December 2, 2007 By Shane Peterson
Despite the high-profile campaign to prod the health-care world to adopt information systems that share patient data, the adoption pace isn't exactly on the fast track.
In part, the slow pace is a natural byproduct of the task's enormity. The health-care sector is mired in paper, perhaps more so than any other sector of the U.S. economy. By the end of the 1990s, according to White House data, most American industries spent approximately $8,000 per worker for IT. The health-care industry, however, spent only $1,000 per worker.
Erasing that gap will require a lot of hard work and money. Perhaps most importantly, formerly competitive parts of the health-care system will have to work together to solve complex health-IT problems.
It's a formula that's worked well for the Indiana Health Information Exchange (IHIE), though only after considerable effort.
The IHIE is a nonprofit created by a cross-section of Indiana health-care entities, including the Regenstrief Institute, private hospitals, local and state health departments, and BioCrossroads, a public-private entity supporting Indiana's research and corporate strengths in life sciences.
The IHIE's success stems from taking incremental steps, said Dr. J. Marc Overhage, president and CEO of the IHIE.
"We're not trying to boil the ocean here, and DOCS4DOCS is an example of that approach," Overhage said.
DOCS4DOCS (D4D) is one of two services the IHIE offers to physicians and hospitals. D4D is a standards-based, electronic clinical messaging service that delivers test results and other clinical information securely and efficiently. More than 25 Indiana hospitals use the fee-based service, and sends approximately 1 million messages per month to 5,000 physicians.
D4D saves millions of dollars per year for the health-care entities that use it, Overhage said, by eliminating duplicate tests ordered by hospitals and associated administrative costs.
The focus on delivering basic services to health-care practitioners is deliberate, said Overhage.
"IHIE is not trying to replace physician-practice systems," he said. "We're trying to be the grease in the middle. We're not focused on applications. We're focused on moving the data."
It's an important distinction, Overhage said, because the IHIE isn't trying to create electronic health record (EHR) software. The vision of a national health information network in which EHRs freely interoperate between hospitals and physicians' offices will take years and hundreds of billions of dollars to build, he said, and the IHIE wants to focus on solving grass-roots problems in the here and now.
"Eighty-eight percent of health care in this country is delivered by physician practices of 10 physicians or less," he said. "These are the practices least able to afford EHR software packages. In the near term, we're delivering a 'poor man's' EHR that's starting to feel like it's a fairly complete picture of what's going on with a patient."
The other part of that complete picture is the IHIE's new service, Quality Health First (QHF), which, unlike the D4D, is available to users at no charge.
The QHF combines medical and drug claims, patient drug information, and laboratory and radiology test results with clinical data from the Regenstrief Institute's Indiana Network for Patient Care.
The idea, Overhage said, is to create a high-level, clinical database of patient-specific sets of diagnoses and preventive care procedures for doctors to help them improve the quality, safety and efficiency of patient care.
To assemble that spectrum of data, the IHIE worked with the Employers Forum of Indiana, participating payers and health-care providers in the nine-county Indianapolis area.
But that was only half of the solution. Making the QHF attractive to physicians on a business level was