The HIE Santa Clause is Coming to Town: How to Outlast the HIE Burgermeister Meisterburger in 2021

By Buff Colchagoff, CEO, RosettaHealth
Twitter: @rosettahealth
Twitter: @BuffColchagoff

Reflecting on the past couple of years and the road ahead for HIEs, I’m reminded of the 1970s Christmas classic claymation story, “Santa Claus Is Comin’ to Town.” You may ask, “what can HIEs learn from a sappy, simplistic kids movie?” Put in the right light, there’s actually plenty of wisdom to be found.

If you don’t remember the plot, Kris Kringle is a young upstart do-gooder making and giving away toys for free in “Sombertown.” Kris is foiled by the selfish and shortsighted town master “the Burgermeister Meisterburger” on numerous occasions. Despite the ongoing challenges, Kris eventually prevails and matures into the global phenomenon of Santa Claus we now know – while the Burgermeister’s waning power and is eventually forgotten.

If you haven’t guessed it yet, this is a metaphor: HIEs are Kris Kringle – but who is the Burgermeister? I’ve identified a number of Bugermesiterian [sic] villains facing HIEs:

  • HIE Customers Often Don’t Know Your Value: Sometimes based on regulatory “musts” or being told HIE connections are for the greater good, many times data sources don’t see a big return value in providing data to HIEs.
  • Competing Networks: The rise of nation networks like CommonWell and eHealthExchange, as well as event notification networks, can have HIE customers thinking that those networks are sufficient.
  • Resource Scarcity: The hub-and-spoke nature of HIEs means that being the “dial-tone” for exchange within a region compounds their problems. Having a “many-to-many” mission with the complexities of exchange and interoperability leads to HIEs being woefully under resourced and/or underfunded.
  • Leveraging Grants and Incentives: Given tight budgets and resources, it may seem that the way to advance an HIE’s capabilities is via grants and incentives. While positive, the effects of these revenue injections can be fleeting and often offer either niche applications or unripe capabilities.

At times, it can seem that HIEs, like Kris Kringle, keep sacrificing, giving gifts and doing noble work for the community – and yet other forces antipathetic to the HIEs mission persist. What’s a well meaning and hard-working HIE to do?

Lessons From the Leader in Worldwide Manufacturing, Logistics and Branding – Kris Kringle:

Santa prevails over his early challenges by utilizing three key strategies:

Strategy #1: Kris’ Value is Clear:

Every kid in town viscerally knows the value of Kris’ toys. He builds quality products that delight everyone.

  • HIE Takeaway: HIE value must become as clear as toys to children. Understandably this is a hard task, but if your customers don’t find tremendous value in your offering, then you are at risk. Imagine if Kris provided toys that didn’t delight. It would be game over. HIEs must find a way to up their value over emerging networks. In addition, HIEs have an advantage, as they are local with more regional connections. Leveraging these advantages to offer value-added use cases for customers is essential.
  • An Example in Action: Providing just-in-time custom selective imaging is an example of this kind of effort. A project at HealtHIE Nevada leveraged its statewide data feed of HL7 v2 data to use custom rules and provide relevant, historical imaging studies just in time for mammography appointments. The radiologist now has all relevant historical imaging available at the time of the visit – and this is completely automated with no queries or long retrievals. The value was instantly clear to the radiologists.

“We found that simply making the data available isn’t enough,” said Derek Plansky, a consultant at HealtHIE Nevada. “It wasn’t until we automated the DICOM imagery pre-fetch process that we saw the 10X in transfer volumes. We knew our radiologists were using the service because there was a hue and cry when the service was temporarily offline during our platform migration.”

It is also important to note that, as a result of the COVID-19 pandemic, public health is finally getting some attention. For example a recent Politico article states that, “It also raises questions about whether the American public health system, supported by state health departments, will be able to sustain itself under the inevitable deluge of Omicron cases.” If HIEs augment states’ capabilities, thereby positioning themselves as required infrastructure to support state and national public health efforts, the value will be obvious.

Strategy #2: Kris is Not a Loner, and He Leverages and Recruits Resources to His Cause:

While initially a lonely outcast, Kris finds a way to join forces with a host of others: a lost penguin, an angelic schoolteacher and grumpy Winter Wizard.

  • HIE Takeaway: HIEs must find force multipliers and stop doing it on their own. When one is financially and resource constrained, it becomes imperative to leverage others of like minds and talents. The lowest hanging fruit here is other HIEs, but there are other potential partners.
  • Examples in Action: In this scenario, a fair example is Patient Centered Data Home (PCDH). Not thrust upon HIEs by ONC, but a clearly valued service developed as a cooperation between HIEs, this service provides the alerting and retrieval of records between HIEs based on existing transports and agreed-upon protocols. A second example is the growing trend of HIEs sharing resources. Rather than paying for all licensing and customization of IT as a single HIE, the load is shared across multiple HIEs. This takes on different forms of collaboration. Whether it be a non-profit or for-profit, aggregated HIE IT platforms provide cooperative firepower needed for HIEs to advance value-added agendas.

Strategy #3: Put One Foot in Front of the Other:

Kris always moves forward and is never stagnate. He wins the alliance of the Winter Wizard by teaching him to just “put one foot in front of the other,” via a catchy song. Kris likewise keeps finding a way to move to a new level of toy-giving capability, despite the increasing adversity.

  • HIE Takeaway: Find a way to move forward, and not just stay in the same place or you’ll be overtaken. These don’t have to be huge strides, but the direction needs to be consistently towards a greater goal.
  • An Example in Action: An HIE client of ours re-platformed last year, as an example. Rather than just replacing the existing capabilities, time and effort was invested into designing a scalable platform – scalable from a total cost (including labor) perspective, and not just technology scaling. The new platform allows the HIE to grow with minimal additional labor and easily expand to multi-HIEs. An emphasis of re-platforming was a HIE-specific rule-based workflow that manages data transformation, MPI orchestration and results delivery. This allows the vast majority of HIE data flows to be managed with simple rules, rather than interface engine configurations and programming. Ultimately, this platform allows the HIE to focus more energy on future value over day-to-day operations.


HIEs have admirable missions, work hard and are often underappreciated. To overcome the Burgermeisters of the world, HIEs can benefit from the lessons that Santa learned a long time ago. And, who knows … hundreds of years in the future there may be a holiday named after HIEs!!