February 7, 2019
As I write this introduction, the countdown to HIMSS19 is down to single digits. The largest annual gathering of health information technology professionals in the world kicks off in Orlando on February 11. One indicator of the growing anticipation for this seminal industry event is the flurry of pre-conference focused content. It covers a range of high profile topics that will certainly capture the attention and focus of conference presenters, exhibitors, and attendees.
The subject of health information exchange and its role in achieving interoperability (whatever that means) is no exception. A quick scan of my reading list from the last week includes a piece on the “Best of Breed Health IT” for achieving interoperability in Electronic Health Reporter by Gevik Nalbandian of NextGate; a preview of John Kanski’s (CEO of the Indiana Health Information Exchange) HIMSS19 presentation by Mike Miliard in Healthcare IT News; and an announcement of the latest bells and whistles offered by CommonWell Health Alliance by Joe Goedert for Health Data Management.
All of this chatter and perspective wielding prompted a familiar reaction – a desire for what Bob Brown, HIE Thought Leader, refers to as “Principles First”. Before we can agree on the best way forward, we first need to agree on exactly what it is we are talking about. I wrote a piece in advance of last year’s HIMSS conference that attempts to get at this need. In the spirit of David Letterman’s “Late Show Top Ten” list, I offer this revised version.
Ten Characteristics of a Health Information Exchange
Health Information Exchange is a Noun
Many organizations are capable of sending and receiving patient specific health information. The act of exchanging health information does NOT make them a Health Information Exchange. In contrast, an HIE makes the exchange of health information for the purpose of informing care delivery and reducing the cost of healthcare for all the entity’s core business.
Yet, depending on the circumstances, healthcare systems, provider organizations, software developers, and health insurers may be regionally designated as an “HIE” as an aspect of their business strategy. Their exchange activities will ultimately be in service (and subservient) to their other primary business purpose.
Health Information Exchange is Non-Profit
The fundamental role of a Health Information Exchange is to facilitate exchange of and access to health information that informs care delivery and reduces the cost of healthcare for all.
This happens among and between healthcare organizations and providers across the continuum of care.
The non-profit status frees the organization from the obligation of delivering a financial return on investment to owners and stockholders. This affords the HIE the latitude to be dedicated to the mission of serving their participants, and the larger goal of contributing to improved quality of life in the communities they serve.
Health Information Exchange is Sustainable
Having the non-profit status does not excuse a Health Information Exchange from the responsibility of demonstrating a sustainable business model. Many HIE pilot programs have failed because they did not establish a revenue model that would sustain them past their initial grant funding.
Like any other business, HIEs must consistently deliver solutions and services that are of value to their customers. These services must generate sufficient recurrent revenue to assure operations and stability.
Health Information Exchange is Neutral
The healthcare landscape across the nation has shifted dramatically since passage of the Affordable Care Act. The move from volume to value based care, alternative payment models, the rise of consumer-based delivery options, and massive revenue-driven consolidation has made competition among healthcare systems and practices more pronounced than ever before.
The pros and cons of this new paradigm are debatable. Nevertheless, the one operational area where lack of collaboration is most detrimental to everyone is in the seamless sharing of electronic patient data.
Part of the responsibility of a HIE is to impartially embrace this tension equally for ALL stakeholders, and assure they have identical and unfettered access to the information that is critical to delivering optimal patient care.
Health Information Exchange is Multilingual and Multidisciplinary
Over 1,100 organizations sell electronic health record systems for the healthcare industry. No single platform will ever be singularly used by the entire care continuum.
Health Information Exchanges must be capable of ingesting, integrating, and organizing patient health information from everyone, regardless of their proprietary software application or language.
They must “speak” to everyone and also have the educational and professional experience within to UNDERSTAND everyone. HIEs need business development acumen, technical and security experts, financial and human resource managers, and support staff. They themselves must bring people together that have diverse backgrounds and goals, just like the healthcare organizations they exist to serve.
Health Information Exchange is Workflow Flexible
If you have seen one healthcare system or medical practice workflow, you have seen ONE workflow, not many. You cannot assume that the next hospital or medical office will have the same processes and workflow.
The adoption and utilization of electronic health information solutions and services is dependent on its ability to integrate seamlessly into the existing workflow of each unique environment where it is deployed.
The role of a health information exchange is to assure that the information will be usable without requiring significant re-design of existing workflow and without adding burden for technical, clinical, or supportive staff.
Health Information Exchange is Patient Focused
We must come back to health, the health of our communities, states, and nation. That means focusing on the people; no matter if you call them patients, clients, consumers, users, patrons, or shoppers.
The fundamental role of Health Information Exchanges is to facilitate exchange of and access to health information that informs care delivery and reduces the cost of healthcare for all.
Health Information Exchange pushes boundaries
Technology changes at the speed of light. Nowhere is this truer than in healthcare. It is inherent that health information exchange be on the forefront of this innovation.
The definition of an HIE put forth by the United States Office of the National Coordinator for Health Information Technology intentionally sets low technological standards.
But the complexity of healthcare organizations in 2019 exceeds “basic”. To meet their mandate, HIEs must anticipate these needs and push the boundaries of technology to build solutions that are responsive, intuitive, and integrated.
Health Information Exchange solves REAL Problems
What do catastrophic weather events, a public health crisis, and a ransomware attack have in common? Each of these events have the potential to disrupt the operational capabilities of healthcare delivery systems.
In the wake of Hurricane Harvey in Houston, TX, The Water Crisis in Flint, MI, and the Erie County Medical Center Ransomware attack in Buffalo, NY, the health information exchange responded, assuring that critical access to patient health information was available to healthcare providers, and that continuity of care was maintained for patients.
No technology or software solution alone can address these types of unexpected emergencies. But HIEs are able to adapt to the emergent needs in their communities.
Health Information Exchange Creates Community
The ongoing transformation of healthcare in the United States is towards a more inclusive, holistic, collaborative, and integrated system.
Achieving this goal will require that we systematically evaluate all aspects of the legacy system and the tear down the silos that separate stakeholders. We need to promote the active participation of patients and redefine the concept of a healthcare “provider”.
Health Information Exchanges sit in the midst of this new paradigm. They are able to provide a means for patients to contribute personal health data to their record and to inform other of their care plan. Simultaneously, the HIE can empower a primary care physician to make a referral to a local food pantry for an individual in need. They can assist providers in identifying and meeting the behavioral and social determinants of health, as well as people’s physical health needs. In doing so, the HIE is a key contributor to achieving Quadruple Aim goals and supporting optimal quality of life for all.
What a Health Information Exchange is NOT…
This list does not mention Interoperability, HL7 or FHIR standards, Blockchain, or any other specific technology.
This is not to say that they or other things are unimportant or unnecessary. Contrastingly, it should be assumed that an HIE possesses expertise in these technical specifications.
The primary function of a Health Information Exchange is to impel, improve, and enhance the delivery, quality, outcomes, and cost of healthcare delivery. Everything else is just HIMSSanity!