Overcoming Barriers to Expanding HIE (Text Version)

Slide Presentation from the AHRQ 2008 Annual Conference

On September 9, 2008, Marc Overhage gave this presentation at the 2008 Annual Conference. Select to access the PowerPoint® presentation (2.6 MB; Plugin Software Help).

Slide 1

Blank Slide

Slide 2

Overcoming Barriers to Expanding Health Information Exchange (HIE)

Notes:

• The goal is to identify the gaps in understanding, barriers and disconnects that may exist with providers' adoption of, and membership in, the Indiana Network for Patient Care.

Slide 3

Health Information Exchange (HIE)

• Current system fragments patient information and creates redundant, inefficient efforts:
  • Public health
  • Primary care physician
  • Specialty physician
  • Ambulatory center (e.g. imaging centers)
  • Payors
  • Pharmacy
  • Laboratory
  • Hospitals

• Note: Icons for each of the above are placed around a circle composed of arrows pointing in every direction.

• Future system will consolidate information and provide a foundation for unifying efforts:
  • Payers
  • Public health
  • Ambulatory centers
  • Physician office
  • Outpatient RX
  • Labs
  • Hospital

• Note: Icons for each of the above are placed around a circle which contains two images representing Data Repository and Network Applications. Arrows point from the icons to the circle which represents the Health Information Exchange.

Slide 4

Most Difficult Challenges for 42 Operational HIEs

The table shows:

• Developing a sustainable business model:
  • Very Difficult Challenge: 15
  • Moderately Difficult Challenge:15
  • Total: 30
• Addressing technical aspects including architecture, applications and connectivity:
  • Very Difficult Challenge: 4
  • Moderately Difficult Challenge: 25
  • Total: 29
• Defining the value that accrues to users:
  • Very Difficult Challenge:14
  • Moderately Difficult Challenge:15
  • Total: 29
• Engaging practicing clinicians in your coverage area:
  • Very Difficult Challenge: 0
  • Moderately Difficult Challenge: 29
  • Total: 29
• Addressing privacy and confidentiality issues—HIPAA and other:
  • Very Difficult Challenge: 3
  • Moderately Difficult Challenge: 24
  • Total: 27
• Securing upfront funding:
  • Very Difficult Challenge: 10
  • Moderately Difficult Challenge: 16
  • Total:26

• Note: eHealth Initiative: 2008 Survey on Health Information Exchange

Slide 5

The document image from "Research Brief: Findings from HSC and NIHCM Foundation," No. 2, February 2008, shows an article entitled "Creating Sustainable Local Health Information Exchanges: Can Barriers to Stakeholder Participation be Overcome?"

Notes:

• Four exchanges (IHIE, HB, CareSpark, Tampa Bay Regional Health Information Organizations [RHIO])

Slide 6

HIE Barriers

• Weigh benefits, upfront and ongoing costs of the business, legal and technical issues
• Concerns:
  • Data will be used for marketing purposes
  • Patients will be redirected to other providers
  • Use of data for hospital performance measurement
  • HIE data policies would make them non-compliant with federal patient privacy requirements
• Balance competitive strategies with playing good corporate citizen role

Slide 7

The map shows the State of Indiana with hospitals marked and the area around Indianapolis highlighted.

Slide 8

Block Randomized Sampling

The table shows:

• Small Hospitals:
  • Initial Sample: 43
  • Total INPC participant: 5
  • Total previously contacted:16
  • Total not previously contacted: 27
• Small Physician Groups:
  • Initial Sample: 39
  • Total INPC participant: 0
  • Total previously contacted:0
  • Total not previously contacted: 39
• Large Physician Groups:
  • Initial Sample: 40
  • Total INPC participant: 6
  • Total previously contacted: 11
  • Total not previously contacted: 29

Slide 9

Survey and Interview Guide Development

• Literature review and brainstorming to identify potential barriers
• Expert review and feedback
• Pilot with nine organizations
• Revised survey
• Office of Management and Budget (OMB) review
• Final survey

Slide 10

Data Collection

• Telephone Contact
• E-mail Packet
  
  1. HIE description and definition.
  2. Description of the INPC.
  3. Survey information:
     • Web Survey
     • Telephone Interview

Slide 11

The slide shows a pile of "HIE Non-Participants" surveys with notes made in the margins.

Slide 12

Analytical Methods

• A grounded theory approach will be used to identify emergent themes
• Grounded means "based on and connected to the context-dependent observations and perceptions of the social scene;" so the informants' own words will guide development of codes*
• Two individuals will independently review the field notes, annotating important themes in the margins
• Two other researchers will carefully review the documentation and note major themes
• The team will meet up to four times to reach consensus on identifying and naming the patterns and themes

• Note: *Crabtree BF, Miller WL. Doing Qualitative Research.
  Newbury Park, CA, Sage, 1992.

Slide 13

Rural Hospital Informant's Words

• Rural hospital in Lawrence Co near Bloomington:
  • Already have an interface from hospital system to their employed physicians' Electronic Medical Record (EMR) which provides most of the benefit to be received from an HIE.
  • Costs
  • Physicians not thrilled with change
• Rural hospital in Gibson Co in southwest IN:
  • Not sure they understand the difference between and EMR and HIE?
  • Need to upgrade bandwidth for communication
  • Need help financially (grants)
  • Need available IT staff
  • Older MDs want paper—need to be sold

Slide 14

Rural Hospital Informant's Words

• Rural hospital between Ft Wayne and Muncie in Northwest IN:
  • Not sure they understand difference between EMR and HIE
  • Bandwidth is the largest issue

Slide 15

Physician Informant's Words

• Large specialty urban physician group in central IN:
  • Physicians must see the benefit to THEM
  • MDs "hold data close"
  • Strategic IT projects are being addressed
• Large specialty urban physician group in central IN:
  • No buy-in from the MDs
• Small specialty physician practice in southeastern IN:
  • No buy-in from the MDs

Slide 16

Non-barriers

• Concerns about how their data will be used among hospitals:
  • Competitive positioning
  • For quality measurement
  • For payment negotiations
• Patient privacy
• Critical mass of data