Direct is a federally developed package of electronic messaging standards and implementation specifications that will permit basic, encrypted clinical messaging, such as the transmission of referral letters or care summaries, between providers with established authentication and business relationships.
Silva, named in 2012 as one of Modern Healthcare's Top 25 Clinical Informaticists, said RHIO members are “looking to try to get into” more robust clinical information exchange “by the middle of the next calendar year.”
Planning for the RHIO began in 2011 by the Metropolitan Chicago Healthcare Council, a local healthcare service association that claims 170 member hospitals and healthcare organizations.
But the 34 starting exchange members represent “a core group of institutions that have been working together for quite some time to find the best approach to get this launched,” Silva said. “One of the things we were looking for is to see whether we could get a significant share of the marketplace together to see value.” With roughly a third of the Chicago region's 89 hospitals, planners believe they have reached sufficient market share.
Silva said providers in the region use electronic health-record systems from “quite a few” different developers, but the hospitals are “pretty heavy with Epic and Cerner” and “some shops with Meditech,” which are among the top five vendors of complete EHRs to hospitals that have been paid under the federal EHR incentive payment program. Complicating matters will be the goal of RHIO planners to offer HIE services to office-based physicians with a wider array of EHRs, even though some hospitals have extended their EHRs to their owned groups and affiliates.
To tackle the interface problem, the MetroChicago HIE hired SandLot Solutions, a technology company launched in 2006 by North Texas Specialty Physicians, a Forth Worth-based independent practice association and the 2010 winner of Modern Healthcare's health IT case study contest.
The weakness—or complete absence—of a business case has been fatal to regional health information exchanges nationwide and throughout their history, but Silva is optimistic the business climate for information exchange has changed.
“Every institution has seen the value of sharing data within their walls,” he said. “As we look at some of the initiatives across the country, pay for performance, care coordination and medical home networks, it's all about capturing data and taking a long look at that longitudinal record, so you have the full breadth of the care experience, and have the full care-delivery approach.”
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