time for patient check-in has been cut in half, Gabard says. For patients with complications, Gabard estimates the patient data-sharing probably shaves 45 minutes off a normal one-hour new patient intake.
A3 HIE is a good example of a small community HIE, says A. John Blair III, M.D., chairman and chief executive of MedAllies, a Fishkill, N.Y.-based EMR implementation company.
“There are very few HIEs like A3 HIE,” Blair says. “Doctors in small communities can work off the same database (EMR), exchange information and make it work very well. I believe these types of HIEs will grow” as more doctors adopt EMRs.
While 165 HIEs were in existence in 2006, only 33 are actually sharing clinical data with their partners, says Christine Bechtel, vice president of public policy and government relations with eHealth Initiative, a Washington-based health information association.
A3 HIE is only one of a handful of physician-founded health information exchanges, Bechtel says. Most HIEs include multiple partners, including hospitals, employers, payers, reference laboratories, pharmacies, consumers and ancillary providers.
However, 91% of HIEs reported in the survey that primary-care physicians were involved in 2006 compared with 42% in 2005. Participation of specialty physicians also increased in 2006 to 77% from 46% in 2005.
“Most groups aren’t doing it because you can make a tremendous amount of investment and time and then be told this isn’t the (EMR) standard (for interoperability) we are going to use,” says William Bria, M.D., chairman of the Association of Medical Directors of Information Systems.
“You need standards to have (health information) interchanges, but there is no consensus for (EMR) standards or a blueprint on how they should be implemented,” says Bria, a pulmonologist and chief medical information officer for the Shriners Hospitals for Children system in Tampa, Fla. Since 2005, the American Health Information Community has been working on uniform EMR standards.
Lukewarm physician interest and high installation costs are other reasons why only 10% of physician practices use EMRs, Bria says. However, President Bush has suggested that all physicians should adopt EMRs by 2014.
Despite the uncertainty, Gabard says the four groups decided to form A3 HIE to streamline the patient registration process, improve patient satisfaction and more efficiently collect pay-for-performance dollars.
One huge advantage the consortium partners share is they all use an EMR system designed by NextGen Healthcare Information Systems, a Horsham, Pa.-based company.
“It made sense to go with NextGen because we were talking about sharing information in a patient registry,” Gabard says. “We had it written into the contract that (NextGen) would help us build the clinical data repository.”
While A3 HIE collects the clinical data that helps the groups collect pay-for-performance payments, each physician group keeps its own bonus payments. “I don’t think that will change,” Gabard says. “The groups feel it is their money.”
But for HIEs to become self-sustaining, Gabard says, “We must prove our value by showing how we can help physicians decrease administrative costs and provide them with the clinical data” so they can earn money from pay-for-performance programs.
Gabard says A3 HIE’s annual operating expense is $140,000. “We think operational costs (of HIEs) have to be covered by users,” Gabard says. She says the consortium’s startup costs were partially borne by NextGen because they were considered an alpha and beta site. “It cost us mostly sweat equity to get started,” she says.
Toward providing value, Gabard says the consortium is seeking $100,000 in grant funding to conduct research on how data collection has improved the practices’ quality care and reduced operating expenses.
Groups “will pay for services that help them get the data,” she says. “It is a good return on investment.”
A3 HIE plans to add new partners in coming years. This year, 520-bed St. Joseph Mercy Hospital, Ypsilanti, joined the consortium as a full partner. The hospital contributes laboratory information, and emergency room physicians will soon access the patient registry, Gabard says.
Gabard suggests other groups considering sharing data in a central patient registry first make sure each group is proficient with its EMR system.
“We got caught up in designing the clinical data exchange at the time we were implementing EMRs,” Gabard says. “We didn’t have enough critical mass in the beginning to be fully proficient in EMR at the time we started it.”
But now the groups are starting to reap the benefits of sharing EMR system data, Gabard says.
“We will be ready when Medicare starts its pay-for-performance program,” Gabard says. “The full implementation of EMR, along with our links to specialist colleagues, and lab and documents interfaces, will position IHA to succeed.”
Jay Greene is a former Modern Physician reporter and now a freelance healthcare writer based in St. Paul, Minn. Contact Greene at [email protected]
