Technological advancements make it possible to store massive amounts of health data and information electronically these days. However, securely sharing this data with providers and patients throughout a health network or geographic region remains a significant challenge.
This is the challenge HIE is supposed to address. HIE (as both a noun and a verb) has the potential to vastly improve the speed, quality, safety, and cost of patient care. However, successful regional HIE organizations (the noun) are few and far between, and many in the healthcare industry question their long-term sustainability. Effective application of technologies that enable private HIE (the verb) holds more promise, but these efforts tend to limit the sharing of health data outside a specific health system.
By Scott Westcott, Contributing Editor
HIE remains an elusive concept for many healthcare providers, but the Massachusetts eHealth Collaborative believes it has a strategy for HIE success.
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Technological advancements make it possible to store massive amounts of health data and information electronically these days. However, securely sharing this data with providers and patients throughout a health network or geographic region remains a significant challenge.
This is the challenge HIE is supposed to address. HIE (as both a noun and a verb) has the potential to vastly improve the speed, quality, safety, and cost of patient care. However, successful regional HIE organizations (the noun) are few and far between, and many in the healthcare industry question their long-term sustainability. Effective application of technologies that enable private HIE (the verb) holds more promise, but these efforts tend to limit the sharing of health data outside a specific health system.
Developing an effective approach to establishing and utilizing a well-performing HIE is a key focus for Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative (MAeHC). Created in 2004, the nonprofit Collaborative’s primary mission is to bring together the state’s major healthcare stakeholders for the purpose of establishing an electronic health record system to enhance quality, efficiency, and safety of care in Massachusetts. Tripathi recently shared his insights about how healthcare organizations can map out a strategy for HIE success.
Q: What does the landscape of HIE look like in the U.S. currently?
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A: In general, the HIE landscape is very promising in terms of its energy and forward progress. It is also, like the U.S. healthcare delivery in general, maddeningly heterogeneous with pockets of excellence and innovation and pockets of inactivity.
Q: Where has the concept failed? In what ways is it succeeding?
A: The good news is that there is strong demand for interoperability among providers — and increasingly among patients. Whenever that happens in a market, it’s just a matter of time before the supply side catches up. That’s what we’re seeing today. We’re in a transition from what I call HIE 1.0, or HIE “the noun,” and HIE 2.0, which is HIE “the verb.” We’ve seen that most HIE organizations are continuing to struggle with sustainability because they are difficult businesses to build. In the HIE 2.0 world, provider organizations want to take greater control of their own HIE activities because these activities are seen as business-critical. Thus, they are pursuing and implementing tactical HIE solutions focused on their core interoperability needs. That, in general, is a very good thing, but in the short run, it does mean that interoperability will remain somewhat fragmented for awhile.
Q: Why do you think HIE gets a bad rap by many naysayers?
A: Well, think about it like this: People don’t complain about the concept of the Internet, though they may very much dislike their Internet service provider. Similarly, I don’t think that it’s HIE that is getting a bad rap, it’s the HIE organizations that are getting the bad rap. I have sympathy for them because it is extremely difficult to pull off a public, collaborative, multistakeholder HIE business. That said, I don’t have sympathy for HIE organizations that don’t realize that they have to change with the market. Vendordriven HIE platforms such as Epic’s CareEverywhere and the multivendor CommonWell effort are growing rapidly because they offer practical capabilities and focused value at an affordable price on market timelines — they don’t try to solve every interoperability problem under the sun. Most “public” HIE organizations have had a difficult time making that kind of a focused value proposition.
Q: What approach has MAeHC taken with HIE?
A: We are not a HIE organization, but we provide strategic and business advisory and management services to a number of public and private HIE efforts. We lived through the HIE 1.0 phase and had our share of failures, so we’ve learned our lessons the hard way. In all of our HIE activities, we focus on business value. A HIE effort can’t be an answer looking for a question. It will only work through hard-nosed business analysis that considers what customers really want, what competencies the business has, and what competitive alternatives are available to customers. As customers narrow their HIE requirements, and the market offers more focused HIE technologies and services in response to these needs, it becomes ever harder to sell a top-down, full-blown, repository-style, multistakeholder, collaborative HIE solution. In many cases, there may not be a viable value proposition there. When that becomes evident, you have to cut your losses and move on to doing things that the market values. That’s a very hard pill for any organization to swallow, especially nonprofit organizations.
Q: What HIE best practices and/or lessons learned have you uncovered along the way?
A: There are four lessons that I remind myself of every day. First, empathize, deeply, with your customers’ problems. Second, recognize the competition and ask yourself how you’re better and worse than they are at meeting your customers’ needs. Third, deliver good value-for-money early and on time. And fourth, be operationally excellent, no excuses. On the latter, goodwill goes only so far — small measurable successes beat large ambiguous promises every time.
Q: What common HIE mistakes do you see others repeat over and over?
A: Simple — not appreciating the points made in the previous question. Too many times, organizations move forward without fully understanding their customers’ true needs as well as the realities of the competitive marketplace. When that happens, they are starting from a position that makes delivering real value and effective execution difficult.
Q: What advice can you offer others on how to successfully address HIE?
A: Provider organizations increasingly have a large number of choices for various types of HIE. They shouldn’t think of HIE as a monolith or as a big bang. Instead, they should do a pareto analysis of their patient flows and incrementally build or buy HIE solutions to enable practical functions with their major clinical partners. The “80 percent rule” is incredibly important in HIE. You don’t have to solve every edge problem — for example, how to connect solo practitioners with obscure EHR systems or how to address issues related to emancipated minors — before rolling out simple, practical, focused HIE solutions. HIE vendors and organizations need to offer a layered service catalog rather than heavy centralized architectures. If they can’t do that, they won’t survive.
Q: What does the future hold for HIE?
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A: The future of HIE is bright because demand is large and growing. That’s driven in part by changes in industry structure, payment models, patient awareness, and growing industry conventions about appropriate standards of care. The market will begin to coalesce around standards and market-led governance, just as it has in other industries. It’s taken longer in healthcare because the industry is so fragmented on both the demand side and the supply side. Yet with a tremendous kick-start from the federal HITECH program, the industry is now at a point of maturity that in the next five to seven years we won’t worry about how the “plumbing” works because it will just work. Then we can finally focus on how to make better use of the information.
Technological advancements make it possible to store massive amounts of health data and information electronically these days. However, securely sharing this data with providers and patients throughout a health network or geographic region remains a significant challenge.
A: In general, the HIE landscape is very promising in terms of its energy and forward progress. It is also, like the U.S. healthcare delivery in general, maddeningly heterogeneous with pockets of excellence and innovation and pockets of inactivity.
A: The future of HIE is bright because demand is large and growing. That’s driven in part by changes in industry structure, payment models, patient awareness, and growing industry conventions about appropriate standards of care. The market will begin to coalesce around standards and market-led governance, just as it has in other industries. It’s taken longer in healthcare because the industry is so fragmented on both the demand side and the supply side. Yet with a tremendous kick-start from the federal HITECH program, the industry is now at a point of maturity that in the next five to seven years we won’t worry about how the “plumbing” works because it will just work. Then we can finally focus on how to make better use of the information.
