The HIE in HealtHIE Nevada stands for health information exchange, which helps health care providers coordinate patient care by connecting them with each other and sharing medical records in a secure, accurate manner. Michael Gagnon, executive director of HealtHIE Nevada, talked to us about the satisfaction he receives from working in the nonprofit sector and how much money it would take to develop a fully integrated, statewide network of health information.
Do you have any recent news or updates about yourself, your work or your organization that you’d like to share?
Since I started as executive director last August, our organization has made some major strides. We have improved our finances, begun formal marketing, rebranded, added new technology, established staff training, were accredited by the Electronic Healthcare Network Accreditation Commission (EHNAC) and certified by the state of Nevada. We also obtained $1.2 million in state and federal Health Information Technology for Economic and Clinical Health (HITECH) funding to connect underserved health care organizations and several state organizations.
Who are your community partners?
In a health information exchange, you need to partner with as many provider, payer and patient organizations as possible. You also want to partner with provider associations and vendors who provide specific services. Our close alignment with HealthInsight, the Medicare quality improvement organization for Nevada, is one key to our success. HealtHIE Nevada contracts with HealthInsight to provide the management contract and staffing for the HIE. This give us numerous advantages in staffing and back office functions like payroll and benefits that other HIEs normally do not have.
When did you know this is the field you wanted to get into?
Early in my career, I worked for a defense company with some very good engineers. After working for 10 years in defense, I had an opportunity to work for the Mayo Clinic. When I first got into health care, it seemed so far behind in its use of technology. But then I started to view this as an opportunity to make a difference. Ever since that point, I knew this was the field I wanted to be in.
How does working for a nonprofit organization differ from a for-profit firm?
First, the culture of a not-for-profit is different. Our primary goal is not to make money but to have a community mission we are trying to accomplish. Second is how we are funded. We depend on grants, donations and the fees we charge to our clients. For many not-for-profits, they mostly need operating funds and have relatively small needs for capital funds. But since we are building a health network, we have significant need for capital funds. This is our biggest challenge. The value of the network is highest when you have many contributors.
Do you foresee any proposed legislation in the 2019 state session that will affect your company or health care in Nevada?
We are not aware of any pending legislation that would affect our work. However, we would like to see some additional legislation that could improve the way we deliver services. Specifically, we would like to see the Legislature allocate some state funding to be matched by the Centers for Medicare and Medicaid Services. The HITECH appropriates funds for health information exchanges at the rate of 90-10, meaning that if the state can come up with 10 percent, CMS will fund the remaining 90 percent. I estimate that we could connect nearly all the providers (clinics, hospitals and post-acute care) to the HIE for approximately $20 million. If the state could come up with $700,000 per year for the next three years, we could obtain $21 million and have nearly all providers connected.
The other legislative change we would like to see is to change the law that requires all patients to sign a consent form for their data to be shared with providers. Most states are opt-out, which means that patient data can be shared unless a patient opts out. Here, the consent model is opt-in. After seven years of collecting consent and data, we now have statistics showing that 95 percent of patients who are asked choose to opt in. In both cases, patients can decline consent, but when you are an opt-in, state you must collect consent forms on all patients rather than only 5 percent. This adds administrative burdens for providers who are already suffering burnout. Our rough estimate is that it will cost Nevada $12 million to collect consent forms on all patients while not improving privacy. Adding administrative complexity does not improve privacy.
What’s the biggest issue facing Southern Nevada?
A lack of primary care providers and specialists makes access to care difficult for patients, so many residents use emergency rooms and urgent care centers for their primary care. That is very expensive. Urgent care centers are much more cost effective, but they are best suited for relatively simple patient issues that can be resolved in a single visit. If the patient has chronic or complex conditions, then this episodic care is far less effective. One way to solve this is to have all emergency rooms and urgent care centers connected to the HIE so each provider location could access the patient’s medical records.
What is the best business advice you’ve received?
The most successful people are not the smartest or even the hardest working. The most successful are those who are willing to do what unsuccessful people are unwilling to do.
What book are you currently reading?
I’m reading “Hillbilly Elegy,” which describes the struggles that many segments of our nation have with breaking out of their predetermined destinies.
Whom do you admire?
Bill Gates, Tom Brady and anyone who devotes their life to something bigger than themselves.
What is something that people might not know about you?
I am a certified scuba diver and I love to cook. My specialties are anything Italian or grilled.