Indiana Health Information Exchange (IHIE)

Indiana HIE Logo

The Indiana Health Information Exchange (IHIE) is a non-profit organization formed by the Regenstrief Institute, private hospitals, local and state health departments, BioCrossroads and other healthcare and community organizations in Indiana. IHIE connects over 90 hospitals, long-term care facilities, rehabilitation centers, community health clinics and other healthcare providers in Indiana, serving an area with a population of about six million people and over 25,000 physicians throughout the country.

The Indiana Health Information Exchange is a HIMSS Non-Profit Partner, and participates in the monthly HIMSS HIE Non-Profit Partner Roundtable. Below, Deb Hemler, Director of Engagement for IHIE and HIMSS HIE Committee member, shares her thoughts on health information exchange, building and sustaining an HIE organization, and the value of active engagement with HIMSS.

Personally, I entered the healthcare field as an IT Director back in 2001. That was when I became acquainted with many of the healthcare associations and a HIMSS member. In 2006 I joined IHIE and continued my HIMSS membership with IHIE. In addition, I became involved with the Indiana chapter of HIMSS and was a Chapter Board Member for 5 years. I and others from IHIE regularly attend the HIMSS Annual Conference as well as the Midwest HIMSS Technology Conference, and volunteer on various HIMSS committees.

The Indiana Health Information Exchange (IHIE) has been involved with HIMSS since its inception in 2004. Many people from IHIE have attended conferences and participated on HIMSS national and local committees and boards.

The interaction with other HIMSS members and organizations for learning, sharing knowledge and ideas, and participating in policy decisions is rewarding. The learning opportunities within HIMSS are endless and have been invaluable to me personally as my career continues to grow within the healthcare industry. The Indiana Health Information Exchange has had the opportunity to provide input to other organizations looking to start or develop sustainable business models for health information exchange. In addition, the many opportunities for involvement at the national policy level are so important for our industry as the HIMSS organization continues to assist in framing the future direction of healthcare information technology.

IHIE was formed in 2004 to support, enhance and advance the technology developed by the Regenstrief Institute. We have experienced many milestones over our ten years. An early and most important milestones for IHIE was being able to develop a sustainable business model for the nation’s largest inter-organizational clinical data repository, which began as a grant-funded research project. Developing a business model that our customers agreed to was a massive undertaking and one of the most important steps to becoming a sustainable HIE. 

One of the more recent milestones was our ability to support our customers as they moved into Meaningful Use Stage 2, specifically the Transition of Care objective. As our customers were planning for MU2, they discovered that their intended recipients were not yet planning for Stage 2 and had not begun to implement DIRECT in their environments. IHIE developed a solution that works with our customers' EHR vendors and/or HISPs, supporting the connectivity method that they have adopted for DIRECT (SMPT, XDR/SOAP and XDM). IHIE developed a solution that utilizes our DOCS4DOCS Clinical Messaging System to deliver the CCDs to the intended recipients in the same method that these providers receive other clinical results.

IHIE is currently delivering over 90,000 CCDs per month for over 50 hospitals, enabling them to meet the Transition of Care objective for the first year of Stage 2. This was a huge milestone for IHIE in that we were able to both support the standards required for MU and utilize our current solutions in the marketplace to reduce the impact on the providers that were not yet at the same stage of MU and DIRECT implementation. 

One of the most notable changes for health IT is Meaningful Use. The changes have been both good and bad. It has pushed this industry forward in the adoption of electronic health records, and as a result is pushing the conversations and solutions for interoperability and health information exchange. This industry has been talking about EHRs for years, but the implementation was moving at a glacial pace until MU.

  • Flexibility. As an organization that is supporting many stakeholders, IHIE has developed the ability to be flexible. Our agile in-house development structure allows us to work with our customers and provide creative solutions to meet their challenges. Health information exchange has been happening in Indiana for many, many years, and the technology was developed long before the recent standards that have been part of the MU regulations and eHealth Exchange initiatives.
  • As other HIEs have expressed, the challenge for IHIE is trying to support all of the adopted standards in our industry.  Our core services support HL7 V2.x and have for many years. This way we are able to support all of the various vendors as long as they can send us some version of HL7. We also are an eHealth Exchange organization and utilize Connect to exchange data with the Veterans Administration and SSA. Now we are supporting the three DIRECT protocols, and also have on our roadmap to support the Integrating the Healthcare Enterprise (IHE) protocols.
  • It is imperative that an HIE run like a business. An HIE organization has to have products and services that provide value to the customers/stakeholders who are willing to pay for the services. If the HIE customers do not perceive value, then the HIE will not survive.

IHIE’s Clinical Data Repository, the Indiana Network for Patient Care (INPC), was started many years ago by the Regenstrief Institute. This is the largest inter-organizational clinical data repository in the country. It is a centrally managed federated model whose data is normalized at a very granular level. Organizations send information to the INPC via HL7 2.X interfaces. Legacy systems are usually able to send some version of HL7 and we are able to integrate the various versions. 

As the industry has matured and regulations are moving everyone towards HL7 2.5.1 and beyond, our participating organizations are upgrading their systems and more and more are now sending HL7 2.5.1. We also are able to receive various flavors of CCDs (C32, C62) and are able to parse and store the data in the INPC. The INPC is that platform that brings together clinical data from multiple systems/versions, normalizes and organizes that data into viewable content for providers at the point of patient care. As the standards change, mature, and evolve, with IHIE’s development team in-house we are able to adjust and accommodate our stakeholders’ needs as they develop.

Find the value for your stakeholders. 

Listen to your customers, hear what their struggles are and look to offer solutions that address their challenges.  Keep patient care, patient health as the focus. Don’t try to boil the ocean all at once. It’s a marathon, not a sprint, and the first step is creating a partnership with your stakeholders so that you can build those bridges for data flow that support patient care.

In addition, your stakeholders need to represent all areas of our healthcare continuum – acute care, post-acute care, ambulatory, home health, payors, patients. An HIE has to build a sustainable business model around the value proposition of the services that they can provide to their customers.

Learn more about becoming a HIMSS HIE Organization Non-Profit Partner.