Implementation Challenges and Barriers to Successful HIEs

HIEs Need Cultural “MegaChange” to Flourish

John Smith

The alchemy involved in developing and executing a successful health information exchange (HIE) is complex. Technology, policy and specific organizational situations are core components embedded in the success/failure equation that can either help or hinder the creation of a thriving clinical data-sharing network, whether in a hospital, IDN or region. Because HIE, by definition, requires the cooperation and coordination of multiple groups factions and individuals within an organization, it is important that the various agendas of these groups be identified and addressed.

A White Paper published earlier this year by the Brookings Institution on the governance of HIEs finds that implementation challenges and barriers to successful HIEs are similar to the challenges found in setting up government programs because of the density and complexities intrinsically found in both. “Mission ambiguity, problems of organizational coordination, resource and organizational capacity restraints, political interference, as well as lack of clarity and consensus, limit the ability of policy makers to achieve the desired goals.”[1] Institutional and regional HIEs face these same issues, which are also further complicated by a heavy dose of technology which is at the heart of HIE and what makes it possible.

States and organizations that have implemented HIE are well aware of these challenges and all are in different stages of the throes of wrestling them to the ground to either start-up or improve the distribution and sharing of patient data. For example, Tennessee, an early adopter of HIE, has chosen to build an HIE network on the foundation of former RHIOs (regional health information organizations). This approach has the advantage of embedding interoperability into an existing structure between organizations. The state leverages a “network of networks”[2] methodology of using already accessible networks at the local and regional levels to provide a universal layer of connectivity.

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