Florida HIE adapts to changing federal rules, focuses on sustainability

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The Florida Health Information Exchange has worked hard to keep costs low by using open source components and a lean infrastructure. But along with all the other challenges that HIEs face, changing federal regulations are forcing it to adapt its software and figure out how to pay for it.

Program director Janet Hofmeister told Government Health IT that Florida was out front in developing its HIE, but the federal rules are "developed as we go."

Like other HIEs, it's focused on how to sustain the operation after initial funding runs out. Continuing to keep the cost of participation by physicians low by looking to payers and increasingly EHR vendors that it's bringing on board is a priority.

The organization is looking at a lot of different avenues to meet its annual sustainability budget of less than $2.5 million, Hofmeister said, but not at providing data mining or analytics services from the data exchanged. In fact, it purposefully created a structure without the central repository that would be otherwise be required.

"…Florida is a pretty conservative state and there was a lot of fear from the physicians that their data would be harvested and sold. Generally, the sense we get is that they feel strongly that the data is theirs, they want to keep control of it, and they don't want people having the ability to share it without their consent," Hofmeister said.

Security and privacy have to be handled at the point where the patient is seen, but to join the HIE, providers are required a specified level of security. The HIE also has developed its own security best practices that apply to both the Direct secure messaging side and the patient look-up side.

For the new year, among the HIE's challenges are ensuring it has the proper policy and governance in place and taking on the extra work to bring vendors on board.

HIEs must be able to show return on investment and key quality metrics to make a strong case for both adoption and investment at the local level, concluded a study published at Perspectives in Health Information Management.

In the FierceHealthIT eBook "Key Lessons in Health Information Exchange," Keith Kelly, vice president of professional services for the Indiana Health Information Exchange (IHIE), advises healthcare leaders to focus their sustainability efforts on providing services that healthcare organizations are willing to pay for. He warns that potential paying customers might not value services that are given away for free.

IHIE, the nation's longest-running statewide HIE, began with a fee-per-transaction model that flopped, but has found success in a subscription model.  It's moving from a non-profit to a for-profit model that uses data for products and services, including retrospective analysis, clinical decision support and, eventually, predictive modeling.

To learn more:
- read the Government Health IT article

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