Highmark creating statewide system to leapfrog UPMC’s regional one

Health insurer Highmark Inc. is preparing to disclose details of a statewide electronic network that will be used to share patient medical information among doctors and hospitals, leapfrogging a competing network that’s being developed in western Pennsylvania.

Highmark’s health information exchange will link hospitals statewide and eventually West Virginia and Delaware, where the company has operations, according to Mike Fiaschetti, senior vice president of provider services and strategy. Highmark wants to create a community resource rather than another point of contention with its rival, the University of Pittsburgh Medical Center, which is backing development of the regional network.

“In an ideal world, everybody will connect with each other,” Fiaschetti said. “These need to be community assets, community resources.

“We want nothing more than a collaborative model, not a way to create division.”

Fiaschetti declined further comment. Company spokesman Aaron Billger said the company would announce details of its network Feb. 20.

Such a move by Highmark would be a key decision in building an alternate health care delivery system with the West Penn Allegheny Health System, which Highmark is seeking regulatory approval to acquire. In recent months, Highmark also dramatically extended its reach by affiliating with Monroeville-based Premier Medical Associates, the region’s biggest independent physicians’ group, and by making a “significant investment” in Morgantown-based MedExpress Urgent Care, which has become ubiquitous in western Pennsylvania with 28 clinics. Highmark also has been planning outpatient medical centers around the city, including ones in Murrysville and Pine Township.

Separately, a regional electronic medical record exchange network is scheduled to go live in late March or early April, giving doctors access to patient treatment information from nine member institutions.

Heritage Valley Health System is spearheading a venture called ClinicalConnect, which is a nonprofit health information exchange that will make it possible for doctors to retrieve medical records from participating hospitals. Butler Health System, Armstrong County Memorial Hospital, Jefferson Regional Medical Center and UPMC are among the participating institutions, and the goal is to eventually link to hospitals statewide, according to Heritage Valley CIO David Carleton.

“There was a tremendous amount of effort even before UPMC got involved,” Carleton said. “It’s moving rapidly because we’ve been building trust and relationships.

“It’s working well.”

Electronic medical records store patients’ treatment information, and there’s no easy way to get to that data until the first health information exchange is up and running. Fewer medication errors and duplicate medical tests such as X-rays are among the anticipated benefits when patients receive care by different doctors at different institutions.

Here’s how it will work: A family doctor, for example, who wants details of the treatment rendered by a hospital for a particular patient will be able to electronically query the participating hospital where the care was provided. The information will then be securely transmitted to the doctor, which will shape his decisions about caring for the patient.

Start-up costs for ClinicalConnect were estimated at $4 million, which will be shared among participating institutions, with fees determined by size and number of patients, according to Chris Carmody, vice president of information technology outreach services. So far, 60 percent of patient records have matching files at UPMC, which is much higher than expected.

“We’re at a great place right now,” Carmody said. “It has been building incrementally.”

The fee structure will be designed to eliminate as many barriers to participation as possible, Carmody said. The electronic network is expected to have all of the hospitals connected by July. The eventual goal is to link all physicians, whether or not they are employed by a hospital system, nursing homes and other health care facilities.

Driving the development of health information exchanges is a federal requirement that hospital electronic medical record systems have the ability to “talk” to other hospitals and doctors.

It’s not yet clear how many health information exchanges will be needed in the state, according to James Younkin, program director at Danville, Pa.-based Keystone Health Information Exchange, the first such network in Pennsylvania. Keystone was formed in 2005, and it links 50 hospitals and health care facilities in 31 counties.

“You could end up consolidating HIEs, getting some economies of scale,” he said. “But at the same time, you could wind up providing services to smaller and smaller units,” using multiple networks.