🔒CT health information exchange efforts forge ahead

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Connecticut has tried and failed several times over the past decade to build a statewide network that would enable more seamless sharing of patients' health data between their doctors and various other providers.

After a multimillion-dollar project died in 2014 — doomed by a legal fight with an IT contractor and other problems — it was unclear if the state would ever have a so-called health information exchange (HIE) that connects most, or even all, hospitals and doctors across the state.

But now two new competing exchanges are under development and could be launched soon.

The Connecticut State Medical Society (CSMS), which represents physicians, and the state — which earlier this year hired a health information technology officer — are each planning to launch HIE systems. CSMS is expected to be first, with the state's launch planned for next year.

While it's possible the two systems may eventually connect with each other, they will likely contend for paying members, such as hospitals, nursing homes, physicians' practices and accountable care organizations, which hope the technology will improve care coordination and health outcomes.

That subscriber revenue will be vital to making the HIEs financially self-sustaining, a challenge faced by many information exchange efforts around the country. The federal government has doled out billions of dollars in federal grants for healthcare IT infrastructure since 2009, but very few states have been able to develop statewide information exchanges.

“The greatest challenge facing standalone [exchanges] … is that too few providers participate and subscription fees are intended to generate revenue,” the National Governors Association wrote in a December analysis of HIEs around the country.

State and medical society officials say they are trying to take advantage of evolving technology that's making lower cost and better performing exchange offerings available. Launching an HIE no longer means starting from scratch because already built and tested systems are available for licensing.

The state's Health IT Officer Allan Hackney, formerly CIO for John Hancock Financial Services, said he and his advisory board are examining several potential options, including HIEs developed in Michigan and Maryland. He predicted the system might cost several million dollars to get up and running, to be paid for with federal funds granted to Connecticut's State Innovation Model program, as well as allocations in the state's capital budget.

Hackney said he recognizes that providers have already invested many millions into their own IT systems, and that the state must find ways to provide value in that landscape.

“What can I be doing that embraces those investments and accelerates the output and the outcomes?” he said.

Meanwhile, CSMS has already licensed an HIE system developed in Kansas.

Matthew Katz, the society's CEO, anticipates launch costs to total several hundred thousand dollars.

“It's a near turnkey solution,” Katz said. “We're talking millions of dollars, normally, to build these.”

Need still exists

Both the state and medical society hope providers will see enough value in their systems to pay fees.

The systems could help analyze health trends among certain patient populations on a deeper level — a key factor for accountable care organizations, where health outcomes are tied to financial incentives.

They could also help providers meet certain federal requirements related to immunization registries and a standard known as meaningful use of electronic health records.

Despite increasing consolidation in the healthcare sector, doctors and other providers remain as desperate as ever for an information technology solution, said Dr. Jeffrey Gordon, a Waterford hematologist-oncologist and president of CSMS' board of directors.

“One of the major hurdles I face is patients come to me and I have to spend a gigantic amount of time, usually after I see a patient in the office, trying to track down information about other care they've received,” Gordon said. “Sometimes that can take anywhere from hours to days to even weeks, and it massively disrupts real-time patient care.”

Gordon's perspective is informed through his experience working as part of an independent practice as well as in a larger health system. His Waterford practice was acquired by Hartford HealthCare (HHC) last year.

That's helped Gordon on the data sharing front, since he is now linked into HHC's internal electronic health record system, built by Epic. He also benefits from information-sharing arrangements that exist between HHC and some other providers.

But consolidation doesn't solve the whole problem, nor have systems offered by competing vendors like Epic, Allscripts, eClinicalWorks, Cerner and others.

“It hasn't actually reduced [the need] at all for the simple reason that people go to see different providers and most people don't stay within one hospital network,” Gordon said.

Replicating success

Connecticut isn't alone in its previous HIE missteps. Various other states have also failed in their attempts to launch sustainable data-sharing vehicles. One of several exceptions has been Kansas.

A collaboration between a medical liability insurer (Kansas Medical Mutual Insurance Co.), hospitals, doctors and state government resulted in the creation of the Kansas Health Information Network (KHIN), a nonprofit HIE that launched in 2012 and now counts virtually all of the state's 126 hospitals and three-quarters of its physician practices as paying customers.

Katz said that bodes well for CSMS.

“There's no 100 percent guarantee it's going to work here in Connecticut, but it's worked somewhere else, and we don't have to build it,” he said.

KHIN's success in enrolling providers has drawn attention from other states including Georgia and South Carolina, which have licensed the technology. CSMS is the latest customer. The success has come despite the existence of competing exchanges in Kansas, similar to what's unfolding in Connecticut.

Laura McCrary, KHIN's executive director, said governance is crucial to an HIE's long-term prospects. “An exchange needs the trust of the provider community,” she said, adding that some providers might not trust an exchange run by a private technology vendor, or by state government.

Hackney is betting that's not the case in Connecticut, at least not this time around.

He said he's spent the past several months soliciting input from providers and other stakeholders about how an HIE might create value for them.

His advisory council, which includes representatives of hospitals, doctors, insurers, state agencies and consumers, is expected to be the governing body for the state's HIE, but all the details aren't final yet.

“It would be housed in some kind of entity … a neutral, trusted third party,” Hackney said. “We have to figure out what that means in practical terms.”

Meanwhile, Katz says CSMS' information exchange intends to be a not-for-profit.

Officials from Connecticut hospitals — which would pay relatively large fees to access data — say they are watching the exchange developments closely.

“We fully support efforts to exchange information and we personally have exchanged with all 50 states and thousands of [emergency departments] and clinics,” said Lisa Stump, Yale New Haven Health's chief information officer.

Stump said Yale is awaiting final word on governance and patient consent standards.

The cost to participate “will need to be evaluated against any potential incremental benefit for our patients,” Stump added.

Jess Kupec, CEO of St. Francis Healthcare Partners, had a similar take. He also wants to see a statewide HIE, but is awaiting more information about exactly how it would be governed.