State and Regional Demonstration in Health Information Technology: Indiana

The Indiana Network for Patient Care (INPC), an operational health information exchange (HIE) in central Indiana, is one of six Agency for Healthcare Research and Quality sponsored State and Regional demonstration projects begun in late 2004 and early 2005 to create State or regional HIEs. The INPC has operated since 1995, providing population-based, longitudinal, structurally coded, and text patient data on citizens of Indiana.

The Regenstrief Institute, acting on behalf of the participants, created and operates the exchange and helped create the Indiana Health Information Exchange (IHIE) to establish a sustainable business model to support the INPC. The INPC covers most of the Indianapolis Metropolitan Statistical Area, a 3,200 square-mile region in central Indiana with 1.7 million residents, but continues to expand with a goal to cover all 6.4 million residents of Indiana. The main objectives of the project were to:

• Assess the effects of HIE on productivity, service utilization, patient quality, safety, satisfaction, and ongoing marginal costs.
• Create a sustainable business and funding model to assure the HIE’s long-term survival by providing services built on top of the HIE, such as clinical messaging, quality improvement, and public health services.

The INPC has continued to grow and support clinical care, public health surveillance, quality measurement, coordination of care, and clinical research. In 2010, 14 hospitals joined the network, and work began to incorporate Golden Living extended care facilities. As of the end of 2010, the INPC stored data for 23 million unique patient registrations, representing more than 11 million unique individuals, 600 million encounters, and 3.5 billion rows of structured results. The project team began to track and share the level of participating providers' utilization of the data with the participating facilities. Quality measures for 5.3 million individuals are now generated monthly. Participating providers and payers receive data on these measures, which physicians use to receive millions of dollars in incentives from payers. The Quality Health First® program, which relies on INPC data, had nearly 1,500 participating primary care physicians at the end of 2010.

Preliminary findings from the study examining barriers to expanding HIE indicate that many stakeholders are still not well-informed about HIE. Small hospitals report that two major reasons for non-participation are financial concerns and lack of IT infrastructure. Several HIE participants were concerned about data confidentiality. INPC is still seeking other data sources, from home health workers and nurse case managers, as well as seeking to extend services.