Joy M. Grossman, Thomas Bodenheimer,
Kelly McKenzie
AcademyHealth Annual Research
Meeting, June 27, 2006

Clinical Data Exchange
 Recent focus on IT to share clinical data across patient care settings
 Public and private efforts have created momentum for regional health information organizations
(RHIOs) but large obstacles remain
 Little known about extent of clinical data exchange
•
• within organizations among affiliated providers
• among unaffiliated providers

Research Objectives
 Assess baseline on extent of IT to share clinical data across patient care settings
 Examine how adoption varies across local communities
 Identify barriers and facilitators to adoption unique to this type of IT

Study Design
 Project part of Community Tracking Study (CTS)
Round 5 site visits (1/05-6/05) funded by RWJF
 Qualitative analysis of interviews in 12 CTS communities randomly selected to be nationally representative
 Took advantage of multi-stakeholder design
• Open-ended questions asked of 250+ respondents in largest hospitals, physician groups, safety net providers and health plans; local health IT groups

CTS Site Visit Communities
Seattle, WA
Lansing, MI
Syracuse, NY
Boston, MA
Indianapolis, IN
Cleveland, OH
Northern NJ
Orange County, CA
Phoenix, AZ
Little Rock, AR
Greenville, SC
Miami, FL

Clinical Data Sharing Among Affiliated
Providers Most Prevalent
 Little clinical data exchange between unaffiliated organizations
 Most hospitals developing proprietary physician web portals that provide admitting physicians with remote access to patient records
 Ambulatory data sharing lags behind

Hospital-based Physician Portals Most
Common Tool
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
Portals provide unified view of a patient’s record, integrating data from hospital’s disparate IT systems
Variation in data available, reflecting sophistication of underlying IT systems
•
•
•
Most typically labs, radiology, PACs reports and images, admission/discharge summaries
May also access hospital’s archival or real-time EMR
Many have transaction capabilities, e.g. electronic signatures, CPOE
• More developed portals have linkages to other IT systems, e.g. ED records, inpatient fetal monitors

Efforts to Interface with Physician
EMRs Slow
 Hospitals working to interface with EMRs of closely affiliated practices
 Significant technological hurdles mean few practices can import data directly from portals
 Handful of examples where hospital-based physicians, e.g. ED physicians, can access ambulatory data from physician practice EMRs

Hospital Competition Driving
Widespread Portal Adoption
 Viewed as strategy to align physicians more closely
• Often responding to pressure from heavy admitters
• Portals are relatively low-cost and easy to implement so a quick “win” with potential to improve efficiency and quality
 One or two hospital leaders in every market
• More market variation in active “followers” versus slower
“laggards”
• Variation within and across hospital types
• Laggards typically weaker financially

Competition Barrier to Community-
Wide Exchange
 Little data sharing between unaffiliated organizations
• Indianapolis and MA/Boston most active
• Some other local and state efforts just beginning
 Provider and health plan competition and adversarial relationships between providers and plans are viewed as significant barriers to collaborative activities
• In Boston and Indianapolis, collaboration among competitors a necessary condition for success

Competition as Barrier (cont’d)
 Patients and their data viewed as key competitive asset by hospitals, physicians and health plans
• Failed past efforts have created additional mistrust in some markets
• More recent efforts have addressed governance and control issues
 Health plans are not viewed as likely conveners in many markets

Policy Implications
 Competitive dynamics may influence pace of RHIO development and choice of business model
• Smaller and rural hospitals may see greater gains than larger and urban hospitals
• RHIOs providing core IT infrastructure or collecting fees for clinical messaging may be less attractive to urban hospitals that have made IT investments
• Proprietary portals do not preclude RHIO development
 Portal development likely to continue but whether interim step towards development of nationwide network of RHIOs remains to be seen