Easy HIT Keeps Jersey HIE In Business

By Health IT Outcomes staff

How a SaaS secure messaging solution became the underlying technology infrastructure for one of the most successful HIEs in the U.S.

Health information exchanges (HIEs) have spent a significant amount of time in the industry spotlight in recent years. What was first a high-level concept born out of the HITECH Act has evolved into a concrete initiative currently taken on by approximately 222 HIEs across the country, according to the eHealth Initiative 2012 Report on Health Information Exchange. Initially, many providers and government regulators saw the exchange of patient data via HIE as a natural and very necessary stepping stone between the initial adoption of EMRs and achieving truly accountable care. But, as with any concept that involves different personalities and workplace cultures, technology, regulatory oversight, and finite budgets, what seemed like a simple stepping stone has quickly turned into a mountain some states have had trouble scaling in a timely and cost-effective way. The state of New Jersey, however, seems to have reached the summit of the HIE mountain, in large part due to the technology behind it.

HIE Technology Is The Easy Part
Jersey Health Connect (JHC) is perhaps the most well known of the state’s four HIEs. It is the fourth largest in the country in terms of physician participants, and one of the oldest. Though technically formed in 2010, the idea for JHC was born several years earlier out of regular discussions among four New Jersey hospital CIOs, all members of the New Jersey Hospital Association. They put competitive natures aside in the interest of patient care, and realized that sharing data among their facilities needed to be done sooner rather than later. Their decision to formalize their HIE was made easier because their facilities were already using secure messaging, results delivery, and e-prescribing technologies from RelayHealth.

“We had a number of meetings to discuss what would be the best model to form an HIE, and then the ONC grants became a reality,” explains Lou Hermans, a founding JHC board member, and VP and CIO of JFK Health System. “After speaking with a number of other area hospitals interested in joining the HIE, and realizing we could possibly obtain funding through grants earmarked for state HIE development, we decided to formally apply for a grant to create JHC.”

Settling on a technology vendor was perhaps the easiest part of the application process. “We were required to include a technology solution in the proposal that would be used to support HIE,” explains Hermans. “Since many of us were already familiar with the secure messaging and results-delivery technologies from RelayHealth we were already using, we designated that system in our proposal.

“Furthermore, the fact that the RelayHealth solution is a SaaS (Software as a Service) model made it easier to deploy,” he adds. “Everyone appreciated that we wouldn’t have to invest in a huge infrastructure.”

The state of New Jersey ultimately received $11.4 million dollars in HIE grants, enabling the formation of JHC along with three other exchanges. Nearly four years later, JHC has grown to include more than 1,300 physicians and 27 facilities, which include hospitals, physician groups, and a long-term care facility. More than 65,000 patients are served through the HIE’s ability to share data from 1.3 million patient records. More than 3,000 secure electronic messages have been sent by patients through participating physicians’ patient portals, and more than 9,500 by physicians themselves. Just over 30,000 prescriptions have been electronically sent to connected pharmacies.

These numbers give some indication of the size and scope of JHC, but they belie the ease with which its participating facilities share data. “You don’t have to have a huge infrastructure or some complicated system to achieve what we’ve achieved thus far,” says Hermans. “Technology is the easy part of putting an HIE together. It’s the issues of organization, governance, and financial sustainability that become very time-consuming.”

EMR Usability Facilitates Exchange
Since JHC was formed, it has brought on three to four hospitals a quarter. “As we bring new facilities on board, our first priority is to get them onto the RelayHealth platform and sharing data. Sixty-six percent of our hospitals currently do so, and our main goal this year is to get physician offices on board and everyone’s EMRs connected.”

To connect EMRs, however, they must be installed, and Hermans relates that only 40 percent of JHC participants have done so. State organizations such as the NJ-HITECH regional extension center have helped spur EMR adoption, but there is more convincing that needs to be done, especially among the one-, two-, and three-physician offices so popular in the state.

Though an EMR isn’t required to participate in JHC, it certainly facilitates data exchange in a more accessible and secure manner. Hermans and his JHC colleagues are working to increase EMR adoption to 85 percent during the next three to four years. “Many of these providers are also busy trying to move through Meaningful Use. Those objectives have certainly become a part of our marketing to those that still haven’t implemented an EMR and to those that are looking at Stage 2.

“It’s a big challenge because there are so many different vendors of EMRs out there, and everyone needs a standard way of connecting to the HIE. We’re going after the top 10 EMR vendors and coming up with a strategy for each of them so that we can have a predictable way of getting their solutions installed, connected to the JHC network, and then utilized by staff.”

Hermans reiterates that technology is not the hardest part of forming an HIE, but adds a caveat around usability. “Making technology usable for the clinician that has to deal with this data sharing on a regular basis is important to us, so we’re really honing in on workflow and usability issues when we sit down with those top EMR vendors. We want to make sure they understand what interfaces our participants need to be successful participants.”

Benefits Begin To Take Shape
When Hermans and his New Jersey colleagues started this journey, they knew the ability to share patient data in real time between facilities in different parts of the state would offer significant benefits to patient care. “The ability of a physician in one county to access patient data culled from a hospital or physician’s office in another county in an easily accessible manner will do wonders for reducing duplicate tests and lab work,” Hermans says. Though solid statistics around the HIE’s benefits to patient care won’t be available until early 2014, Hermans is already starting to see anecdotal positive clinical outcomes data as a result of JHC utilization.

“Through JHC, one of our emergency department physicians determined that a patient in his care had received four CAT scans and four metabolic panels in a four-month time frame,” he explains. “That’s information he may not have had access to otherwise, and it definitely influenced the care regimen he developed for that patient.

“Many of our physicians also benefited from JHC during Hurricane Sandy in late 2012. There were quite a few physician offices that lost everything, and because we had data on their patients from JHC hospitals, they were able to gather some of that and get back on their feet. They weren’t able to gather all of their patient information, unfortunately, because some of the facilities weren’t yet contributing to the network.”

HIE Progress Assumes Sustainability
Networks big or small require financing, and JHC is taking a hard look at the next 5 to 10 years in an effort to avoid the fate of several shuttered HIEs. “We’ve contracted with RelayHealth for the next four to five years,” Hermans explains. “To do this, we’ve set up a contribution model where our hospitals have committed to invest in JHC after our grant funds dry up. They realize they are receiving economies of scale, and so that model is working very well.”

From a higher-level perspective, JHC is working to address how it can help ACOs (accountable care organizations) in the area, specifically in the area of claims. “There’s a big benefit to the payers in terms of what we’re doing,” Hermans says, especially when you look at the potential for reduction in unnecessary, repeat testing.

“Obviously, we want to build and grow the network,” he says, adding that he’d like to see JHC work with Medicaid and its drug formulary, and integrated with CVS for immunization data. “We want to expand our footprint and get into other care settings like long-term care and federally qualified health centers. We also want to connect to other HIEs in New Jersey. There’s a grant proposal out right now to start what’s called the New Jersey Health Information Network, and JHC is one of the networks bidding to get that done. We also plan to focus on marketing the benefits of HIE to patients over the next year and a half. We need to make sure New Jersey residents know we have information available they can use to better manage their care.”