Seven regional health information exchanges in the upper Midwest are increasing the number of patient records they're sharing through a collaborative that spans five states.

Since last fall, the HIEs have been working to complete technical connections, as well as settling on appropriate legal agreements to permit data exchange, executives say.

In addition, the participating organizations are working to implement a virtual integrated record that would enable physicians outside of the five states covered by the HIEs to access patient records. The virtual access initiative offers a model that could be replicated by other HIEs to more widely share information that clinicians need in the course of treatment.

Participating HIEs include:

  • Indiana Health Information Exchange, Indianapolis.
  • HealthLINC, Bloomington, Ind.
  • Michiana Health Information Network, South Bend, Ind.
  • East Tennessee Health Information Exchange, Nashville.
  • The Health Collaborative, Cincinnati.
  • The Kentucky Health Information Exchange, Frankfort.
  • Great Lakes Health Connect, Grand Rapids, Mich.

Last October, the HIEs agreed to exchange patient data among themselves. The initiative, called the Heartland Project, received a $270,000 grant from the Department of Health and Human Services, with funds being shared among all seven entities; in addition, the money is helping to develop a governance structure for the Heartland Project.
This past fall, Great Lakes Health Connect, a health information exchange in the State of Michigan since 2010, was the last HIE to join the project. Since April, Great Lakes has received 10,057 admit/discharge/transfer messages and has sent 57,690 such messages to partnering HIEs.

“Heartland Project is seven HIEs working among ourselves with the goal of broadening beyond our regions when patients go outside these areas,” says Doug Dietzman, executive director at Great Lakes Health Connect.

Doug Dietzman

With the use of the virtual integrated patient record, if a Michigan resident receives care in another state, an admit/discharge/transfer message is transmitted to Great Lakes Health Connect, which then notifies the patient’s primary care physician. This enables better continuity of care and better communication among clinicians

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With all participating HIEs now live on the system, the exchanges now are developing a query process for Continuity of Care Documents, with hopes that CCDs can be exchanged by year-end.

The new seven-HIE data exchange service has been named the Patient-Centered Data Home, which will enable information to be forwarded to a physician to support a complete medical record, Dietzman says.

As technical work progressed in recent months to link the HIEs, so did work to develop policies and procedures governing the actual exchange of data across the region. It took three or four months of work to develop a trust framework for how information will be shared and how participants will handle the information once they have it, Dietzman says.

One big challenge was managing identities, which was handled by running admit/discharge/transfer messages through a master patient index (MPI), and each HIE has its own technology vendors, so they also have their own MPIs and a unique identifier for each patient.

The long-term intent of Heartland Project is to be a model for other HIE initiatives, Dietzman says, but how to do that isn’t yet clear, he acknowledges. But the ultimate goal is quite bigger—to tie all HIEs at some point across the nation.

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