HIE Challenge: Breadth of subjects
As I mentioned in my initial report covering the MetroChicago HIE, some three-fourths of Chicago-area hospitals have signed on with one of the nation’s most ambitious data exchange projects. To learn more about what has propelled the HIE, I caught up recently with Terri Jacobsen, the project’s director. She’s part of the Metropolitan Chicago Healthcare Council, a long-standing Chicago-based membership organization that is spearheading the data exchange. Some 69 area hospitals have joined, signing letters of intent to participate as dues-paying members. Unlike some data exchanges, which had to build from scratch not-for-profit organizations and boards to operate, the council has enjoyed relationships with Chicago-area providers for years. “Our pre-existing relationships have helped facilitate the effort so far,” Jacobsen says. (click here for a video interview MCHC conducted with Terri).
Nonetheless, the council has taken a step-wise approach in launching the exchange. At each critical juncture, the council has reached out to its members to reaffirm consensus before moving ahead. And at each point, the members have said yes. Early on, the board of the council gave a vote of confidence to proceed with the concept. Then, after the group secured its initial grant money from the state to begin, members were polled on their support to continue with final planning, and later, to proceed with vendor selection. Most recently, members have been asked to make their financial commitments to participating.
The mere fact that the MetroChicago HIE is addressing financial longevity upfront distinguishes the effort. As my colleague Joe Goedert reported recently, less than 10 percent of data exchanges nationwide have a sustainable business model. That’s what you call a small fact with major implications. As important as data exchanges are, it’s difficult to imagine that financially strapped state and local governments will be able to fund them indefinitely. Clearly, MetroChicago HIE does not take its success for granted. “Our process of outreach has been continuous,” Jacobsen says. “Every time you go a step, you have to re-engage people.”
What’s changed as the effort progresses are the questions the members raise, Jacobsen explains, ticking off a list of common issues raised. How does the Chicago HIE fit with state plans? Will the HIE be ready in time for Stage Two Meaningful Use requirements? How will we handle patient consent? Will the payers participate? The toughest challenge, Jacobsen adds, is “the breadth of subjects and topics that have to be handled simultaneously.” There are business and financial plans, federal rules, state programs, and hiring staff. “The technology is not as daunting as the social capital, policy issues and financing that have to come together. HIE really takes a community. But we have had fabulous stakeholder engagement so far.”
The answers to many participant questions remain a bit of a moving target. For example, the HIE is still hammering out the details of its patient consent policy, and has to scrutinize applicable state laws carefully. The general approach, Jacobsen says, will be around “opt out,” meaning that patient information will be shared on the exchange unless a patient specifically requests otherwise. “But you have to inform the patient and have a provider relationship” to see any data, she adds. Likewise, for some sensitive data, such as mental health or STD data, the policy will likely be “opt-in,” meaning the information won’t be shared freely, unless the patient consents.
As the day-to-day manager of the exchange, Jacobsen wears multiple hats—and must speak to a wide breadth of subjects. “There are days your head spins,” she says. “Then you think, wow, what an opportunity. We know this will make a difference long-term.”
In future posts on this project, I will reach out to some of the participating hospitals to find out what a local data exchange means to them. If you have questions you’d like me to explore, please send them to firstname.lastname@example.org.