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            Health Information Exchange (HIE) Sustainability:
            Lessons Learned by the Indiana Health Information Exchange

                                John P. Kansky, MSE, MBA
                          Vice President – Strategy and Planning
                          Indiana Health Information Exchange
8/22/2012                   Copyright ©2012 Indiana Health Information Exchange, Inc.   1
The Indiana Health Information Exchange

• Founded in February 2004
• Based on the technology,
  knowledge, and experience of the
  Regenstrief Institute
• 75 employees
• Non-grant revenue in excess of $5
  million annually
• Participation from 93 hospitals (30
  health systems), 19,000 clinicians,
  and 5 payors
• Serving an area with a population of
  approximately 4 million people


                                  Copyright © 2011 Indiana Health Information Exchange, Inc


                                                                                              www.ihie.org
The Soapbox and the Green Eyeshade

There are services that a health information exchange could theoretically provide
for which there is no apparent business model. There are also services that have
business models that are outside the mission of a typical HIE.

The                                                                                                The Green
Soapbox                                                                                            Eyeshade
                              Services on
          Stuff an HIE       which you can                               Stuff an HIE
          could do to            base a                                  could do that
          help “save the                                                 someone will
          healthcare          sustainable                                pay for
          system”                Health
                              Information
                               Exchange


                                       Copyright © 2011 Indiana Health Information Exchange, Inc


                                                                                                       www.ihie.org
HIE Sustainability – Basic Conceptual Principles


Based on the experience of 8 years of operation and an on-going history
of service development, launch, and support, IHIE bases its sustainability
plans seven basic principles. We believe these principles are key to
health information exchange being a self-sustaining endeavor.

•   Principle 1: HIE is a Business
•   Principle 2: The Leveraging of High-cost, High-value Assets
•   Principle 3: No Loss Leaders
•   Principle 4: Independent, Local Sustainability
•   Principle 5: Natural Monopoly
•   Principle 6: The Need for Scale
•   Principle 7: Avoidance of Grants for Operational Cost

                                     Copyright © 2011 Indiana Health Information Exchange, Inc


                                                                                                 www.ihie.org
Principle 1: HIE is a Business


HIE is a business and as with all
businesses, creating a sustainable HIE
requires:
  • offering services that the market wants…
  • at a price the market will bear…
  • doing so in such a way that revenue exceeds
    expenses.
  • services delivered by the HIE must be at a
    level that healthcare organizations have
    come to expect from their suppliers.

                              Copyright © 2011 Indiana Health Information Exchange, Inc


                                                                                          www.ihie.org
Health Data Sources                                                                   Value-Added Services
                                                                                                                    • Results Delivery
                                                                                                                    • MU Support
                                                                                                                    • Public Health Integration

                            Hospital                                                                  Hospital
                               s                                                                         s
                                                                                                                    •   Results Delivery
              Physician                                                                                             •   MU Support
                                                                                                                    •   Clinical Quality Services
                                                                                                                    •   Community Health
                                                                                                                        Record Access
                            Physician                                                                 Physician
                             Offices                                                                   Offices

                                                                                                                    • Results Delivery
                                                                                                                    • Community Health
                                           Health Information Exchange                                                Record System


                          Labs / Imaging                                                           Labs / Imaging
                             Centers                                                                  Centers
Patient       Physician
                                                                                                                    • Biosurveillance
                                                                                                                    • Reportable Conditions
                                              Data                Network                                           • Results Delivery
                          Public Health     Repository           Application                        Public Health
                                                                      s

                                                                                                                        • Quality Reporting
                                                                                                                        • Physician Bonus
                                                                                                                          Administration
                                                                                                        Payors
                            Payors
              Physician                                 Data
                                                     Stewardship                                                        • De-identified,
                                                                                                                          longitudinal clinical
                                                                                                                          data

                           Outpatient                                                               Researchers
                              Rx
                                                Copyright © 2012 Indiana Health Information Exchange, Inc


                                                                                                                          www.ihie.org
Health Data Sources                                                                 Value-Added Services
                                                                                                                • Results Delivery
                                                                                                                • MU Support
                                                                                                                • Public Health
                                                                                                                  Integration
                             Hospitals                                                            Hospital
                                                                                                     s
                                                                                                                • Results Delivery
              Physician                                                                                         • MU Support
                                                                                                                • Clinical Quality
                                                                                                                       ™
                                                                                                                Services
                            Physician                                                             Physician     • Community Health
                             Offices                                                               Offices        Record Access

                                                                                                                • Results Delivery
                                                                                                                • Community
                                                      Health Information Exchange                               Health
                                                                                                                  Record System
                          Labs / Imaging                                                            Labs /
                             Centers                                                               Imaging
Patient       Physician                                                                            Centers
                                                                                                                • Biosurveillance
                                                                                                                • Reportable
                                                          Data                Network
                           Public Health                                                                        Conditions
                                                        Repository           Application              Public
                                                                                                                • Results Delivery
                                                                                  s                   Health


                                                                                                                 • Quality Reporting
                                                                                                                 • Physician Bonus
                                                                                                                   Administration
                             Payors
              Physician                                              Data
                                                                  Stewardship                    Public Health
                                                                                                         • De-identified,
                                                                                             Emergency Surveillance
                                                                                                           longitudinal clinical
                                                                                                           data
                                                                                               System (PHESS)
                           Outpatient Rx                                                          Researchers

                                 Copyright © 2012 Indiana Health Information Exchange, Inc

                                                                                                                   www.ihie.org
The Leveraging of High-cost, High-value Assets

      HIE assets are interdependent and, once created, can be leveraged to
      deliver additional services.

                                                                                                                                       New
                                                               ED Abstract           Inpatient          Ambulatory         Clinical
                                                                                                                                      Value-
                                                               and Results            Results            Results           Quality
                                                      New                                                                             added
                                                                 Review               Review             Review            Services
                                       Medication    Value-                                                                           Service

                              New       Profile      added
Public Health    Clinical    Value-                  Service
Surveillance    Messaging    added                                    Layer III: Including Repository Services…
                             Service
                                                    Layer II: Including Mapped/Normalized Data…
                            Layer I: Including Interface Engine, Community Trust, …


                       A layer of necessary investment

      Value-added services that can be built upon the HIE investment

                                                               Copyright © 2011 Indiana Health Information Exchange, Inc


                                                                                                                                  www.ihie.org
The Peanut Butter Principle
                 Problem to          Solution         Byproduct                     Secondary                        Outcome
                    Solve                               Issue                        Solution
George           Soil depleted      Plant Peanuts    What to do with            Make and sell                      Sustain the
Washington       by Cotton          to replenish     all the peanuts?           products that use                  southern
Carver                              lost nutrients                              peanuts, e.g.:                     economy
                                    in the soil                                 • Peanut butter                    (Keep growing
(early 1900’s)                                                                                                     cotton)
                                                                                • Peanut oil


Health           • Rising cost of   Build HIE        How does                   Offer/sell services                Make positive
                 healthcare         infrastructure   society (or a              that use (and                      contributions to
Information
                 • Need to          (and use it to   given                      reuse) the HIE                     health and
Exchange                                             community) pay             infrastructure, e.g.:              healthcare
                 improve            address the
(2012)           healthcare         problems)        for HIE?                   • Electronic Results
                 quality and                         i.e. financially           delivery
                 safety                              sustain it                 • Clinical Quality
                                                                                Services
                                                                                • Medication profile




                                                       Copyright © 2011 Indiana Health Information Exchange, Inc


                                                                                                                         www.ihie.org
Questions?


For Further Information, Please Contact:

             John P. Kansky
Vice President – Strategy and Planning
Indiana Health Information Exchange
           Jkansky@ihie.org




                   Copyright © 2011 Indiana Health Information Exchange, Inc


                                                                               www.ihie.org

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Sustainability of HIE - A How To Guide

  • 1. Better Outcomes. Delivered. Health Information Exchange (HIE) Sustainability: Lessons Learned by the Indiana Health Information Exchange John P. Kansky, MSE, MBA Vice President – Strategy and Planning Indiana Health Information Exchange 8/22/2012 Copyright ©2012 Indiana Health Information Exchange, Inc. 1
  • 2. The Indiana Health Information Exchange • Founded in February 2004 • Based on the technology, knowledge, and experience of the Regenstrief Institute • 75 employees • Non-grant revenue in excess of $5 million annually • Participation from 93 hospitals (30 health systems), 19,000 clinicians, and 5 payors • Serving an area with a population of approximately 4 million people Copyright © 2011 Indiana Health Information Exchange, Inc www.ihie.org
  • 3. The Soapbox and the Green Eyeshade There are services that a health information exchange could theoretically provide for which there is no apparent business model. There are also services that have business models that are outside the mission of a typical HIE. The The Green Soapbox Eyeshade Services on Stuff an HIE which you can Stuff an HIE could do to base a could do that help “save the someone will healthcare sustainable pay for system” Health Information Exchange Copyright © 2011 Indiana Health Information Exchange, Inc www.ihie.org
  • 4. HIE Sustainability – Basic Conceptual Principles Based on the experience of 8 years of operation and an on-going history of service development, launch, and support, IHIE bases its sustainability plans seven basic principles. We believe these principles are key to health information exchange being a self-sustaining endeavor. • Principle 1: HIE is a Business • Principle 2: The Leveraging of High-cost, High-value Assets • Principle 3: No Loss Leaders • Principle 4: Independent, Local Sustainability • Principle 5: Natural Monopoly • Principle 6: The Need for Scale • Principle 7: Avoidance of Grants for Operational Cost Copyright © 2011 Indiana Health Information Exchange, Inc www.ihie.org
  • 5. Principle 1: HIE is a Business HIE is a business and as with all businesses, creating a sustainable HIE requires: • offering services that the market wants… • at a price the market will bear… • doing so in such a way that revenue exceeds expenses. • services delivered by the HIE must be at a level that healthcare organizations have come to expect from their suppliers. Copyright © 2011 Indiana Health Information Exchange, Inc www.ihie.org
  • 6. Health Data Sources Value-Added Services • Results Delivery • MU Support • Public Health Integration Hospital Hospital s s • Results Delivery Physician • MU Support • Clinical Quality Services • Community Health Record Access Physician Physician Offices Offices • Results Delivery • Community Health Health Information Exchange Record System Labs / Imaging Labs / Imaging Centers Centers Patient Physician • Biosurveillance • Reportable Conditions Data Network • Results Delivery Public Health Repository Application Public Health s • Quality Reporting • Physician Bonus Administration Payors Payors Physician Data Stewardship • De-identified, longitudinal clinical data Outpatient Researchers Rx Copyright © 2012 Indiana Health Information Exchange, Inc www.ihie.org
  • 7. Health Data Sources Value-Added Services • Results Delivery • MU Support • Public Health Integration Hospitals Hospital s • Results Delivery Physician • MU Support • Clinical Quality ™ Services Physician Physician • Community Health Offices Offices Record Access • Results Delivery • Community Health Information Exchange Health Record System Labs / Imaging Labs / Centers Imaging Patient Physician Centers • Biosurveillance • Reportable Data Network Public Health Conditions Repository Application Public • Results Delivery s Health • Quality Reporting • Physician Bonus Administration Payors Physician Data Stewardship Public Health • De-identified, Emergency Surveillance longitudinal clinical data System (PHESS) Outpatient Rx Researchers Copyright © 2012 Indiana Health Information Exchange, Inc www.ihie.org
  • 8. The Leveraging of High-cost, High-value Assets HIE assets are interdependent and, once created, can be leveraged to deliver additional services. New ED Abstract Inpatient Ambulatory Clinical Value- and Results Results Results Quality New added Review Review Review Services Medication Value- Service New Profile added Public Health Clinical Value- Service Surveillance Messaging added Layer III: Including Repository Services… Service Layer II: Including Mapped/Normalized Data… Layer I: Including Interface Engine, Community Trust, … A layer of necessary investment Value-added services that can be built upon the HIE investment Copyright © 2011 Indiana Health Information Exchange, Inc www.ihie.org
  • 9. The Peanut Butter Principle Problem to Solution Byproduct Secondary Outcome Solve Issue Solution George Soil depleted Plant Peanuts What to do with Make and sell Sustain the Washington by Cotton to replenish all the peanuts? products that use southern Carver lost nutrients peanuts, e.g.: economy in the soil • Peanut butter (Keep growing (early 1900’s) cotton) • Peanut oil Health • Rising cost of Build HIE How does Offer/sell services Make positive healthcare infrastructure society (or a that use (and contributions to Information • Need to (and use it to given reuse) the HIE health and Exchange community) pay infrastructure, e.g.: healthcare improve address the (2012) healthcare problems) for HIE? • Electronic Results quality and i.e. financially delivery safety sustain it • Clinical Quality Services • Medication profile Copyright © 2011 Indiana Health Information Exchange, Inc www.ihie.org
  • 10. Questions? For Further Information, Please Contact: John P. Kansky Vice President – Strategy and Planning Indiana Health Information Exchange Jkansky@ihie.org Copyright © 2011 Indiana Health Information Exchange, Inc www.ihie.org