About Porter Research
Porter assists our clients with custom business-to-business, primary research designed to
improve sales success, increase customer satisfaction and validate opportunities
•
•
•
Atlanta-based market research firm founded in 1989
Healthcare focused
Four key service lines
Customer Experience
Research
Market Needs &
Opportunity Research
Market Needs Reveals
Executive
 New Product Launch
End-User
 Concept Testing
Promoter
 Advertising Testing
Attrition/Defector
Brand Awareness
 Market Segmentation/Sizing
Market
Driven
Organization
Marketing
Professional Services
“On-line” Focus Groups
Account Profiling & Lead Generation
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Intelligence
Win Loss Program
Strategy Development
White Papers
Distribution Plans ……..
 Prospects, Sales
 No Decision, Early Elimination
Competitor Profiles/Analysis……
"[Health] Information should follow the patient, and
artificial obstacles – technical, business related,
bureaucratic – should not get in the way."
Dr. Blumenthal
About the Research
Porter Research and Billian’s HealthDATA fielded a primary market research
program aimed at understanding providers’ perceptions of the Health Information
Exchange (HIE) movement
• Web-based survey designed by Porter Research
• Fielded October 2010
• Select titles targeted and pulled from Billian HealthDATA’s 150,000+ database of hospital
decision makers
• More than 120 respondents
• Participating organizations represent critical access to multi-facility systems and IDNs
• Respondents were typically at a C- (54%) or Director-level (21%) within their organization
• Functionally, most participants had Information Technology (39%), Medical/Clinical (15%), or
Finance (13%) responsibilities
HITECH Transforming Healthcare
Goals:
• Quality
• Efficiency
• Safety
• Equity
Business Transformation:
•
Movement toward outcome-based
vs. transaction-based
reimbursement
•
Reengineering of business models to
facilitate risk sharing of outcomesbased healthcare
New Business Model?
“Is your organization considering moving to one of the new business models below
to support healthcare reform? Select all apply…”
• Overall, 43% of facilities are considering moving to an Accountable Care Organization model
• The Patient Centered Medical Home model is being considered by 34%
• Single Hospital facilities are significantly less likely to consider a change, specifically to the
Patient Centered Medical home model
Challenge – Meeting Long Term Exchange Demands
Regional/
State
NHIN
Affiliations
(Physician,
etc).
Health System
HIE – Primary Strategic Initiative
“Which of the following best summarizes your organization's primary strategic
initiative as it relates to health information exchange?”
• Nearly half of all respondents indicate their primary strategic initiative is “to improve
connectivity within the health system”
• Approximately 30% stated that their focus extends beyond the health system
• There is no significant difference in the responses based on organization size
Current State of HIE Environment
Simple HIE Approach
38% of the Respondents
Transitioning to a More
Complex HIE Approach
Complex HIE
Approach
37% of the Respondents
25% of the Respondents
General Definition – Data is being
exchanged from the hospital to other
entities which are part of the health
system (i.e., physician affiliates)
General Definition – Data is being
exchanged within the health system and
to entities external to the system (i.e.,
non-affiliate physicians)
General Definition – Data is being
exchanged internally and externally to the
organization and data is not view only but
is actionable and can be transacted upon.
 “The sharing of information between
health care entities via an electronic
medium.”
 “The ability to 'share' patient information
with appropriate caregivers, inside and
outside of our facility, and payors within
HIPAA regulations.”
 “Health Information Exchange is the
capability to share and aggregate patient
information across organizations/EHRs to
provide a more complete picture of past
clinical care so clinicians can make more
informed decisions.”
 “The ability for information systems to
be able to connect with each other and
share information. We have multiple
systems that we use throughout our
organization and for them to be able link
together and share information would be
so beneficial. Interoperability to me
would be the ability for the information
systems to be able to connect from the
primary physician office through the
acute care stage and then post acute
care.”
 “Seamless and secure information
transfer among providers.”


“Bi-directional exchange of patient health
records as well as secure messaging,
patient-centric views of patient records.
Exchange includes orders, referrals, lab
results, diagnostic reports, transcribed
reports, CCD, PHR linkage.”
“Being able to exchange patient
information from a healthcare organization
to an ambulatory site - physician practice to provide accurate patient care.”

“HIE means the ability for multiple record
systems to contribute to a central hub which
can be called by the record systems to pull
data out as needed.”
 “Ability to request, process, obtain and
document pertinent patient-related
information in the provision of medical
treatment across any information systems
and/or intranet.”
Current State – “Simple”
• Focus is on connectivity
of information systems,
primarily within their own
health system
Connectivity/ seamless integration
58%
20%
Structured data
Industry standards
HIE within health system
Basic exchange of electronic data
Accessibility
16%
13%
11%
9%
Current State – “Transitioning”
Transitioning
37%
• Focus shifts to sharing
data with entities
external to the health
system, primarily within
the community
Current State – “Complex”
• Focus begins to shift
to true coordinated
care with the
implementation of an
HIE central repository/
clearinghouse
HIE Today - Internally
“Considering organizations internal to your health system, with whom does your
organization exchange information with today?”
• Most organizations are exchanging with Labs, Imaging, and Physician Practices Within the
Health System
• Multi-hospital orgs were significantly more likely to exchange with Post Acute Care Facilities,
Pharmacies, Physician Practices Within the Health System, and Other Organization Types
HIE Today & Tomorrow - Externally
“With whom does your organization exchange information with today that would be
considered external (i.e., not affiliated) to your health system? With whom does
your organization want to exchange with in the future?”
• Today, the most common
exchange partners are
Physician Practices External to
the Health System and Labs
(i.e., Reference)
• 86% of respondents believe
they’ll be exchanging data with
physician practices external to
the hospital in the future.
HIE Today - Externally
“What type of data are you exchanging? Please select all that apply...”
• Hospital Lab Results and Radiology Results/Reports Sent to Physician Practices or Other
Providers were both mentioned by more than 70% of respondents
• Multi-hospital facilities were significantly more likely to claim exchanging Patient Summaries,
Orders, Lab and Radiology Results
Barriers/ Challenges
“What are the greatest barriers and/or challenges perceived by your organization
regarding implementing HIE solutions in the care process?”
• When asked top-of-mind, costs
were significantly more likely to
be cited
• There is little to no discernable
difference between multi/ single
hospital systems
Top Concern
“Of the following, what is your top concern?”
• Respondents were asked to select one of thirteen possible responses
• Again, Cost/ Funding emerged as the top concern, selected by 46%
• In this instance, single-hospital facilities were significantly more likely to select cost/ funding
HIE Benefits
“What does your organization perceive to be the tangible benefits of health
information exchange (HIE)?”
• Most respondents –57% - believe HIE will bring Improved Quality/ Care
• Other areas of benefit include Administrative/ Clinical Efficiencies and generic Access to
Information
• Multi-hospital organizations were significantly more likely to provide Administrative/ Clinical
Efficiencies as a response
HIE Benefactor
“In your opinion, who do you believe benefits most from health information
exchange (HIE) and a more comprehensive view of a patient’s health status
provided across care settings?”
• Most respondents – 63% –
believe the Patient benefits most
• 16% believe the Community at
Large is the benefactor
• Only 4% selected the Health
System
HIE Funding
“How should health information exchange technologies and services be funded?
Please select all that apply…”
• Nearly two-thirds of respondents believe that the Federal Government should provide funding
• Single-hospital organizations were significantly more likely to select the Federal Government or
Unsure; Providers (Hospitals/ Health Systems) was significantly more likely to be cited by multihospital organizations
Sustainability of HIE
“Which of the following cost saving measures do you believe can be projected
as serious contributors to a sustainable model for health information
exchange technologies?”
• Multi-hospital facilities were 24% more likely to select Decreased Cost of Care for Chronic Care
Patients.
Status
%
Decreased Dollars Spent on Redundant Tests
78%
Reduced Medication Errors
64%
Decreased Cost of Care for Chronic Care Patients
57%
Reduced Staff Time Spent on Lab and Radiology Results Handling
53%
Reduced Staff Time Spent on Clerical Administration and Filing
50%
Reduced Costs to Process Claims
30%
Preferred Data Architecture
“In your opinion what is the preferred data architecture for health information
exchange for your organization?”
• The Centralized data warehouse model is most preferred at 27%
• 21% of respondents were unsure, although this was significantly more common among single
hospital organizations
Comprehensive View of Patient’s Health Status
“Do you see achievement of a more comprehensive view of the patient’s status for
Health Information Exchange initiatives as an essential element to your
organization meeting the requirements highlighted within the HITECH Act?”
• Overall, 74% responded positively
• Multi-hospital organizations were significantly more likely to select Yes
Role of Traditional Integration Tools
“Do you believe traditional integration tools (i.e., interface engine) can achieve the
HIE requirements for the following stages of Meaningful Use?”
• While just over half of respondents believe traditional integration tools can meet Stage 1
requirements, only 26% believe they’ll meet requirements determined for Stage 2-3
• Multi-hospital orgs are significantly more likely to believe traditional integration tools will meet
Stage 1 requirements and not meet Stage 2-3 requirements
Meaningful Use Preparedness –
HIE Requirements
“On a scale from 1 (“Have Not Started”) to 5 (“Fully Prepared”), how would you rate
your organization in terms of preparedness for the HIE requirements of Meaningful
Use in the following stages?”
• While nearly half rated themselves as mostly prepared (4 or 5) for Stage 1 requirements, less
than ten percent believe they’re prepared to meet requirements determined for Stage 2-3
• Overall, multi-hospital organizations tend to rate themselves only slightly higher than singlehospital organizations
23%
Unprepared
for Stage 1
10%
13%
26%
28%
65% Unprepared
for Stage 2-3
Rated 1 ("Have Not Started")
39%
Rated 2
Rated 3
40%
Rated 4
27%
Rated 5 ("Fully Prepared")
9%
7%
2%
Stage 1
Stage 2-3
HIE Investment to Date
“Has your organization made any purchases of technology solutions that facilitate
the health information exchange (HIE) process?”
• Overall, 61% indicated they have
made investments in technology
to facilitate the health information
exchange process
• Single-hospital systems
responded negatively 35% of the
time, compared 25% for multihospital organizations
Detailed HIE Investment – To Date/ Planned
“For each of the following types of health information exchange technologies, please
indicate your timeframe to purchase.”
Detailed HIE Investment – To Date/ Planned
“For each of the following types of health information exchange technologies, please
indicate your timeframe to purchase.”
Detailed HIE Investment – To Date/ Planned
“For each of the following types of health information exchange technologies, please
indicate your timeframe to purchase.”
Vendors in Consideration
“What vendors will your organization consider for future purchases of health
information exchange technology? Select all that apply...”
• Overall, just over 40% of respondents were “Unsure”
• However, single hospital organizations were considerably more likely to respond “Unsure”
• Epic – the most mentioned single vendor – was significantly more common among multihospital systems
40%
25%
19%
14%
14%
9%
8%
8%
7%
7%
7%
5%
4%
Perceived Market Leaders
“Who do you consider to be the market leader among vendors that provide health
information exchange technologies?”
• Again, no clear leader has emerged, with nearly half of all respondents indicating that they are
“Unsure”
48%
9%
8%
7%
6%
7%
4%
3%
3%
2%
2%
2%
Vendor Attributes
“What are the key attributes you will look for in a vendor when selecting health
information exchange technology solutions for your hospital or health system?”
• The most common attribute mentioned was Costs/ Value at 43%
• Costs/ Value was also significantly more common to single hospital systems, as was Service/
Support
Preferred Supplier Type – HIE Technologies
“What type of organization would you like to obtain health information exchange
(HIE) capabilities/technologies from? Please check all that apply...”
• The most common response, “A Vendor Solely Focused on Delivering Interoperability
Solutions,” was cited by just over one-third of respondents
• Also significant: “Current Acute Care EHR Vendor” and “Unsure”
In Summary
• “Wide variety” of perceptions in the market of what
defines HIE
• Focus on HIE today is internally within the health
system, shifting to external entities in the future
• HIE is perceived as a critical piece of the puzzle to
achieving MU requirements
• The majority of providers feel prepared in achieving
Stage 1 HIE requirements (50%) while (65%) feel
unprepared for Stage 2 and 3 requirements
• Providers see the greatest barrier to adoption as cost
/funding – sustainability
•
No clear market leader in this space - emerging
• Providers prefer to acquire their HIE technologies
either from a sole provider or their EHR vendor
Tift Regional Medical Center - Profile
With a reputation as an innovative provider of
quality care, Tift Regional Medical Center
(TRMC) is a not-for-profit, 191-bed regional
hospital serving 12 counties in South Central
Georgia. Located in Tifton, the hospital’s
medical staff includes more than 95 physicians
with the majority board-certified in over 30
specialties.
Tift Regional provides a wide-range of
services, including six Centers of Excellence
offering advanced, expert care in oncology,
cardiology, neurology, surgery, women's health
and emergency medicine.
Tift Regional's HIE Journey to Date
Data Exchanged Today
•
In 2007 Tift Regional Medical Center began an IT initiative to share data with a large
multi-specialty physician practice in the community.
•
.
This
collaboration resulted in hospital patient results
(lab and radiology) being shared with the physicians –
populating their respective EMRs
MedTrans handles
Radiology transcription
services – transcribing
dictation into Star;
Radiologists release results
from Star
TRMC
Affinity
HPF
Allscripts
Novo agent displays work
queue for TRMC Patient
Access personnel
Novo sends Rad/lab results
to Allscripts where patient
matching occurs
MedTrans
Outbound message
goes from Star to Novo
with Radiology results
Novo Agent
Order requisitions from
Allscripts outbound to Novo
agent
Star
Work
Queues
Demographics from Allscripts are
available in the Novo queue and
through copy/paste technique;
updates are made as needed in
Star for TRMC registration
process
Tift Regional’s HIE - Initial Steps
Initial Steps in Data Exchange
•
Focused on hybrid registration process. HIE technology intercepts all order
requisitions to a web work que.
•
Patients are pre-registered into the hospital ADT solution – for Lab and Radiology
orders based on this que and matching occurs.
•
Signed physician orders for lab and radiology tests are sent electronically to the
hospital documentation system to become part of the medical record.
•
Results for lab and radiology tests performed at the hospital are sent to the practice
and populate the AllScripts EMR TouchWorks for viewing.
Tift Regional’s HIE Plan for the “Future”
Future Steps in Data Exchange
•
Focus on solidifying exchange within the health system
– Implementation of a comprehensive enterprise MPI solution, as well as, improved
integration between Allscripts and McKesson’s Horizon solutions.
•
Exchange patient data within the medical community of Tifton.
- Exchange data with other physician affiliated (non-owned)
•
Exchange of patient and quality data within an
Accountable Care Organization (ACO)
that will extend beyond Tifton.
•
Exchange data with a statewide Georgia HIE.
Common Barriers/Challenges
• Lack of Common Definitions
― What is an HIE? There are different meanings and understandings. Some
think interfaces are all that is required, some think an HIE is a patient portal,
still others see HIE as something else. Vendors even describe an HIE
differently. We need to all speak the same language with the same purpose.
• Growing need for more robust eMPI solutions
– Matching a patient across one or two organizations is no longer satisfactory.
We need to make sure the same patient matches throughout an organization,
an ACO and an HIE
• Integration and Interfaces
– Many of today’s healthcare IT vendors are stuck 10 years in the past.
Interfaces between hospital systems and physician EMRs are challenging and
vendors are reluctant to cooperate in developing outbound clinical interfaces to
other entities.
Common Barriers/Challenges
• Security
– Meeting HIPAA mandates while sharing PHI with other entities will require
investment in robust security measures.
• Cost
– Health systems are struggling with managing to higher IT costs and reduced
reimbursements. HIE expenses could be formidable. Who will foot the bill? Is
and HIE model sustainable?
Healthcare Reform
HIE: A Critical Piece of the Puzzle