CIO Unplugged – 4/15/09

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

Health Information Exchange Begins at Home
By Ed Marx

To date, I’ve had the privilege of holding three CIO positions. First, for a physician managed services organization. Second, in an academic-based multi-hospital system. And currently, as CIO for a large faith-based community hospital system. In my first C-suite gig, we talked about CHINs, which morphed into talks of RHIOs, while today we discuss HIEs. All of these have had the big, hairy, audacious goal to exchange information on increasing quality and decreasing costs.

Clinical, financial and now federal incentives generate a noble rush to participate. As I dug into details of certain opportunities at current and former organizations, I discovered that neither technology nor the sustainable business model posed the greatest challenges. Instead, the information exchange within the walls of my own institutions verged on nonexistence or lacked vision. We talked at high levels about exchange while knowing full-well we had not yet achieved this nirvana internally. Much work needed to be done at home, and we had to act with purpose to prepare for HIE.

In 1995, at Parkview Episcopal Medical Center, we reached advanced stages of interoperability. First, we implemented strong inpatient clinical systems and practice EMRs. We began sending electronic scripts to the local pharmacies. Participating physicians received a 10 percent discount on their malpractice insurance. We stopped printing and sent all reports to our medical staff electronically. Only after getting our own house in order could we achieve this exchange.

At University Hospitals, our team was awarded the very first NHIN grants. We freely exchanged data with other sites across the country. We exchanged clinical information with our joint-venture hospitals, with federally qualified health centers, and with others. We achieved our increased quality and reduced costs objectives. Our success came after we laid a firm internal foundation and developed our own portal.

At Texas Health, we’ve used a similar approach. Because we had disparate applications early on, we built a portal that essentially mimics an HIE but fits our health system. We exchange externally but on a limited basis. We’re just now completing our overall HIE strategy that might be as simple as plug-and-play going forward. Despite the years of futile conversations regarding data exchange taking place in the region, we would not have been ready without the current portal.

HIE is a critical component of our American health care landscape. It’s the right thing to do. Caution! First look in the mirror and ensure that you’re exchanging data internally before placing your expectations externally. We don’t want to find ourselves saying "do you remember the word HIE," just like we do today with CHIN.

Take action now.

Ed Marx is senior vice president and CIO at Texas Health Resources in Dallas-Fort Worth, TX. Ed encourages your interaction through this blog. (Use the “add a comment” function at the bottom of each post.) You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook, and you can follow him via Twitter – User Name “marxists.”