Keystone Health Information Exchange


The Keystone Health Information Exchange (KeyHIE) was founded in 2005 and is both one of the oldest and largest HIEs in the United States. KeyHIE is governed as a Regional Health Information Organization (RHIO), with more than 50 separate healthcare organizations participating as members. Serving the Pennsylvania area including 53 counties, KeyHIE has hundreds of participating providers with the mission to provide timely and secure patient-focused exchange.

Jim Younkin, Director of Information Technology at the Geisinger Health System, joins us and shares his insights and experience from the Keystone Health Information Exchange. In order to succeed, he emphasizes the importance of patient privacy, organizational representation, showing immediate value and the need for the ability to connect with technology at any level.

I began attending the HIMSS Annual Conference in the mid-1990s as part of my IT management responsibilities and have continued to participate through a number of different hospitals and health systems.

I have enjoyed working with colleagues in various workgroups. I recently served on the Board for the Central PA Chapter, and had the privilege of leading a team to host an educational event for meaningful use, which had great participation. It’s terrific to have an opportunity to work with like-minded folks with a passion for improving healthcare through better information services.

Keystone Health Information Exchange major milestones include:

  • KeyHIE was formed in 2005 as the Central Pennsylvania Health Information Collaborative. We started with a group of eight hospitals and health systems who were interested in finding better ways to exchange health information between disparate healthcare organizations.
  • Went live in 2007 with a rudimentary clinical portal that allowed a clinician to see health records for the other two systems.
  • KeyHIE issued a request for proposal (RFP) in 2008 to implement a document registry and repository based on the Integrating the Health Enterprise (IHE) model described at the HIMSS Interoperability Showcase™.
  • In 2009, the new version of the exchange where documents could be exchanged using the IHE profiles.
  • In 2012, KeyHIE first offered an HIE-connected patient portal that allows patients to see electronic health records from all their providers
  • In 2013, Keystone Health Information Exchange (KeyHIE) was incorporated as an independent, not-for-profit corporation.
  • In 2013, EHRs began consuming clinical documents directly from KeyHIE using the IHE model without logging into a separate clinical portal.

It has been great to see involvement spread over the years from hospital participation to include many physicians and nurses, which has led to practices and other entities getting involved with HIMSS. I am very excited to see growing participation by long-term, post-acute care and behavioral health providers joining the program.

There are a number of things that I have picked up and learned over the years. Nothing earth-shattering, but absolutely borne out by experience.

  • Don’t underestimate the challenges to addressing patient privacy. State laws vary, as do legal opinions from one health system to the next. This single issue can hamstring an HIE initiative and should be addressed as early as possible.
  • A strong governance model with organizational representation is critical to achieving buy-in and building trust. I don’t know who said it first, but information exchange activities “move at the speed of trust”.
  • Finally, I learned from Dr. Marc Overhage to not try to “boil the ocean” and to focus on “rough consensus and running code”. You need to start small, show immediate value, then grow incrementally.

Each member of the healthcare continuum brings value to care coordination, but not all providers have systems that can be easily connected. We made sure that all have a place at the table for discussion, and we have developed our systems to allow for connections with the lowest level of technology. The KeyHIE Transform tool, developed as part of our Beacon Communities program with ONC, is a good example of creating a method for using existing data from long-term and post-acute care providers.

The advice would depend on where the HIE organization is in the process. For those at the beginning, I’d recommend that they move from “talking” to “doing” and show some level of value early. I’d also recommend working with ConCert by HIMSS™ approved vendors to ensure greater success for your implementations. For those more mature HIEs I would encourage them to share their learnings with others, and to work together across state lines on issues related to privacy so we can keep the momentum going.

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