Indiana HIE Innovates in the ER While Teaming Up With Five Other HIEs to Extend Reach

Indiana's largest health system is now using a FHIR app developed by the Indiana Health Information Exchange, providing emergency physicians with one-button data gathering for common symptoms.

As the oldest health information exchange in the United States, founded in 2004, the Indiana Health Information Exchange (IHIE) has provided a road map for other HIEs to follow. And as pandemics rage and physician burnout threatens to spiral out of control, the IHIE is more than just a pipeline in which for medical records to flow.

It operates the Indiana Network for Patient Care (INPC), the nation's largest interorganizational clinical data repository, with participation from more than 120 hospitals, 18,000 practices, and 50,000 providers. All told, it includes data on more than 17 million patients, at a time when interoperability remains a challenge nationwide.

The IHIE is also a member of the Strategic Health Information Exchange Collaborative, a national collaborative of more than 80 HIEs, which collectively serve 95% of the U.S. population.

Now, the IHIE has stepped up its game, with initiatives reaching into emergency departments and across states. IHIE president and CEO John Kansky recently spoke with HealthLeaders about its newest initiatives, and the resources that HIEs are bringing to bear during a time of pandemic. This transcript has been edited for clarity and brevity.

HealthLeaders: In the past, we got to see each state compete to build the best-looking HIE model, and then maybe others emulated it. To what extent has that actually come to pass?

John Kansky: We've moved on from the “let a bunch of flowers bloom,” and some states are going to figure out the best way to do an HIE and then we'll copy them, to a way for the successful models to be adopted and employed by the states whose models weren't as successful. We just had a pandemic, and states that had good health data utilities had good access to high quality information across their state regarding testing and hospitalizations, and states that didn't, didn't.

For any number of reasons, every state should have one of these things. That's where the discussion begins about the Consortium for State and Regional Interoperability (CSRI), which we joined earlier this year. The CSRI is six large, robust HIE organizations that started collaborating around the pandemic response, because the ONC and CDC were saying you need to have a lot of good data(and) it's too bad you can't make a national COVID dashboard. And we said that's true, we can't make a national COVID dashboard, but in three weeks we showed them a six-state COVID dashboard.

HL: What else does the CSRI do?

Kansky: One area is advocacy. We believe that the statewide health data utility model - and we believe every state should have one of these – (is) never going to happen if we don't work together to communicate and advocate for policy change.

HL: What about having a national HIE?

Kansky: That ship has sailed and it's not going to happen. The TEFCA (Trusted Exchange Framework and Common Agreement) is the federal government's answer to that question, a framework that will unify all of the existing efforts.

HL: Are efforts by vendors to replace HIEs going to take away the need for HIEs?

Kansky:  HIEs have value, and as I stated earlier, I passionately believe that every state needs to have one and one that works well. Part of the challenge of the belief in the value of health information exchange is that we don't have good health information exchanges in every market and every state in the country, and no one would argue that point.

We're going to achieve national interoperability in this country the way we do a lot of things in America. We're going to try 14 things all at once, and we're going to create massive chaos. And we're going to end up with a system that turns out it works pretty darn well, even if it's more complicated than it needed to be.

HL: People like to compare it unfavorably to how smoothly the banking system works as one system.

Kansky: The financial system works. But if you really start peeling that onion, you will find that it took over 20 years for these complex networks and subnetworks to evolve. Whether people like that answer or not, I think if you let the market figure it out, as EHRs (electronic health records) are getting better at interoperability capabilities of their products, and the federal government is focusing more policy on advancing interoperability, and the HIEs are figuring out how to be more capable and more sustainable serving state governments as well as the healthcare system, I think we're on a decent path.

HL: So where in the 20-year curve are we?

Kansky (laughing): Year 22. Don't take me too literally on banking taking 20 years. Even in countries where they have nationalized healthcare, they have healthcare information exchange problems. So we will never be without challenges. it's so much better than it was even, I'll say, seven years ago, because before, we didn't have CareQuality, we didn't have Commonwell, we didn't have the eHealthExchange. There's a whole bunch of things that have matured and advanced.

HL: We still haven't run into many doctors' offices that have retired the fax machine.

Kansky: It's really hard to get people off of fax. Part of the reason is because EHR vendors have - I'm air quoting - solved the problem. I'm not criticizing them; I would have done the same thing. But a lot of faxing isn't via fax machine. It's faxed into their EHR platform, but not structured data. So where they've taken the pain out of it is the problem.

You have to make the alternative either more economical or more attractive. We used to think that if we just had all of the data on every patient from every source, and we put it in a giant repository, and every time a patient presented for care we made all of that information available to the clinician, that that would be HIE nirvana. And that was wrong. Because physicians do not want to know every darn thing about their patient. They need to know the things they need to know when they need to know them.

So we have created this app. It uses FHIR (Fast Healthcare Interoperability Resources). We have added a button for the top primary complaints of patients that the emergency physicians told us they encounter. The first one they asked us to do was chest pain. We work with the emergency physicians to say, when you have a chest pain patient, what information do you always pull together? "I always need to know what meds they're taking. I need to know their latest labs, I want to see their last EKG." And they just rattled off seven things that they wanted. So we built a button in their EHR that says chest pain. They get a patient that says they have chest pain, they push that button, and within like four clicks, and then five seconds, they have all the things on that list pulled from the health information exchange. Then they said, that's great, can you do more? Because we have these other six common primary complaints. So we built that.

HL: How widely deployed has that become?

Kansky: It's used by the largest health system in the state at all of their emergency departments statewide. We haven't deployed it yet beyond that first large customer. Now we need to implement it on another EHR platform.