In the year since it was created by the merger of two Michigan health information exchanges, Great Lakes Health Connect has become one of the highest volume HIEs in the country with 1 billion health information transactions, 1,000 medical practices using its closed-loop Referrals application, and soon, 1,000 provider practices linked to the state's immunization registry.
By achieving this critical mass, GLHC can provide secure data connections that are unparalleled in scope, says Executive Director Doug Dietzman. Furthermore, the organization intends to leverage its stature to serve as an example at the national level.
When CMS or the ONC look to advanced networks to see how how they are solving problems, there has been a traditional cast of characters, Dietzman says, and GLHC plans to be a part of it.
"There are some good HIEs out there that are always part of the conversation, and what we're trying to demonstrate, kind of on a national scale, is that we're doing some good things here in Michigan," Dietzman says. He adds that as an advanced player, they could also help the CMS, ONC or others to develop additional solutions.
Dietzman spoke with Healthcare Dive to discuss the company's self-sustaining business model and vision for the future.
Sustainable growth
GLHC is proud to note that it succeeds through member fees rather than outside funding.
"There's a lot of talk in the industry about whether HIE is sustainable and whether you can do this in the private sector," Dietzman says. "I think as a large community-based exchange, one of the things that we are showing is that you can in fact do that. We continue to grow and add services and solutions, and do it all without federal or state funding."
He also attributes the organization's success to its attention to workflow as opposed to technology.
"If at the end of the day we don't actually change the way care is being delivered for the citizens of Michigan, then we haven't done much," he says.
With that view in mind, the organization has been focused on how to help each office or hospital, which does things uniquely, to utilize their tools the best ways possible.
"I think that's one of the reasons that we've been successful, and how we stand out from some who just see this as a transaction business. It's really a workflow—it's a process business that has a technology component to it, so we spend a lot of time trying to figure out how we can do that as best we can."
Even without further standards, Dietzman adds, there are things that can be done in HIE with current technology in the current environment.
The future
GLHC is looking to build on its success in creating a single interface that talks to EMRs and the state.
"That's one of the things we're trying to do across the board," he says, for efforts such as syndromic surveillance messaging to the state, results delivery and lab ordering.
As for the possibility of expansion or further mergers, Dietzman sees a mixture of opportunity and practical limitations when it comes to HIE efforts crossing state boundaries.
One factor is the purchasing power of CMS and state Medicaid programs, which do not create incentive for states to regionalize, Dietzman says.
Another practical matter is that the value of a network is who's in it, Dietzman says, so there's little value in adding on individual hospitals or communities—communities need to align together.
The biggest factor, however, may be state laws.
"I think part of that question will get answered based on how state law, perhaps, gets more uniform, relative to opt in vs. opt out and some of the other things that are potentially challenging in how exchange works across state lines," Dietzman says.
He looks to the banking industry as an example, noting that when ATMs were developed, every bank had its own. "You didn’t need as many as there were, so those banks and networks regionalized themselves and went behind the scenes—so now you don't need to know the network behind any ATM," he says.
"I think in the HIE world we're kind of in the early stages like the ATM, where we've got probably more than we need," Dietzman says. He expects that ultimately, some of these networks are going to regionalize as well.
"Our goal is to get behind the scenes so you don't even know were back there," he says.