The term Health Information Exchange (“HIE”) has become confused, to say the least. HIE no longer has a single, definitive definition; rather, the healthcare market has inappropriately related the definition of HIE with funding sources for various state and regional initiatives without any consideration regarding what constitutes a sustainable counterparty. Moreover, the myriad HIE definitions include feature sets and technologies that are only tangentially related and thus thrown into the definition to accommodate the numerous vendors wishing to participate in the HIE tsunami currently generating energy. HIEWorks will discuss this particular issue more broadly in our next blog entry. Today, I’d like to address just one dimension of this HIE definition problem.
Most HIE vendors spin a similar yarn – they sell technology. With very few exceptions, the common sales pitch is a variation of a technology sale. PowerPoint presentations are replete with complicated architectural diagrams of “sophisticated” technologies built using state-of-the-art methods to pull, push, publish, route, integrate, and authenticate clinical, administrative and user data. Some vendors use key words and tricky phrases like 128-bit encryption, secure channel, real-time communications, IPSEC VPN, SOA, web-services, federated, centralized, portals, and portlets. Frankly, such a list is common to virtually all HIE vendors. Only the diagrams look different. Some even offer “magical” devices that simply need power and connectivity – the device handles the rest. In small print one finds that…
(Like pharmaceutical ads listing potential side-effects, please read the rest of this paragraph very fast to get the gist.)
The device does require implementation, configuration, regular checkups, and IT support to ensure proper operation. Device configurations may vary from site to site and the user should therefore check with the vendor during implementation to ensure proper operation. Other issues may exist. Please check with your vendor to fully understand the ramifications of implementing the “magical” device.
While significant technological sophistication is certainly required to support HIE initiatives (other than core architecture such as a federated model vs. a centralized model, which carries significant technical considerations), candidly no single vendor in the market has a technological solution that is sufficiently better than the other to justify material differentiation based on technology alone. True, some patents are pending, and some may have been awarded. But, the patents are for technology that is easily handled just as efficiently in other innovative ways. To wit: The NHIN-CONNECT initiative offers open source technology. And, there are numerous other open source technologies that provide various HIE features, ironically, the polar opposite of a patent. A patent is only useful (read valuable) if the patent adds value and creates a barrier to entry into the market. That is not the case for the HIE-oriented patents / patents pending of which I am familiar. So, please don’t be smitten by the mere mention of a patent.
My experience implementing numerous successful HIEs has illuminated the incredibly important and differentiating role services play in the deployment, support, and adoption of an HIE and the corresponding business model that accompanies the delivery of these services by the HIE vendors. By services, I’m not merely referring to implementation services after which clients are left to fend for themselves. The services of which I speak extend well beyond SaaS to the strategic nature and value of an HIE. I call this offering SaaS Plus.
- Marketing services to encourage adoption
- Community outreach and awareness campaign services
- Levels I, II, and III support services
- Hosting services
- Training services
- Disparate vendor relationship management services
- Semantic interoperability services
- Security services
- Configuration, change management and quality assurance services
And, the business model that accompanies these services is best offered as a single monthly or annual subscription fee or license – no open-ended time and materials engagements, and no nickel and dime out of scope work orders. Rather, successful HIEs are consistently defined, in large part, by a comprehensive offering that obviously includes the technological sophistication necessary to securely and rapidly provide for the exchange of and access to critical patient health information, but balances such technology with the services necessary to successfully support an HIE deployment. HIE vendors offering HIEs defined to include such services allow the purchasers of HIEs to focus on their mission – deliver quality patient care.
