Six years ago, I interviewed Robert Steffel, the CEO of HealthBridge, an early--and then-rare—example of a health information exchange that actually worked. Back then they were called “RHIOs,” or regional health information organizations. I asked Bob what were the key factors in making the project work and he said it was primarily the spirit of cooperation, but also that the exchange partners were limited in number--their service territories did not highly overlap. Making a data exchange work in a highly competitive, and complicated urban marketplace, such as we have here in Chicago, would be very difficult.

Well, we’re about to see a test case of this notion right here in my home base, the Windy City. As Joe Goedert reported a few weeks back, the Metropolitan Chicago Healthcare Council is spearheading an HIE, one it expects to be “the largest unified metropolitan HIE in the nation, serving more than 9.4 million people.” No doubt, this is an ambitious effort, one that will deserve ongoing attention and coverage. And I plan to do just that—offer regular updates on the exchange, its accomplishments and challenges alike. The story will be a moving target.

“The biggest hurdle is time,” says Mary Anne Kelly, vice president of the MCHC, who spoke with me recently about the effort. “We’re under the gun to get it moving quickly.” According to Kelly, the exchange (whose official name is the MetroChicago Health Information Exchange) hopes to be operational by next January with a group of early adopters--a core group whose existing I.T. enables them to jump in first. The first efforts will revolve around connecting emergency departments and offering public health surveillance. “Our top priority is working with early adopters to offer core services,” she explained.

The Council’s membership is largely hospital-based, and Kelly hopes to engage physician group practices via the hospitals. One group practice, the DuPage Medical Group, has signed on as a founding member and will be an early adopter. And Kelly would like to see payers involved in the exchange down the line.

In a little over two years, the MetroChicago HIE has made strong headway. Sparked by some $900,000 in state money, the HIE has recruited nearly 75 percent of the parent organization’s member hospitals, with 68 hospitals and outpatient organizations signed up. These include both the well-known (Advocate Health Care, a large multi-hospital system) and the obscure (Norwegian Community Hospital, a tiny, neighborhood facility on the West side). Two of Chicago’s more prominent hospitals are noticeable by their absence—Northwestern Memorial Hospital and the University of Chicago Medical Center. Right now the academic medical centers are building their own information systems and unable to commit, Kelly says, although she says it is a question of “when, not if.”  “Our goal is 100 percent participation,” Kelly adds. “And our goal from the beginning was to make it sustainable.”

By that she means not dependent on grant money to maintain operations. That’s the approach HealthBridge has taken over the years, and it goes a long way toward building buy-in. Thus far, the members of the MetroChicago HIE have put their money on the table. The founding members added about $1 million to the project to keep it going after the initial grant period ended. So the HIE has enough to keep going until it begins charging subscription fees. “The HIE is about patients,” Kelly says. “The technology is the secondary piece. The real effort is building the consensus.”

If you have questions about the exchange you’d like answered in future posts, please send them to me at

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