Challenges in Governance and Technology in Creating HIE Success

Ensuring the Success of an HIE

There are positives and negatives to existing governance and technology models for HIEs across the country. Tennessee, for example, which recently aborted its statewide HIE effort, like many other community, regional or state initiatives, developed their technologic solution based on the available standards at the time of vendor selection.  Unfortunately, the federal government changed course in the middle of their policy formulation efforts requiring a complete retooling of both technology and policy.  In the development of an HIE, as many know, the technology is hard, but policy formulation and stakeholder buy-in is harder.  Having to revisit the painful process of policy review because of changing politics, evolving standards and changes in federal direction can prove to be a challenge too difficult to hold together stakeholders exceeding 200-500 across a region or state.  Combine that with multiple vendors trying to retool their applications to meet the swing in policy, standards and timetables, and the project becomes “mission impossible”.

Let me propose four main points to help ensure the success of an HIE:

  1. Develop a set of value-based use-cases that the policy makers can agree to support financially from the very beginning.
  2. Create achievable, short term, value-based goals to show early victories with successful goals throughout the project and that enhances value as the project moves along.  Too many HIEs set their threshold of success much too high from the start.
  3. Select a vendor with a flexible, standards-based infrastructure accommodating participants with the latest technology and those without current technology (or for that matter those with none at all) who can implement a step-by-step value-based solution.
  4. Select an Executive Director for the HIE who is business and marketing savvy.  They do not need to have healthcare experience, technology experience or project management experience, but they must understand the vision, be leaders and above all be marketers focused on the sustainability and value-based messaging to all participants from the onset. They must begin every meeting re-iterating the vision to all participants so that the HIE is not mired in obstacles to its vision.

If you haven’t noticed the obvious in my four main points – EVERYTHING MUST EMANATE FROM VALUE.  A big mistake in the early state-wide and community HIEs was taking a “build it and they will come” mentality without clear use-cases, objectives and value propositions.

ICA believes that no governance model is right for every situation and no single protocol is going to solve the communication gaps in exchanging health information across the continuum of care.

I encourage you to provide input to this discussion and enlighten readers with points for enabling success I missed in this discussion.

John Tempesco, FACHE, is the Chief Marketing Officer at ICA. This blog post was first published on ICA’s HITme Blog. John has 37 years of healthcare experience, including a two decade career in health information technology in both the government and civilian sectors. He is a Fellow in both the American College of Healthcare Executives and the Life Management Institute, as well as a Certified Managed Care Executive.