Uncovering The True Value Of HIE

By Ken Congdon, editor in chief, Health IT Outcomes
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A new study by Vanderbilt University reveals that access to HIE (health information exchange) data resulted in significant cost savings. What should the healthcare industry take away from this study?

I recently had the opportunity to read a 2011 study by representatives of Vanderbilt University that assessed the financial impact of HIE (health information exchange) in emergency departments (EDs) throughout Memphis, Tennessee. This study examined ED encounters in which HIE was used to support the visit, and measured these outcomes against ED encounters not supported by HIE access. Outcomes studied included ED-originated hospital admissions, admissions for observation, laboratory testing, head CT, body CT, ankle radiographs, chest radiographs, and echocardiograms.

The study showed that HIE data was only accessed in 6.8% of visits across the 12 EDs involved in the study. However, the financial impact of HIE access, even when used so sparingly, was noteworthy. The research indicated that HIE resulted in an annual cost savings of $1.9 million in this sample population, with 97.6% of these cost reductions coming as a result of reduced hospital admissions. In other words, HIE helped to significantly reduce the frequency of hospital admissions, eliminating the hospital-related expenses patients and health insurers had to incur.

The industry has always touted the potential of HIE to reduce medical errors, improve quality of care, and lower medical costs. I have also personally written case studies that provide real-world examples of how HIE is helping healthcare facilities improve data accuracy, timeliness of information, and HIPAA compliance (e.g. BayCare’s HIE Blueprint). However, this was the first published work I have seen that actually ties a hard dollar savings to HIE use. Surely this Vanderbilt study is just what the industry needs to propel HIE initiatives forward. Well, according to some HIE leaders, it’s just not that simple.

The Public Vs. Enterprise HIE Debate

“The Vanderbilt study clearly shows the financial benefits that HIE can provide a healthcare facility, but the Memphis sample was kind of like Disneyland in the fact that all providers in the study were willing to share their health data with one another,” says David Caldwell, executive VP of Certify Data Systems. “In the historically competitive healthcare landscape, provider agreeability to this type of information sharing is uncommon.”

Caldwell goes on to argue that this lack of cooperation is but one of the inherent weaknesses in a public (or centralized) approach to HIE — the approach that has been the focus of most HIE efforts to date. “Until recently, the healthcare industry has focused on just the HI (health information) part of HIE,” says Caldwell. “It has focused on making health data available in public HIEs, but these networks aren’t true exchanges. They allow participating physicians to view provided information on a separate portal, but they don’t upload health data from a variety of different care points into a physician’s native EHR system. This is where we need to get to as an industry. This is when the true value of HIE will be realized.”

It’s not surprising that Caldwell feels this way given that his employer, Certify Data Systems, specializes in delivering enterprise HIE solutions to healthcare facilities. Enterprise HIEs are typically investments made by individual hospitals and IDNs, and focus on providing native interoperability between disparate clinical systems within the enterprise.

According to recent research, the enterprise HIE market is on the rise. For example, a 2012 study by Chilmark Research showed that the HIE market grew 40% last year, and most of this growth was propelled by enterprise HIE investments. However, for all the strides enterprise HIEs have made in the market, Caldwell believes the focus of government EHR incentives could also be serving to impede true HIE.

“Government incentives have forced EHR software vendors to focus on ensuring their products are certified for Meaningful Use,” says Caldwell. “To date, these certification efforts have not placed a high priority on interoperability between systems. As a result, many software vendors have placed this initiative on the backburner. EHR vendors have yet to receive the proper incentives to accelerate the capabilities of their products to easily exchange clinical information with other disparate systems. Redirecting incentives towards this goal could make a significant impact.”

HIE Drives Operational Improvements, But What About Patient Care?

While Caldwell applauds the Vanderbilt University HIE study, he also recognizes the need for more palpable data on the financial, operational, and societal value of HIE. In fact, Certify Data Systems has made an effort to track and document these measurable results from a number of their clients. To date, most of this data focuses on the benefit of moving from a paper-based exchange of health information to an automated electronic exchange.

For example, Certify client Alpine Family Practice was able to eliminate 3 full-time positions dedicated to scanning paper results into their EMR by leveraging an enterprise HIE. These employees were reassigned to other service-oriented and revenue-generating jobs within the practice. Likewise, one of Certify’s cardiology clients previously had nurses rekey lab results into the EMR system. The move to an enterprise HIE removed this data entry burden from nurses and allowed them to refocus 20 hours per week on patient care.

“We as an industry need to get better at measuring the value of HIE,” says Caldwell. “We’re starting to see research emerge that chronicles the financial and operational benefits of HIE, but more needs to be done. In particular, we need to do a better job on measuring how HIE impacts patient care. For example, does HIE result in better outcomes for patients with chronic diseases (e.g. better foot care, improved control of hemoglobin H1C, etc.)? This will be the true test of the technology.”