March 13, 2008

"The Expanding Data Bridge"

By Gary Baldwin

A dispute among key members will not derail the Cincinnati-based HealthBridge data exchange,
says CEO Bob Steffel.

The July 2005 cover story of HealthLeaders analyzed the success of HealthBridge, a data-sharing collaborative based in Cincinnati. At that time, HealthBridge's membership comprised four delivery systems that encompassed 17 hospitals. The collaborative served as the hub of delivering lab results and other clinical reports to area physicians. Since then, HealthBridge has added new members and services, continuing to deliver on what much of the industry continues to debate. Technology Editor Gary Baldwin recently caught up with HealthBridge Chief Executive Officer Robert Steffel to discuss how the collaborative has grown--and how it reacted to an internal dispute involving a key health system member.

HealthLeaders: How big is HealthBridge these days?

Robert Steffel: We now have 27 hospitals. In October 2007, we sent 2.31 million clinical results to 4,431 physicians. We maintain the same business model, with member hospitals paying dues. We now have more interaction with health plans, and one plan is on our board. We have added ambulatory lab ordering through the messaging system, and we have seen substantial growth in electronic medical record adoption among physicians to whom we are feeding data directly. Of the 2.31 million results, 95 percent were delivered electronically either through our clinical messaging system or directly to an EMR. The rest we print, mail or fax. We have 1.8 million people in our unique master patient index. When we talk about the notion of the medical home and the continuity of care record, the MPI is going to be pivotal to making it happen.

HL: Have you had to upgrade your infrastructure to accommodate the increased traffic?

Steffel: About two years ago, we upgraded to a SAN [storage area network]. We've made major changes to our technical infrastructure. We are moving to blade servers and making use of virtual servers. It is a technology refresh along with another round of standardization. We used to have edge servers at each customer site, but version control was an issue. That arrangement gave us minor issues with standardizing the data and major issues with maintaining the network. Different organizations had different access policies, so we are pulling all servers into our data center. We should finish by March 2008.

HL: I see you have added additional business partners other than hospitals.

Steffel: Since we talked in 2005, we brought up two major labs, Quest and LabCorp, in 2006. We've also added four radiology companies that use us to send their data. The labs use us to deliver results to physicians.

HL: What effort did it take to get the labs involved?

Steffel: We were talking with the labs and making the ROI argument that instead of having printers at each physician office, you can deliver data through us. We went to one group that had 13 offices, which meant it had 13 printers. The physicians said they liked data coming in through our clinical messaging system, but they said they would still need the printers for the instruments in their offices. But then they had this insight that if they could get the data from their lab system into our clinical messaging system, it would be great. We created an interface from the lab system in the group directly to clinical messaging; we feed them all the results of their own lab instruments through clinical message. It created a single workflow and allowed the lab to get rid of 13 printers. The system incorporates lab flow into other things, like the automated routing of public health data.

HL: What are you doing with public health reporting?

Steffel: Our health department project is extremely exciting--it solidifies the flow of critical public health reportable diseases. Because we have the vast majority of clinical data flowing through a central point, there are ways to look at data analytically and route it based on content. Our current chairman is the public health commissioner. We sat down with 17 local health departments and talked with the state health departments of Ohio and Kentucky. We selected five diseases, including E. coli. Reporting used to be a paper process; when a microbiologist found a positive result, he would write it down and mail it to the Cincinnati Health Department. In turn, the health department would say, "This should go to county." It took two mailings when it worked well. We altered what the microbiologist puts on the test. We added a code, and based on the ZIP code of the patient, we route the data to the public health department that needs it. E. coli notification used to take nine days through the paper system--it is now down to nine minutes. We are in the process of creating similar feeds from public health to state health.

HL: I understand you a doing an OR data project as well.

Steffel: That's another new piece for us. We are testing what we call "OR data search." We have it up for the Health Alliance, a six-hospital health system with facilities in Cincinnati and surrounding communities. We get a daily feed of their OR scheduling--we get the patient identifiers, we know who is having surgery. The system links to our Quest data. Any lab result for a patient with surgery is viewable at the Health Alliance preoperatively. We were surprised at the reaction--people in the OR and recovery area all want access. The plan is to go beyond the Quest data and add any test the patient had in the previous 60 days.

HL: We've seen reports about a legal and financial dispute within the Health Alliance--that two of its hospital members want to drop out. That triggered a dispute over the relative value of their respective assets. Has the controversy affected HealthBridge? Health Alliance is one of your key members, so what happens if hospitals within it drop out? Will they still be members of the data exchange?

Steffel: The problems with the Health Alliance have been all over the newspaper. We realized we needed to think through the controversy without taking sides--whatever decisions we made about our membership structure needed to be transparent. We decided to deal with any controversies like this by modifying our bylaws that govern participation of our members. They needed to be modified anyway--as the market changes, we need to be able to adjust. It is important to have community representation in the governance process of HealthBridge. If the Health Alliance breaks up, we need to figure out how it would be appropriate to include the breakaway hospitals.

HL: HealthBridge has had difficulty getting health plans to participate. It sounds like that may change.

Steffel: The health plans are interested in quality programs and stepping up their participation. We are in early discussions. They have a different set of needs, but the fact is we are working in a health system, and every time you hit the boundary of an organization, there is delay and expense. To the extent we can create integrated processes where patients receive care, there is tremendous opportunity [to reduce both]. HealthBridge is a collaboration of people coming together and sticking with it to create value. We are hopeful that what we have done can be franchised to help others in a similar way.