In an attempt to aggregate health information beyond the proprietary realm of the Medical University of South Carolina (MUSC) in Charleston, Frank C. Clark, PhD, MUSC’s vice president of IT and CIO, currently is spearheading efforts to partner with several other health care organizations in the area to form a health information exchange (HIE). Startup funding was provided in the form of a grant from the Duke Endowment. “We think that the health care organizations best positioned for success in the years ahead will be those that can most readily facilitate the flow of clinical data, within their walls and beyond,” Clark says. The HIE that Clark is helping to construct links nine emergency departments operated by MUSC and three run by other not-for-profit and for-profit hospitals. “When a patient presents at any of these emergency departments, the clinicians there can perform a search across these other hospital organizations to see if residing in their hospital information systems are any relevant clinical data pertaining to the patient, such as laboratory results,” Clark says. “If such data are found, they will be retrieved and presented to the requesting clinicians. This is potentially a tremendous benefit to patient care. At some point in the future, we plan also to make images available through this HIE.”No Walk in the ParkOn paper, HIEs seem like a straightforward proposition. In reality, constructing one can be daunting in the extreme. A major hurdle is bringing together multiple enterprises that, in their usual context, might be rivals. Clark suggests that the most effective way to overcome their competitive impulse is to appeal first to self-interest. “An HIE model sets the stage for better control of costs,” he says. “For example, we’re looking to the HIE to reduce the need to perform tests such as MRI scanning and chest radiography on emergency-department patients, especially those who are frequent visitors. When such a patient presents, it will be helpful to see if recent MRIs and radiographs exist for him or her at any of the other facilities participating in our HIE. If these studies have already been done, it would be economically advantageous to avoid needlessly repeating them.” An even stronger appeal is to competitors’ better instincts. “There is a very definite public good to be advanced by hospitals coming together to share patient information easily,” he says. “Most hospitals see it as their responsibility to promote better care across the community, and they would be likely to be open, at least, to considering an HIE model as the mechanism for that.” Difficult, too, is finding a way around the inertia that quickly becomes evident in partnership-formation efforts on this scale. “It takes an enormous amount of effort to build an HIE, but the organizations involved may already be expending enormous energy on internal initiatives and have little left over to spare,” Clark says. Harder to sidestep is the not-insignificant matter of data sharing. “Each participating organization will have its own set of data-management technologies, policies, and procedures, which will need to be harmonized with those of the other organizations,” Clark says. He notes that on the plus side for his own organization’s HIE development, MUSC has a prior commitment to systems interoperability. “Our clinical data repository is, effectively, an open-system toolkit consisting almost exclusively of HL7-compliant technology. Adherence to that standard gives us confidence our systems will be robustly malleable enough to work bidirectionally with our partners in the HIE,” he says. It is still early in the game, and much work remains to be done before MUSC and its local partners can proclaim their HIE a success. Nevertheless, the time is already right to gaze forward and ponder whether this HIE can be financially self-sustaining once its startup grant money is exhausted (around 2012). “I’m optimistic that we have an economically viable concept here,” Clark says. “It promises to contribute to reduced lengths of stay, improved quality of care, and improved patient satisfaction, which should help lower costs and encourage business growth.”