HIEs indicated they intend to charge ei- ther a fixed or a tiered fee to hospitals to support sustainability. HIEs also say they plan to charge health plans,” he said. North Texas Specialty Physicians’ members don’t pay to participate in Sandlot. Hospitals and labs do pay to connect to the HIE. “Money is brought into the group
through capitation arrangements and is being used to sustain the HIE. Physicians don’t individually write checks, but there is a cost to the group to keep the HIE running,” Dr. Deas said. “Physicians who aren’t members of North Texas Specialty Physicians do pay a monthly fee to use the HIE. The fee varies depending on what services the physician wants.” Dr. Deas explains money invested in
the HIE improves efficiency and quality of care, generating a return on invest- ment and retained earnings from risk management contracts. “We have a solid business model that fosters tremendous value for our users, and the HIE is profitable. We’re able to return some of those profits back to the HIE,” Dr. Deas said. North Texas Accountable Healthcare
Partnership is developing plans to stay in business in the long term that will depend on charging fees to users. Once approved, the partnership will publish the pricing model on its website, www
.ntahp.org. “We’re going to charge only what we have to and not a penny more. The part- nership has been tasked with working as efficiently as possible,” Mr. Lastinger said.
One common theme across all the HIE plans to remain viable is aligning HIE value with the cost so the primary contributors also are the primary benefi- ciaries, Mr. Gilman says. He adds HHSC and THSA monitor local HIEs’ sustain- ability efforts and plan to initiate com- munication regarding sustainability later this year.
Eventually, local exchanges will con-
nect across the state and expand connec- tivity to other states and the nation. Local HIEs will communicate with
THSA using local master indices of pa- tient and physician information from HIEs. THSA will then securely exchange
10 questions to ask HIEs
Before committing to a local health information exchange (HIE), physicians need to ask questions. Physician health infor- mation technology experts recommend physicians consider:
1. What information will the HIE share? Some share only labora- tory data; others allow access to discharge summaries, notes, test results, and more.
2. How can physicians determine the source, date, and time of the data; Physicians need to reconcile contradictory infor- mation they may encounter, such as a “penicillin allergy” for a patient pulled from one electronic health record but “no known allergies” pulled from another.
3. What are the HIE’s privacy and security mechanisms? Physi- cians should find out how the HIE obtains patient consent for using the data. If a patient chooses to exclude some data from being shared, the physician should make sure the HIE discloses that fact.
4. Does the HIE include the patient populations, referral net- works, and the hospitals and other physicians the doctor works with? Make certain the HIEs connect to the local hospi- tals, labs, radiology services, and other facilities.
5. Will the HIE be financially viable in the future? It’s not simple to move from one HIE to another. Physicians should ensure the HIE has a thorough business plan with strategies for long-term success and should ask their colleagues about the exchange’s track record and functionality.
6. Is there a fee to participate? Many HIEs are free initially, but physicians should ask about potential future fees.
7. Who is on the HIE’s board of directors? 8. What are the computer system requirements to connect to the HIE?
9. Does the HIE use a centralized or decentralized model? A centralized model obtains a patient’s permission to have their records and information stored in a database. Physicians can query the database for patient information and share it with others. A decentralized model permits access only by autho- rized personnel and entities.
10.Are there opportunities to provide feedback on HIE opera- tions?
October 2012 TEXAS MEDICINE 45
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