The concept of health information exchanges (HIEs) is not new for healthcare. States, regions and other collections of healthcare entities have been attempting to scale up HIEs for years. Such efforts clearly predate the major drive into electronic health information that was effected by the Meaningful Use program that has ended up with the vast majority of health systems and physician practices having electronic medical records.
The recent push to put HIEs into place can be rooted in the Affordable Care Act, the Meaningful Use program and other initiatives to digitally transform healthcare. As a refresher, an HIE is a dynamic network connecting distinct healthcare systems that enables the transmission of data while maintaining the integrity of the data. The definition of an HIE reveals the idealistic nature of the concept, an idealism that cannot always be matched in actual practice.
Diving further into the purpose of the HIE, as indicated, it is designed to facilitate the transfer of data between providers. As can likely be guessed, enabling the easy transfer of data goes to the ongoing hot issue of interoperability. Ensuring data get to where both providers and patients want it, is the ongoing challenge and frustration.
However, when thinking about whether an HIE will assist in achieving interoperability, it is helpful to remember that various types of HIEs exist. There can be state-wide, private, regional, community, or other forms. The more public-facing HIEs has faced a number of challenges. Over the past five or so years, a fair number of HIEs launched, oftentimes with the initial benefit of government funding. However, those newer HIEs did not last and quickly faded away. The quick fade somewhat tarnished the perception of HIEs.
The negative perception is not fair though. Quickly organized entities that enter a complicated space should not and can not be expected to be overnight successes. That is why it is more instructive to examine more established, older HIEs for the value that can be added to the system. Those examples do exist. The Mass HIWay (still in growth), Great Lakes Health Connect and the Utah Health Information Network (UHIN) offer examples of what can be done, though recognizing that nothing is perfect or at the ultimate goal. Those HIEs seem to have staying power and do not face immediate jeopardy of closure or failure. Each also offers insight into a beneficial structure, which covers not just the data but getting parties and data into the HIE.
Ultimately, the HIE will need to evolve and truly become integrated into the care delivery system. At least that should be the ultimate place if an HIE will place a meaningful role in whatever ecosystem it resides. An HIE cannot solely be a connection that is not utilized. Instead, it should be a trusted partner in the environment that helps connect disparate providers and eases the free flow of data. Maintaining optimism can be difficult, but it should be there.
It is not necessary to take just my thoughts on this matter. Additional commentary and considerations can be found in the episode of Healthcare de Jure where Teresa Rivera, the President and CEO of UHIN was my guest. Teresa discussed the history of HIEs to a degree as well as the role of HIEs in care coordination. Teresa offered firsthand experience and perspective that offer much food for thought.
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This article was originally published on Mirick O’Connell’s Health Law Blog and is republished here with permission.