Catholic Healthcare System Launches Mega Health Information ExchangeCatholic Healthcare System Launches Mega Health Information Exchange

8 Health Information Exchanges Lead The Way

Catholic Health Initiatives (CHI), the nation's second largest Catholic healthcare system, has launched a three-year project to build an enterprise-wide health information exchange (HIE) with the help of HIE vendor Orion Health.

CHI is currently rolling out and upgrading electronic health records (EHRs) in its 76 acute-care hospitals and more than 300 ambulatory care clinics in 19 states; it's also contemplating adding clinical information systems in its 40 long-term care (LTC) and assisted-living facilities and other provider sites. Michael O'Rourke, senior VP and CIO of CHI, told Information Week Healthcare that the Englewood, Colo.-based chain has completed about 25% of its EHR implementation in hospitals and physician practices. CHI won't start up local HIEs, he said, until those systems have gone live in each market.

While it appears that Orion will be helping CHI build a single, gigantic HIE stretching across the country, O'Rourke said that represents only the "architecture" of the project, not its true goal. For example, he said, CHI has hospitals, physicians, and reference labs in Lincoln, Neb. When the HIE goes live in that city, he said, "that community will look like a small community connected together. But when you step back a little further in Nebraska, you see [the HIE in] Kearney, which will also look like its own community. Combining those exchanges, we'll be able to cross over patient information, and that community becomes a little bigger."

Having a standardized set of clinical information will make it easier, he said, to "snap into" statewide information exchanges than if CHI tried to build totally separate HIEs in each state. Eventually, he added, CHI would also like to join the Nationwide Health Information Network (NwHIN).

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CHI will not take a proprietary approach to its local HIEs, O'Rourke noted. The organization welcomes non-related providers that want to participate in its exchanges; in some markets, he added, its facilities may join other HIEs.

"That's the real intent and desired outcome of having a health information exchange: to take that disparate information and bring it together so that you have a continuity-of-care look at the patient's information," he said. "In fact, as we move into integrated delivery networks, sharing information between different parts of the community and the population becomes an imperative. You can no longer say, 'This is my information and it's a competitive advantage for me to keep it.' It's actually a competitive disadvantage to keep it in the future."

CHI has healthcare facilities across the country, from Tacoma, Wash., to Baltimore. While it has clumps of hospitals and clinics in about 45 markets, O'Rourke said, its biggest groups of facilities are in Tacoma; Des Moines, Iowa; Lincoln, Neb.; Chattanooga, Tenn.; and Little Rock, Ark. He didn't say so, but these are markets where CHI might provide the "backbone" for community HIEs.

CHI also views its post-acute-care settings as an integral part of its HIE strategy. "The plan is to incorporate whatever site of care our members are seen at," O'Rourke explained. However, he admitted that there are obstacles. Whereas CHI hospitals use Cerner or Meditech systems, and its clinics are running on Allscripts, its post-acute-care facilities utilize a variety of information systems, most of which can't communicate with the major EHR products. "Some long-term-care organizations don't really have an electronic system at all," he said. "We have 40 LTC facilities, and we're working on a strategy to have a product for them."

The big healthcare system must also figure out how to accommodate data from non-CHI providers. The organization's HIE architecture, O'Rourke pointed out, is a hybrid of central data repositories within a federated model. The federated, or peer-to-peer, approach is necessary to view data in non-CHI systems when that's required to complete the patient record.

On the other hand, he observed, "Nobody can have a completely federated model; they need to have some data in repositories [at the local level]."

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