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Update on the MidSouth eHealth Alliance - Memphis Health Information Exchange

Posted Jun 03 2009 4:52pm
While national experts urge "implement now" and press releases announce early award of non-profit status, some established exchanges - Memphis included - are wondering what the big deal is about.

In May, the Memphis health information exchange funded through AHRQ and the State of Tennessee will have been in operation for three years. The Exchange is governed through data-sharing agreements based on Markle and, through the Vanderbilt Regional Informatics, have supported efforts by organizations in thirty states. The system includes all major hospitals, all consenting patients, and is used hundreds of times a day in 14 emergency departments and 14 ambulatory clinics. The major value has been in a demonstrable reduction in duplicate radiology tests and significant impact on transitions from hospitals to safety net clinics and value to hospitalists seeing newly hospitalized patients. The model is generalized and will be extended to other regions.
To us, "health information exchange" is a verb more than a noun. Our project and organizations are viewed as interim measures to build trust among providers and the public to create a secure, simple, inexpensive approach to patient-centered care. Our mantra is not "make our project sustainable" but instead "find a way to make sure that every consenting Tennessean has access to their care information whenver - and wherever - it is needed for clinical care."

To us, such a reality will be inevitable whether achieved through our approach, PHRs, or some nascent combination of policies and technologies. This writer remembers speaking of "hypertext" in 1986 and saying that in the future, people won't believe you had to go to libraries to read books and newspapers. Audiences were skeptical. Looking forward a few years, few will believe that personal health information wasn't "liquid" and available in a secure and trusted way where it is needed. Can one really envision a health care system without such data liquidity?

Returning to the Memphis Exchange, the coverage is extensive. As of April, 2009, salient metrics include
  • Total number of encounter records: 4,704,000
  • Total # of patients: 1,284,000
  • Total # of patients with clinical data: 1,018,000
  • Estimates of monthly volume include:
  • Monthly Encounter Data: 140,000
  • Monthly ICD-9 admission codes (Chief complaints): 34,000
  • Monthly labs: 2,400,000
  • Monthly microbiology reports: 26,000
  • Monthly chest x-ray reports: 35,000
Operational costs are under $3 million per year. That's less than $3 annually per person. Administrative claims data are available to some degree, but are considered by users largely irrelevant when they have access to labs, dictated reports, and other real clinical data.

But is this enough? It's not clear. The entire health care system has one primary sustainability strategy: get the health care dollars of the public first and hold on to as many of them as possible.

Is the not the absolute volume that counts, but instead the coverage for specific individuals and populations. Health care will be improved not so much by having 10% of the data of everyone as it will be when the Exchange supports care by making availble 90% of the important clinical information for specific individuals and groups. Hence a broad push into ambulatory arenas.

Governor Phil Bredesen spoke of "building version 1.0" when addressing HIMSS in 2007. That's what we are trying to do. Heavily influenced by Clayton Christensen and other innovation thought-leaders, we strive to build something simple that provides a low barrier to entry and incremental evolution as a "disruptive" approach to health care IT. We believe the standards are by and large sufficient, that value can be derived from semi-structured data, that systems can be inexpensive, and that, by and large, things are really pretty good if organizations would only focus on collaboration. Memphis isn't a final answer, but it has provided us with some insights into what it takes to improve care.
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