The Nebraska Health Information Initiative (NeHII), a collaborative comprising healthcare organizations, hospital systems, physician groups, business groups and payers, has been working towards a health information exchange (HIE), but the model that has emerged that all stakeholders are hanging their hats on is a “community betterment” model.


“This is not just an HIE,” said Deb Bass, NeHII interim executive director and president and CEO of Bass & Associates, consultants to the organization. “We’re looking at the big picture of community betterment for all Nebraska residents,” she said.


Incorporated in 2008, NeHII grew out of efforts five years ago to enhance economic development and recruitment of biomedical sciences companies through the implementation of a statewide electronic medical record (EMR) system, said Harris Frankel, MD, NeHII president and one of the original visionaries. The collaboration grew and Blue Cross Blue Shield of Nebraska originally sponsored the effort that brought together a broad stakeholder group.


“Through hard work and determination, the collaboration really stuck with this,” said Frankel.


In a relatively short period of time, NeHII, which is filing for 501(C) (3) non-profit status, is rapidly moving forward. NeHII is finalizing its contract with Axolotl, which will be deploying its Elysium Exchange to connect Omaha pilot participants, including hospitals, clinics, physician offices, radiology centers, reference labs and pharmacies, sometime during the fourth quarter of 2008. Pilot participants include the Methodist Health System, the Nebraska Medical Center, Alegent Healthcare System and Children's Hospital, with the VA Nebraska-Western Iowa Health Care System a tentative participant.


The three focuses will be on clinical messaging of lab and X-ray results, e-prescribing and physician reference, said Bass. After an evaluation following 90 days of operation, NeHII will bring its HIE capabilities statewide, she said.


NeHII will be embarking on a two-day trip to make a presentation to Governor Dave Heineman and Lt. Governor Rick Sheehy and request to be included as a line item on the state budget. While Heineman has made no promises of funding NeHII, he has asked to see a demonstration of the pilot after 45 days to determine its financial viability, Bass said. The trip will also include meetings across the state with hospital CEOs, CTOs, CFOs and CIOs.


NeHII is approaching a number of local business leaders and foundations, including the Leland J. and Dorothy H. Olson Charitable Foundation, the Yanney Foundation and the Peter Kiewit Foundation, to solicit start-up funding to keep barriers to a minimum for the smaller hospitals, Bass said.


Nebraska’s rural population is challenged with healthcare access issues, and its second state in the nation ranking for its aging citizenry presents access problems as well, both of which make the physician referral piece so critical for NeHII, she said.


While the organization has no formal consumer education program in place, NeHII has made itself available to the general population and business leaders through participation in the Nebraska Rural Health Association Conference and the Greater Omaha Chamber of Commerce.


Patients are the major beneficiaries of NeHII’s efforts when physicians can access electronic medical information at the point of care and deliver safer, higher quality healthcare in a cost-effective manner, said Frankel. Patients will have truly portable information that can only be shared through their authorization, he said.


Non-hospital-employed physicians and primary care physicians would also benefit. Adoption rates of EMRs and EHRs are still fairly low, mainly due to implementation costs and the inability of physician EMR systems to communicate with the multiple hospital EMR systems out there, he said. Axolotl’s ASP model is cost effective and its Elysium EMR Lite solution enables physicians who don’t have a system in place to participate and access patient information, he said.


“There is great interest that’s being expressed among physicians,” Frankel said, to have access to these types of decision-support tools.


Employer groups also benefit by having aggregated, de-identified data to help with population health management programs.


Bass said NeHII has been successful in such a short period of time because of its mastery of project management, business networking, building group consensus and more importantly creating a value statement for each stakeholder. “We’ve had tremendous success in getting things done,” she said.