Implementation Challenges and Barriers to Successful HIEs

This approach has worked very well for Tennessee, whose HIE is a public-private partnership comprised of physicians, nurses, pharmacists, hospitals, insurers and patients. Other states have had similar, as well as a host of other issues, to deal with. Among them are:

1) Governance mechanisms which have a huge effect on implementation. These players typically include hospitals, medical societies, government health departments, universities, physicians and public officials. Others often include payers and unions. The number of players, all with varying agendas, makes implementation a tremendous challenge.

2) Consensus on the path forward. With many aspects of healthcare reform being contentious, tensions inevitably arise between local, regional and state organizations which further slow down implementation.

3) The role of the federal government which includes the Direct Program designed to effect simple and secure clinical messaging. While Direct’s goal is to connect many physicians and hospitals, many claim that the program undermines efforts to connect at broader levels. And demand for Direct protocols, thus far, has been weak.

4) Privacy and security continues to complicate HIE performance since data exchange requires permission and consent. Uncertainty about privacy can greatly impede, if not kill, an exchange network unless sufficient guidance is made explicit.

5) Finally, the elephant in the room is sustainability. With HITECH Act funding not being eternal, HIEs must plan for ongoing self-sufficiency. This inevitability is complicated by the current weak economy with states still cutting budgets. Options being considered are membership or subscription fees along with a small “claims tax” which will enable sustainability.

In short, HIEs, while in many ways the clear answer to the kind of connectivity that will ultimately reduce healthcare costs and improve outcomes over the long haul, face daunting challenges. These challenges, taken as a whole, are probably best addressed through a cultural shift, or MegaChange in attitudes that will enable the tackling of these issues broadly in order to get us where we want and need to be: the transformation of healthcare delivery in the U.S.

[1] Kent Weaver, “But Will It Work?: Implementation Analysis to Improve Government Performance,” Issues in Governance Studies, February, 2010, pp. 3-8.

[2] Darrell M. West and Allan Friedman, “Health Information Exchanges and Megachange”, Governance Studies at Brookings, February 8, 2012, pp 20-21.

John Smith is Director of Communications at ICA. This blog post was first published on ICA’s HITme Blog. John has over 20 years of experience in healthcare communications with a focus on health information technology, having served as Senior Vice President and Healthcare Practice Leader at several communications firms, including Fleishmann Hillard, Manning Selvage and Lee and Brodeur Worldwide.