Indiana Health Information Exchange Case Study

The Indiana Health Information Exchange (IHIE) has been the gold standard for HIE design for decades. One of the reasons for its long-term success has been its implementation strategy. The IHIE built on the success of a regional clinical data repository in Indianapolis and surrounding counties. This repository, known as the Indiana Network for Patient Care (INPC), resulted from the incorporation of five major hospital systems, state and county public health departments, Indiana Medicaid and RxHub, an e-prescription broker (McDonald, 2005). The INPC has been operated by the Regenstrief Institute since 1998. The INPC operates under a centralized model collecting information from multiple sites into a single patient medical record. This data is

Sustainability has differentiated the IHIE from the rest. It has been exceptionally difficult to develop a sustainable business plan for HIEs. HIEs are most often non-profit organizations operating through temporary grant funding. Historically many HIEs have failed to appropriately allocate and transition from grant funding to a subscription payment model. One of the policies that helped lead them to success, was the requirement that any new service that they developed needed to be profitable within 24 months (Office of the National Coordinator of Health Information Technology, 2009). This allowed them to avoid the use of grant money for operational costs avoiding catastrophic failure when grant money was unavailable. Another strategy that allowed the IHIE to be sustainable was the use of the same system for both a repository and for clinical messaging. This allowed them to obtain a great amount of value out of an expensive asset. The IHIE continues to use this strategy to layer more services using the current infrastructure. The IHIE has a monopoly over HIE services in Indiana (Office of the National Coordinator of Health Information Technology, 2009). This has allowed them to begin in the Indianapolis area, a region able to sustain a HIE, and expand to markets in Indiana that could not support a HIE alone. This has provided them with the ability to grow their network and develop

The best design for success would be incremental implementation of new technologies. This would allow for the greatest provider buy-in and would allow for appropriate allocation of resources. These technologies should optimally be integrated into existing interfaces to optimize the value generated from these high value assets. In implementing the HIE I believe utilizing a high population area to initially start the HIE would be highly beneficial. This would allow a focused development of the interface followed by further growth and expansion. This method would also allow the HIE to become well established before expanding to rural Iowa which would not be able to support a critical data mass. Des Moines would be an excellent location for initial implementation, since it is the home of UnityPoint Health, Iowa’s largest health system.. Iowa has done a great deal to promote the value of its HIE. The continued use of policy and legislation can help to make the use of HIE a necessity rather than a luxury. Iowa utilized this well already through the use of HITECH and ACO mandate. Passing legislation mandating the reporting of public health information could additionally increase the value of HIE use. One of the largest issues the IHIN is faced with is financial sustainability. The IHIN would be wise to follow in the footsteps of the IHIE. First and foremost, the IHIN