Top-of-Mind Pitfalls to Avoid When Launching HIEs

What Problem is the HIE Seeking to Solve?

The number of health information exchanges (HIEs) increased from 234 in 2010 to 255 in 2011, or 9 percent, according to a report last year from the eHealth Initiative. Rapid growth is projected between now and Oct. 1, 2013, as providers move to comply with the proposed Meaningful Use Stage 2 rule now being finalized. In addition, the reform incentive is expected to raise the bar for HIE.

To date, only a small number of HIEs are operational and most, if history is any guide, will not move past the planning stages. However, it doesn’t necessarily have to be that way. HIE organizers can learn the top-of-mind pitfalls to avoid before starting their journey to becoming operational.

No matter whether HIEs are public or private, the fundamental question all interested parties must ask before launching one is, “What problem is the HIE seeking to solve?” Is it to increase care coordination amongst the potential provider participants responsible for contributing data to the HIE? Is it to reduce duplicate laboratory tests, procedures and costs? Will it combat 30-day readmissions of patients discharged with heart failure, heart attack and pneumonia in light of ceased Medicare funds, effective Oct. 1? Is it to facilitate or support a component of health reform such as accountable care organizations or patient-centered medical homes?

As participants mull over the answers, it is essential for them to select at least one, but not more than two, problems to address. If HIEs tackle more than two issues at once, they will find it extremely difficult to reach consensus and make the leap from the drawing board to go-live. Thus, starting small is an easier path to achieving consensus. Case in point: The MidSouth eHealth Alliance in Memphis, Tenn., chose to improve care coordination and reduce costs by focusing solely on sharing health information between hospital emergency departments and ambulatory clinics.

Establishing a good governance structure is a must. The effort begins with the formation of a board of directors comprised of the executive leaders from HIE participants. Next, select an executive director with a solid grounding in healthcare’s unique ecosystem and with an understanding of the fundamentals of data exchange and the intent behind HIE. Another key qualification for the executive director is consensus building, as this skill is essential in bringing disparate opinions together to form a cohesive HIE strategy. An attorney well versed in HIPAA privacy and security rules is also a prerequisite for sound governance.

To be successful, HIEs must have committed executive sponsorship for sustainability. Without that, the HIE is doomed, because no one will take it seriously, particularly if clinician-mandated technology outside of current workflow is involved.

As the HIE is forming, it is imperative that organizers thoroughly vet the technological capabilities of prospective participants to avoid a major pitfall that prevents or hurts the chance of the HIE becoming operational. The HIE must assess whether participants’ source systems can transmit data seamlessly through its channel, and if system upgrades are planned before a scheduled go-live. If participants are unable to aggregate or maintain a reliable data feed, clinicians and other care team members will not join or use the HIE.

Before or after completing that assessment, the HIE organizers must select a vendor that can integrate members’ disparate source systems. An ideal candidate has a HIE software platform designed to support evolving and established standards, e.g., DICOM, XDS and HL7, promoted by the Integrating the Healthcare Enterprise interoperability initiative.

Finally, if the HIE elects to replace its current vendor, the HIE executive director, board and participants should universally champion and support the new system. An educational campaign to users can help explain this decision and reason behind the switch.

Hays Green, Healthcare Policy Practice Lead at WPC. This article first appeared on Porter Research. Green has more than 15 years of healthcare experience with clinical and administration skill sets. He has managed several operational HIEs and has experience with initial implementation of participants and the subsequent expansion of on-boarding of new hospitals, clinics, and systems. He holds a Masters of Public Health in epidemiology from the University of Alabama at Birmingham. You can contact him at: