The Nebraska Health Information Initiative (NeHII) is gearing up for the next level of work with its sights set on statewide implementation, after celebrating the success of its pilot at its annual meeting in July.
"This is our opportunity to demonstrate to the rest of the country our leadership model," said Deb Bass, interim executive director.
NeHII's pilot met the criteria established for it by the board and its evaluation process, said Steve Martin, president and CEO of Blue Cross Blue Shield of Nebraska and NeHII board member. The pilot technology committee unanimously decided to move NeHII to a statewide implementation and the board concurred, Bass said. In addition, the common sentiment among the CIOs and technology leaderss from the pilot participants was: "Just do it."
Providers, especially the larger facilities, have found value in NeHII's toolset for quality improvement, Martin said.
"It's something that everybody should embrace and can easily be tied to quality initiatives," he said.
Reduction of mistakes and medical errors has been the first benefit gleaned, with impact to quality to come over time, Martin added. Participating hospitalists who work in the local children's hospitals have said how powerful the system is for delivering early care and being able to pass information to the primary care physicians for follow-up care. They are also providing referrals that drive patients to participating hospitals.
While large hospitals are still in the decision-making process for participation, Martin noted that NeHII's pricing is appropriate for smaller hospitals, which are still struggling with basic electronic medical record implementations. By connecting the smaller entities, NeHII would "level the playing field" for independent physicians and physician groups and smaller hospitals, he said.
Even with an EMR system in place, health systems and physician offices and groups need to connect with other systems and not treat themselves as islands. "There are too many conduits for information to flow," he said, and not linking leaves isolated systems at a competitive disadvantage at a time when interoperability is being pushed at the federal, state and regional levels.
NeHII operates a hub to which participants can connect. Hospitals and physicians, who often work in multiple facilities, can access data through a shared-cost portal. Using Axolotl's Master Patient Index, NeHII has produced half a million matches without error. Electronic access establishes an audit trail and ensures that information flows to the right people. "This is more protection than in the current environment," Martin said,
Creating a consumer portal is a future goal, but NeHII needs a critical mass of providers before the portal can be useful, Martin said. Personal health records will also be a future goal that will provide consumers with valuable data such as test results and immunizations, serve as a dialogue between providers and patients, and eliminate the replication of data on charts. The HIE will determine at a later date how to fund PHRs.
NeHII is in discussions with four surrounding states to use its infrastructure as a central hub for a multi-state HIE, Martin said. Bass & Associates, which is NeHII's project management provider, is working with a fifth state in a three-way partnership that involves an HIE management service model, health IT platform and quality reporting and personal health record component. These multi-state initiatives illustrate how NeHII can extend its network and increase its territory, as well as provide additional revenue streams, according to Bass & Associates.
NeHII is awaiting its 501(c)(3) status from the Internal Revenue Service, which will be required for developing the multi-state initiatives, advancing its computing system and assisting with the last stage of funding, Martin said. For the remainder of the year and through next year, NeHII hopes to raise a few million dollars to cover the cost of software and hardware deployment, and ramping up, Martin said. The HIE is continuing to work on its cost model. Thus far, BCBS of Nebraska is the only participating payer, but he hopes more payers will come on board, especially the government payers, at the rate of one dollar per member per year.
NeHII is also enlisting its Class B members for another source of funding to offset implementation costs. Class B members pay a one-time membership fee based on the size of the company, which can be fairly significant, Bass said. In addition, the HIE is also tapping the state, which "has been very helpful and supportive," Martin said. "We hope the state will look at creative ways of funding us," he said.
"We're 'shovel-ready' now and need a little help with government funding," Martin said. Unfortunately, the federal stimulus money for HIEs won't be available until October 2010. While NeHII is positioning itself to be in the running for that pot of money, the irony is that it requires funding now to bridge the gap. "There is a lot of low-hanging fruit," he said, referring to advanced HIEs that require a little more funding to become viable. Martin said he hopes federal officials understand that funding advanced HIEs will bring quicker returns and successes, which in turn will draw more support for the next group of HIEs.
If all goes as planned, Bass said, NeHII will be sustainable in 2011.
