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, said Carlotta Gabard, IHAs vice president of administrative services and executive director of A3 HIE.
The A3 HIE consortium also includes three specialty groups in the Ann Arbor areaMichigan Heart, Huron Gastroenterology and Michigan Multispecialty Physicians. These groups also have earned hundreds of thousands of dollars through other pay-for-performance programs, 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, Gabard said. He added that, 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 is a good example of a small community HIE, according to A. John Blair III, chairman and chief executive of MedAllies, a Fishkill, N.Y.-based EMR implementation company. There are very few HIEs like A3 HIE, Blair said. 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, said 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 said. Most HIEs include multiple partners, including hospitals, employers, payers, reference laboratories, pharmacies, consumers and ancillary providers.
Most groups arent doing it because you can make a tremendous amount of investment and time and then be told this isnt the (EMR) standard (for interoperability) we are going to use, said William Bria, 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, Bria said. Since 2005, the American Health Information Community has been working on uniform EMR standards.
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 said.
While A3 HIE collects the clinical data that helps the groups collect pay-for-performance payments, each physician group keeps its own bonus payments. But for HIEs to become self-sustaining, Gabard said, We must prove our value by showing how we can help physicians decrease administrative costs and provide them with the clinical data.
Gabard said A3 HIEs annual operating expense is $140,000. We think operational costs (of HIEs) have to be covered by users, Gabard said. She added that the consortiums startup costs were partially borne by NextGen because they were considered an alpha and beta site. 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.
A3 HIE plans to add new partners in coming years. This year, 520-bed St. Joseph Mercy Hospital, Ypsilanti, joined the consortium, contributing laboratory information, and emergency room physicians will soon access the registry, Gabard says.
We will be ready when Medicare starts its pay-for-performance program, Gabard said.