that’s economic, and that (unprofitable services) can be subsidized, but only if the institution gets value from it, I don’t think
that is true,” Lenert said during the NeHC discussion. “I think
things like record locator service that looks up every place that
a person has been and integrates that record for emergency
purposes isn’t necessarily economic, but it is really valuable to
“Competition First, Then Cooperation”
A healthy bottom line for those health systems that invest in
private HIEs is good for patients, too, Voigt contends. The private HIE approach of business case supporting information exchange could be the long sought key to HIE success, he says.
“We say at MobileMD, with good economics comes good
care,” Voigt says. “Even though our providers often start using
a MobileMD network for competitive reasons, literally driving
more patients through the door by connecting with more docs
in the community, that’s competitive and maybe makes you not
feel quite the right way, that healthcare should be better than
“But we live in a capitalist economy and that is the way it is.
But even with that physician affinity, we know there is better
data flowing and care can be improved. It is still a good thing.”
While providers might create a private HIE for competitive
reasons at first, Voigt says that as they become more comfort-
able with the HIE’s capabilities, benefits, and risks, many pro-
viders begin to reach out and share data with other HIEs with
care and quality improvement in mind.
Several MobileMD customers have worked with competitors
to trade information through their HIE, but they had to come
to that relationship on their own, Voigt says. He thinks many
providers would be reluctant to join a state HIE that forced collaboration.
“We have a phrase: ‘competition first, then cooperation,’” he
This phrase has rung true for private HIE operator Pinnacle
Health System. Located in Harrisburg, PA, Pinnacle uses the
profits from its most successful HIE functions to invest and support the other services that do not make money but improve
healthcare and support the HIE’s greater good, says Steven
Roth, vice president and chief information officer with Pinnacle.
In 2009, unwilling to wait for Pennsylvania’s then-fledgling
regional HIE to develop, Pinnacle established a private HIE
through MobileMD in an effort to better connect its physician
offices with the healthcare system. Today about 780 physicians
use the Pinnacle HIE, Roth says.
Pinnacle’s earlier attempts at joining a public HIE were not
promising. In 2007, it joined central Pennsylvania’s biggest
health systems and payers to discuss a regional, public HIE. But
after six months of grinding discussions, “it became really clear
to me that the neutral HIE wasn’t really growing arms and legs
and the health systems in the market really weren’t interested,
probably because of competitive reasons,” Roth says. “It became
clear if we wanted to do this, we had to do it ourselves.”
HIE concept: Participants
Source: IL HIE Authority Data Security & Privacy Committee
Though grants were being handed out to establish HIEs, Pinnacle wanted its HIE to be sustainable from the beginning. The
plan was to build an HIE that made a profit by boosting use of
Pinnacle’s ancillary services such as lab and radiology through
referrals from the physicians they would connect to. Electronic
ordering capability and electronic results distribution would
also spur more business.
But Pinnacle does not choose its HIE services solely by profitability. The network’s profits are in part used to support more
community-focused activities that are unprofitable. For example, one initiative helps religious organizations that use the HIE
to proactively manage and monitor the care of their members.
“We started shopping in the market for a product that could
support all of the not-for-profit, community minded and focused set of capabilities as well as a set of functionality that gave
us a reasonable ROI story to tell when we went to ask our board
for funding,” Roth says.
The HIE achieved ROI in nine months, half the time it expected. For the last three years, the HIE has been operating with a
“We had to build the funding mechanism in, but the real focus—and where most of the time is really spent—is around the
community outreach piece of the HIE, patient and community
engagement, physician engagement, the not-for-profit, mission
piece,” Roth says.
The Case for Compatibility
While state HIEs might need wider stakeholder input to develop standards, privacy agreements, and other consensus for the
HIE to develop, some argue that they are in the best position
to ensure data exchange remains the most useful and secure.
Private HIEs must follow HIPAA too, and supporters like Willard
contend that they create exchange that is just as valuable and
private as any state entity.