By many measures, the Keystone HIE has made steady progress toward the goal of widespread community health data exchange. Formed in 2005, the HIE, which serves 14 hospitals in Pennsylvania, has a database of 2.9 million records with seven hospitals and five emergency departments publishing to it. A number of labs and clinics are also members.

About 450,000 patients have given consent to have their information available via the exchange, but more are needed, said James Younkin, director of the HIE, during a HIMSS11 presentation. Younkin, who also serves as I.T. director for Geisinger Health System, a Danville-based provider organization participating in the exchange, noted that only a small minority actually decline to participate in the effort. “Our decline rate is about 5 percent,” he said. “Our ‘not asked’ rate is much higher.”

Currently patients must enroll in the exchange via their local care provider, Younkin explained. And many of them have not built the enrollment request into their workflows as yet. “Most consumers don’t have a clue what HIE means,” he said. “We need to clarify what we are doing to assure their privacy.”

The HIE will serve as the backbone for a grant-funded demonstration project of the medical home model, he said. Called the “Beacon Community,” the medical home project will facilitate the sharing of basic clinical documentation via the HIE, Younkin said. Through the HIE, organizations can publish clinical summaries in a format known as a CCD, which includes such information as problems, medications and allergies. Patients and providers can also communicate via secure messaging.

The HIE attests to the viability of interoperability, Younkin said. The HIE can send lab results directly to a physician EHR, as well as notifications of patient admissions and discharges, he said.  Although the project is in its early stages, primary care practices at Geisinger participating in the medical home effort have seen a one-third reduction in hospital readmissions in the target population of CHF, COPD and post-surgical patients.

The HIE has no payer members, Younkin noted. “To date, we only exchange data needed for patient treatment. We have painted a box around ourselves. We need to think more broadly and consider the utility of the HIE.” In the future, the HIE may approach payers with the idea of delivering quality results and measures to them. “They can be part of the stakeholder group and help support us.”

--Gary Baldwin


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