The HealthShare Exchange of Southeastern Pennsylvania (HSXSEPA), the health information exchange for the five-county area surrounding Philadelphia, wasn't one of the first HIEs out of the blocks, but Executive Director Martin Lupinetti believes the organization, which tested its first live exchange of a CCD document in December 2013, is on solid ground.

Lupinetti says the exchange is aiming for a third quarter 2014 production launch.

The key players in the Philadelphia market, he says, recognized the need for some sort of efficient information exchange for a long time and began concerted efforts to create a framework for it five years ago.

Perhaps the element most responsible for bringing everybody to the table was also the element most responsible for creating a lot of i's to dot and t's to cross – the market is extraordinarily fragmented. Twenty hospital systems deliver care to the residents of the region, with no hospital system holding more than 12 percent market share.

"All the health systems and plans came together, on their own," Lupinetti says. "This goes back almost to 2009. Even prior to that, there was some talk around trying to figure out how to do things better. They recognized they're all competing, they recognize there's no dominant system. We also see a lot of patient flow from New Jersey and Delaware, given our location."

As a result, Lupinetti says, the 34 hospitals and three health plans that make up the HSXSEPA membership have committed combined operating revenue of about $1.3 million annually ($500,000 total from the hospitals and $800,000 from the health plans), with an initial commitment of four years.

"It's not a significant amount per hospital, but it adds up when you take into consideration how many members we have," Lupinetti says.

The exchange also leveraged a $1.5 million grant from the state to begin operations (Lupinetti says that required reimbursement of 75 percent of the grant and was mainly used to ensure cash flow). And, upon the suggestion of the state's former HIT coordinator Robert Torres – who pointed out the Centers for Medicare and Medicaid Services had a vested interest in seeing an exchange succeed in a market that counted almost a third of the state's Medicaid population – HSXSEPA also secured $1.3 million from CMS.

"What was interesting about that was the state asked CMS for a regional grant request," Lupinetti says. "Most the time a request like this is a statewide request. We offered just the SEPA request and they agreed to it."

The exchange's near-term operating plans call for rolling out automatic discharge notifications in the third quarter of this year via the Direct messaging protocol, expanding out to exchange of medication and claims histories late this year or early 2015. Lupinetti emphasizes that the member plans will be an inherent part of the data loop throughout the process, which exchange executives are calling "enhanced Direct."

"At the time a patient is discharged from an emergency situation from a member hospital, we will go to the patient's plan and say 'Who's that patient's primary care physician? What specialists have they seen recently? Who's the care manager who needs this information?' And we are going to automate sending that to that downstream care team. That will happen pretty close to the timing of when they actually exit the hospital."

Lupinetti also says he expects the exchange members and staff will have some opportunities to dig deeply into the intricacies of HIE-to-HIE communications, given that many patients who live in the city's suburbs and exurbs of southern New Jersey and northern Delaware are expected to travel to HSXSEPA member facilities for treatment. Lupinetti, who worked as a consultant with New Jersey public sector officials prior to joining the exchange, says the overall HIE effort in southern New Jersey has faced some challenges, but that HSXSEPA staff is looking at how they might scale existing provider-to-provider communication between the New Jersey-based Virtua health system and the Children's Hospital of Philadelphia, an exchange member.

"Delaware's a bit different, it's a smaller state with eight hospitals and a single HIE," Lupinetti says. "Mark Jacobs, the CIO, and I talk about how we begin some sort of multi-state exchange. So I think that's coming quickly."

Looking northward, to Pennsylvania's pioneering Keystone HIE (KeyHIE), Lupinetti says he and KeyHIE director Jim Younkin recognize there may be some overlap on the fringes of each HIE's service areas. However, Lupinetti does not foresee a competitive situation between the two eastern Pennsylvania exchanges brewing.

"We've always said this is a five-county, Philadelphia region HIE," he says, adding that one can almost discern the county boundaries by looking at the membership of the exchange’s three insurers.

"Our mission right now is to get our current membership exchanging information, getting some of these use cases deployed, and folks seeing some value," he adds.

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