Operational since 2005, Keystone Health Information Exchange (KeyHIE) is one of the oldest and largest health information exchanges (HIEs) in the country.

The Pennsylvania HIE began with only three participating hospitals but has since expanded to include 100 unique healthcare organizations comprising 26 hospitals, 335 physician practice groups, 29 home health agencies, 89 long-term care facilities, one pharmacy, four EMS services, and three insurance payers.

KeyHIE aims to improve care coordination at all participating facilities in Pennsylvania. And in an industry subject to as many technological shifts as healthcare, that requires the ability to adapt. Most recently, KeyHIE has developed a tool — the Information Delivery Service (IDS) — to consolidate a patient’s data into a single comprehensive health record.

The health data tool is also capable of identifying high-risk patients as well as patients with chronic conditions. By aggregating each patient’s data into a central repository, the system enables improved population health management for care teams and accountable care organizations (ACOs) part of the KeyHIE network. The service also provides alerts, notifications, and patient data to inform providers of where patients receive care within the KeyHIE network.

So far, IDS has paid off.


“We’re actually seeing a huge cost savings for these practices,” KeyHIE Director of Operations Kim Chaundy told EHRIntelligence.com. “We did a case study for just one month and found we’re saving one practice $56,000.00 in one year, just through utilizing this service.”

The service was designed with population health management in mind — developers built the technology to have the capabilities to identify specific patient populations, notify providers of when results or specific information is coming through the system, and identify qualifiers informing providers of what to do with issued results.

“When it comes through we look at the ordering doctor to see if that patient is already identified in a special cohort,” said Geisinger Health System Associate CIO Joe Fisne. “Then it goes through an algorithm that says, ‘Okay. This particular doctor wants it delivered to them via HL7 and directly into their EHR chart.’”

By using sets of standards — including HL7 — as part of its technology, KeyHIE can directly embed incoming information from IDS into patient medical records.

“We route it directly into the EHR system, the patient’s chart, and it follows the natural workflow,” said Fisne. “It follows their existing workflow — it’s a new clinical document that needs to be reviewed and signed off on, but you don’t have to physically touch that piece of paper or move that electronic chart to say where it needs to be filed. That’s where the cost savings is.”

Integrating information directly into the workflow places documents where providers need them to be right away, saving providers money and an extra step. Reducing the amount of time providers need to spend filing and managing patient medical records improves clinical efficiency and expedites patient care.

Beyond HL7, IDS is also capable of delivering notifications according to the DirectTrust exchange framework.

“We can deliver it via direct secure messaging,” said Fisne. “We could do HL7. We have also the ability to send it off to an ACO or to a care manager.”

Furthermore, IDS can deliver information to several different providers at once or separately.

“Depending on what the patient’s relationship is or what the physician has chosen as his delivery mechanism, that’s how we can send it off and automatically deliver and disseminate it in real time to multiple physicians at multiple times,” he continued.

According to Fisne, solutions such as IDS owe their creation to KeyHIE’s focus on enabling interoperability at all care sites connected to the network.

“It’s really in the aspect of how we deploy the connectivity,” he said. “The beauty of how we work with this is that it doesn’t matter what type of EHR you have — although there’s a lot of work behind the scenes in terms of putting the standards together — but we focus on the interoperability standards that tie it together.”


Using standardized frameworks such as DirectTrust and HL7 are helpful in enabling this level of interoperability. However, KeyHIE still needs to make exceptions for certain care settings that lag behind technologically.

“You have to think about organizations — like nursing homes — that have not truly been automated to the nth degree that we have,” said Fisne. “A lot of them still run paper, so how do we get their paper transactions into an exchange that can be interoperable between sites?”

KeyHIE’s Transform tool is the solution to this problem.

“The Transform tool allows organizations such as home health agencies or nursing homes that use different systems to take data and ingest it directly into the exchange,” he said.

The Transform tool pulls information from minimum data sheets (MDS) or outcome and assessment information set (OASIS) forms and converts them into HL7-compliant documents.

“For example, if you have a patient that was in the hospital and has been admitted to a nursing home or vice-versa, they fill out the MDS,” said Fisne. “Then we use the tool to send a standard document directly to the health exchange so that information can be freely utilized by the physician. So my physician knows I’ve gone to a nursing home, been in a hospital, or whatever it may be.”

Converted documents from these care settings can be accessed by multiple EHR systems.

“We look at all of the basic systems, try to make sure they’re connected, and then we can go to the very complex EHRs and make them connect based on standards,” he added.

This level of interoperability falls in line with KeyHIE’s vision as an information highway allowing participating organizations to improve clinical efficiency and yield positive patient outcomes.

KeyHIE attributes its success in enabling seamless health data exchange to its infrastructure, which is provided through a collaborative effort with its partner Orion Health.

“We look at ourselves as the connection point — the bridge to distribute that information to where it needs to be,” said Chaundy. “We can take information for an ACO that’s focusing on a given population of patients. We collect data from all of those edge points of the system and then begin to bring that together into a point and distribute that to an analytics system that can demonstrate where care gaps may exist.”

Forthcoming projects for KeyHIE include a statewide HIE collaboration called the Pennsylvania Patient & Provider Network (P3N) which aims to further improve clinical efficiency and care coordination through the use of notifications that alert providers to a patient’s movement across the continuum of care in the state.

“Currently we’re doing a pilot project to send and administer notifications from one HIE to the other HIE,” said Chaundy. “So if our patients leave our community for some reason and are seen in a different community area, we want our physicians to be able to get the same clinical information, the same notification that they would get if that patient was here within our existing geographical area.”

The project is presently in the proof of concept stage at a beta-testing site.

“We are starting out with just emergency departments, just to pilot it to make sure that it works instead of causing complete chaos,” she said. “Then if that does go well, and we work through any potential stumbling blocks, we want to move on to the acute setting by the middle of the winter months.”

Chaundy expects P3N will be deployed for production in mid to late fall. 

The original article can be found at the EHR Intelligence site here.