Many organizations wonder how to start a health information exchange (HIE). They also wonder whether or not it provides a return on investment or dividends to patients in improved outcomes. At Barnabas Health, we decided early on that it does and joined other healthcare organizations in central New Jersey by forming Jersey Health Connect (JHC).

The catalyst that sparked our adventure into an exchange occurred in 2007, when Atlantic Health System began looking for a way to connect its hospitals and affiliated physicians. Because only 10% of those physicians had implemented an EHR, it landed on the RelayHealth software-as-a-service (SaaS) connectivity platform from McKesson’s connectivity business.

The platform provides cloud-based access to hospital-based laboratory and radiology results, cardiac diagnostic tests, consult notes and discharge summaries. After the service met with rapid adoption, Atlantic Health added non-affiliated physicians, essentially creating a local HIE.

Once the government tied interoperability to the meaningful use of EHRs, interest grew in Atlantic Health’s model, and so did the HIE.

On the Front End of Disruptive Change 

In September 2009, the CIOs from Atlantic Health, Barnabas Health, JFK Health System and St. Peter’s Healthcare System came together to discuss joining together in an HIE. We decided to leverage the RelayHealth technology platform we already were using to connect within our own walls.

Meaningful use requirements, along with Office of the National Coordinator (ONC) grant funding, provided the economic incentives we needed to sell the initiative internally and to launch a sustainable structure. By the time the organization incorporated in February 2010, there were 18 healthcare entities that became founding members of Jersey Health Connect.

The Benefits of Patient Data Exchange

The purpose of the exchange is to bring value to the patient by bringing value to the clinician, but it’s the accountable care dividends that provide the return on investment (ROI). Barnabas Health has two accountable care organizations (ACOs) that participate in the Medicare Shared Savings Program where the provider assumes the risk for achieving outcomes tied to savings.

Seeing all available data on your patients, whether from another hospital, a nursing home, a reference lab, even referral doctors outside your ACO, is critical to managing the patient. With robust data exchange in place, we are starting to see the clinical value.

For example, a patient can walk into the St. Barnabas ED, and if he presented in Atlantic Health’s Morristown Medical Center last month, we can see what tests were done, what medications were dispensed, and so on. If the patient had a CT scan during that admission, the physician can think twice about ordering one today. The Continuity of Care Document (CCD) standard introduced with meaningful use, which becomes more detailed at Stage 2, enables the treatment team to see the patient’s history without recreating it from scratch.

Interoperability Outsourced

Interoperability is not easy. Technical challenges include managing patient IDs, reconciling duplicates, blocking private information and verifying access. Initially we looked at building our own framework. Then we saw how the SaaS platform would help us get up and running quickly, without having to implement or finance a complex infrastructure. JHC participants can purchase modular subscriptions for services that address our specific business needs.

Key components of the HIE include:

  • Record locator service for linking participants’ data to the right patient, so authorized clinicians can locate and review records from any provider within the exchange
  • CCDs, the Stage 1 Meaningful Use standard, for exchanging human-readable health summaries between clinicians and with patients
  • Secure messaging for HIPAA-compliant communication between clinicians and with patients
  • Lab and radiology results reporting, which can eliminate unnecessary duplicate tests and improve throughput
  • Personal health records, which serve as the repository for aggregated data and enable patients to access their health record

 

Selling Itself to Clinicians

Nothing beats positive clinician feedback to boost sustainability. When the president of the medical staff says good things about the HIE, and that enthusiasm reaches other executives, it means more than all the metrics in the world.

Shortly before the HIE went live, Barnabas Health transplant specialists were in my office asking for immediate access. They saw that the HIE would quickly provide them with information on patient histories and potential matches that previously took dedicated resources and a staggering amount of research.

Sustainable Exchange

JHC’s business model has been self-sustaining from the start. The ONC grants and stimulus incentives have helped, but ongoing funding by exchange participants fuels our growth. We must be able to demonstrate ROI to each potential new participant. Currently we track usage by active physicians and registered patients. Soon we expect to see fewer denials and reduced length of stay.

Today, JHC includes more than 27 entities, including 23 healthcare systems, long-term care organizations, several large medical groups and 1,700 physicians. With nearly 2.5 million transactions a month, we are the nation’s fourth1 largest HIE in volume of directed transactions. With ACOs and other evolving payment models at our doorstep, we are already contemplating new forms of collaboration. We have only scratched the surface on how secure data exchange can help drive breakthroughs in areas like clinical research and disease management.

1Based on testimony delivered by Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative, to a joint meeting of the Office of the National Coordinator policy and standards committees (HITSC/HITPC). When compared to the list of directed transaction volumes for state-wide HIEs, Jersey Health Connect’s volume would place it fourth in the list, even though it is only a regional HIE.

Jersey Health Connect won the 2011 Collaboration Award from the College of Healthcare Information Management Executives (CHIME).

Jersey Health Connect Mission

  • Ensure health information is available when and where it is needed both locally and nationally
  • Accelerate members’ current health information exchange activity
  • Improve care coordination, access, outcomes and efficiencies through the use of technologies facilitating real-time clinical exchange
  • Comply with national standards related to privacy and security considerations
  • Allow organizations to maintain individual technology strategies
  • Provide consumers with their health information and encourage active and informed participation
 
Michael McTigue

About the author

Michael McTigue is vice president and chief information officer for Barnabas Health, the largest not-for-profit integrated health care delivery system in New Jersey and one of the largest in the nation. Barnabas Health’s two large teaching hospitals, Newark Beth Israel Medical Center in Newark and Saint Barnabas Medical Center in Livingston are home to the only state-certified burn treatment program and one of the nation’s first Living Donor Transplant Institutes.

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