Innovation in HIE: An Embarrassing Landscape

Rupinder Colby_Head Shot.jpgChallenging HIT Vendors to Contribute Solutions

By Rupinder Colby M.P.H., Analyst at Ascendian Healthcare Consulting

In 2010 the Office of the National Coordinator for Health Information Technology (ONC) awarded states through a Health Information Exchange (HIE) program that promotes the secure exchange of health information within and across states. This federal support spurred the creation of state and regionally based exchanges. The result has been HIE 1.0. Today’s environment largely consists of providers within a community that share patient information by pushing and pulling episodic data—mainly leveraging Continuity of Care Documents (CCD). Unfortunately, the first generation of exchanges are not prepared to meet healthcare’s long term needs and the time is now for HIE 2.0.

HIE 2.0 can be defined in two ways. First it’s the transition from a single hub and spoke model to a network of networks. Under this definition, HIE 2.0 connects multiple community or regional networks allowing them to engage one another across geographies and states through national standards. The second definition is centered on the capability a HIE enables. HIE 2.0, under this definition, supports true delivery system improvement, superior care coordination, enhanced efficiency, data integration and analysis, financial risk management and true potential for cost savings. This blog examines the latter definition of HIE 2.0.

Of the major HIE vendors examined, in a 2013 market report by Chilmark Research, very few were deemed to be ready for HIE 2.0. With some vendors even stalling to enable the most archaic modes of exchange, we cannot expect to move to HIE 2.0. Where is the promise of improved health care delivery, better chronic care management, cost savings, and healthier populations? Where is HIE that can sufficiently support alternative payment models such as ACOs?

Directed exchange and pushing and pulling of episodic data do not meet the current need for transformative technical innovations in healthcare. We need to move past this 1990s retro revival and actually do something of interest and benefit.

Without the ability to support the fundamental realignment and consolidation occurring in healthcare, pushing and pulling CCDs does nothing more than replace a fax machine. The federal government is increasingly positioning itself along the Direct mode of exchange. The initial call for innovation seems to have faltered to a ‘good enough’ mindset.

The government has helped set the stage; it’s now time for the private sector to progress and evolve the vision. Let’s stop looking to the feds for guidance and deploy our own creativity to create value. Let technology, once again, drive government policy.

Let’s step up to the plate and create a robust business case for HIE.

Let’s commit to the standards that make sense like structured data and create the second wave of HIE across the nation.

Let’s challenge HIT vendors to contribute solutions that make data fluid and exchange of health information ubiquitous. Let’s challenge them to contribute directly to the success of their clients and enhance the healthcare system with thoughtful innovative products—or get out of the way.

About the Author: Rupinder Colby, M.P.H. is an Analyst with Ascendian Healthcare Consulting. She has over six years of healthcare related experience, knowledge of physician and health services, health policy and health information exchange. Rupinder received a Master of Public Health at the University of California, Berkeley. This article was originally published on Ascendian Healthcare Consulting and is republished here with permission.