HIE Case Study: HIE for Public Health - HSX: HealthShare Exchange of Southeastern PA

HealthShare Exchange (HSX) is the Philadelphia region's health information exchange (HIE). HSX is a non-profit 501(c)(3) organization making secure electronic patient-care information available throughout the area’s medical systems. HSX links data across hospital systems, healthcare insurers and other healthcare organizations as a service to HSX members and participants. The HSX platform allows medical centers, insurers and practice offices to share clinical records to make patient care more informed by providing patient histories and event notifications throughout the system. Such exchange is part of the health information future for providers, payers, and consumers seeking better, more cost-effective care. Electronic HIE promotes continuity of care, reduces the need to transmit or transport medical information by fax or in-person by the patient, and helps to reduce duplicate services.

HSX was established in May 2012, and their Board and Governance was formed in January 2013. The HIE is governed by a seventeen (17) seat Board of Trustees representing five hospitals, five health plans and seven members at large. Decisions are made through the HSX committee structure and governance process. Committees have member and external stakeholder representation. The Executive Committee is very involved in HSX’s operation.

The geographical area served by HSX is the city of Philadelphia and surrounding counties: Montgomery, Delaware, Chester, Bucks and Philadelphia. HSX coverage is primarily metropolitan; there are more than five million patients in HSX’s Master Patient Index (MPI). Participant entities include forty hospitals, seventy independent ambulatory practices, two behavioral health organizations, five health plans, and two accountable care organizations (ACOs). There are more than eight thousand practitioners in the HSX Provider Directory.

Pamela Clarke, Senior Director of Member Services, Policy & Privacy for HSX was interviewed on the topic of using HSX for public health capabilities.

HSX’s business plan is built around enhancing clinical care delivery to patients throughout the region to ensure:

  • Healthcare providers and stakeholders have access to shared community information assets to support key clinical decisions across care settings.
  • Quality outcomes, patient safety, and population health are improved.
  • Costs are contained through improved efficiency and reduction of duplicative services.
  • Patients and consumers benefit through an improved experience with the health care system, with special focus on the chronically ill and underserved communities.

The HealthShare Exchange (HSX) website provides a full list of products and services.

There are two main challenges that HSX faces on delivering value. The first is financial. HSX is primarily supported by membership/subscription fees plus additional service fees for certain value-add products. It also continues to benefit from federal and state grants. As HSX expands its footprint, it will maintain a stable financial position without outside funding. The second challenge is technical. In 2015, HSX was forced to change vendors due to technical challenges. Since the conversion to Mirth as the HIE’s technical vendor, there have been no major technical issues faced. Over the years, HSX has worked through many of the interoperability challenges with providers/practices and their electronic health record (EHR) systems.

HSX and the Freedom Valley YMCA executed an agreement for the YMCA, a community service provider, to use Direct Secure Messaging (DSM) to receive referrals electronically from primary care physicians for a Diabetes Prevention Program (DPP). The YMCA was an existing participant in DPP, a grant-supported program sponsored by the Centers for Disease Control and Prevention (CDC) and this project was initiated to enhance coordination between the physicians and the YMCA. The project went into production in the Spring of 2016.

This agreement with the YMCA is part of an HSX contract with the Health Federation of Philadelphia to increase bi-directional communication between healthcare providers and community resources focused on prevention. The contract is supported by a CDC grant through the Philadelphia Department of Public Health’s The Philly Difference: Connections for Better Chronic Care project, which seeks to prevent and better manage chronic disease. In addition, HSX is developing bi-directional communication between Federally Qualified Health Centers and Temple Health for DPP.

HSX offers Direct webmail services to the YMCA at no charge. The patient population targeted for referral are adult individuals who meet specific clinical criteria identifying them as at risk for diabetes. This is a bi-directional exchange of information between providers and the YMCA:  providers send referrals to the YMCA and the YMCA provides feedback on participation and education for the individuals back to the providers.

This is an ongoing project with regards to ROI. HSX expects that the value derived will be the extension of service to additional community providers that engage with individuals outside of their regular healthcare visits

Additional value from this project will come from the methods and lessons learned in this project, which can be taken and applied to other future projects. For example, pediatricians with patients who suffer from food insecurity could exchange information with social services agencies. This is a service HSX could offer as part of a new program the Commonwealth of Pennsylvania is supporting called the “Health Enterprise Zone.”

The intent of this project is to promote bi-directional communication between providers and the YMCA to support the YMCA’s Diabetes Prevention Program participation and education activities for adults at risk for diabetes. To monitor the Direct webmail communication activity by providers, HSX is generating reports indicating how many referrals are made to the YMCA on a monthly basis.  

This work has not affected the sustainability of HSX. A grant for approximately $25,000 provided financial resources for the project. In addition to deploying the Direct Secure Messaging (DSM) product, HSX also provided a project manager as a resource to test message exchange between providers and YMCA individuals.

Development of the product roadmap for HSX incorporates input by the Board of Trustees and other third parties, including business and strategic leaders in the health industry. HSX’s strategic planning process is currently being kicked-off. 

Business planning for HSX spans two years into the future at any given time, and this has worked well to-date. Contributors to this planning are primarily HSX staff and external consultants; input from the Board of Trustees and HSX committees is also considered.

HSX has applied for a Pennsylvania grant opportunity to provide HSX participants with a Pennsylvania public health gateway for provision of electronic lab reporting (ELR) followed by the potential addition of bi-directional immunization exchange and support for cancer registries in accordance with state public health regulations.

The Diabetes Prevention Program (DPP) project highlights the opportunities for an HIE to provide products and services to facilitate the expansion of information exchange beyond the traditional hospital and provider practice data sharing to other community service providers involved in improving individual and community health.

HIMSS is a global, cause-based, not-for-profit organization focused on better health through information technology (IT). HIMSS leads efforts to optimize health engagements and care outcomes using information technology. The inclusion of an organization name, product or service in this publication should not be construed as a HIMSS endorsement of such organization, product or service, nor is the failure to include an organization name, product or service to be construed as disapproval. The views expressed in this white paper are those of the authors and do not necessarily reflect the views of HIMSS.


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