Building the Fully Loaded HIE: Images on Board

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With a health IT stimulus package valued at $19 billion 1 in play, one of the least controversial subjects in the health-reform debate is the potential of health information exchanges (HIEs) to lower health care costs while improving efficiency and quality of care. A handful of players in health IT have been developing some form of exchange for a decade or more (supported, in part, by the occasional grant), but images typically have not been included.

With this year’s planned disbursement of federal stimulus money to ramp up health IT infrastructure, health-care providers around the country are scrambling to find the best and most economically viable way to connect with one another, and radiology practices with foresight are working toward making imaging part of these efforts.

“I think Indiana might be the mecca for HIE,” Chuck Christian says of his home state, reflecting a sense of regional pride shared by many around the country who were attempting to implement local HIEs long before the concept hit the mainstream. “My comments may be biased,” he adds, “but I’ve been involved in this for quite some time. We have five exchanges in Indiana that have been up and running for 10 years.”

Christian is CIO of Good Samaritan Hospital in Vincennes. He has been involved with the Indiana Health Information Exchange (IHIE) and others for several years, and is now a board member of the Indiana Health Informatics Corp (IHIC). This group was created by the Indiana state legislature in 2007 to determine how best to provide HIE services for the entire state of Indiana, integrating HIEs such as the nonprofits HealthBridge and the Indiana Network for Patient Care (INPC).

imageChuck Christian, CIO

Good Samaritan Hospital connects to the latter, which shares information about emergency care. “INPC gives the emergency-department physicians a 24-hour window of access to all the data available on a given patient, so they can log on using a Web browser and see it all: laboratory results, DICOM images (if shared), transcriptions, discharge summaries, and more,” Christian says. “We showed the INPC data to our emergency-department physicians and they wanted them yesterday.”

imageTodd Thomas, CIO

Christian’s not the only one who’s been involved with HIEs since the 1990s. Austin Radiological Association (ARA), Austin, Texas, got involved with a regional exchange called CriticalConnection® 10 years ago. Todd Thomas, CIO of ARA, says, “We believed in the concept and were interested in participating from the beginning. As an early adopter of PACS, we were very interested in electronic sharing of information and saw this as an opportunity to enhance our services to area physicians’ offices. We provide hosting services, network design, and architecture services.”

These informatics specialists have known for years what is, today, still making headlines in the consumer press as a new idea: that HIEs will be key to unlocking new efficiencies in health care. “One of the linchpins of making health care better is HIE,” Christian says. “Thirteen states have been awarded funding to do HIE planning, but we’ve already planned and implemented on a regional basis. We did it on our own, because we knew it was the right thing to do.”

Adding Images

The Carolinas also appear to be fertile ground for HIE development, spurred in part by the Duke Endowment, which has funded four HIE projects in the region since 2006. These include Data Link, an HIE established four years ago by the Western North Carolina Health Network (WNCHN). The exchange was built on a 16-hospital federation founded more than a decade ago to collaborate on quality-improvement goals and, later, to achieve economies through group purchasing.
Today, Data Link provides approximately 1,500 physicians in the region with access to admission/discharge information and to laboratory, microbiology, and radiology reports (as well as other transcribed reports), according to Dana J. Gibson, MPH, CPHIT, CPHQ, vice president, Data Link Services, WNCHN, Asheville.

WNCHN hired a software developer in Birmingham, Alabama, to create an application that sits on top of each hospital’s server and communicates with the Data Link server, which periodically queries the hospital information system of each of the 16 member hospitals to retrieve the basic patient information that populates the index. Andrew Wells, MD, a radiologist at Margaret R. Pardee Memorial Hospital, Hendersonville, describes the system as a