Time and again, vendors deliver technology and indifferently move on while these “solutions” sit and collect dust. Purchasers, once rapt with the blinking lights of automation, rapidly devolve, suffering buyer’s remorse. While technology is important, it’s just one dimension within which HIE operates. To work, HIE must operate in four dimensions: Technology, Service, Care, and Economic. As a way of creating a mnemonic, let’s compare HIE’s four dimensions to the space-time dimensions learned in school – width, depth, length, and time.
Without technological innovation, HIE would never move past fax, courier, and a myriad unsupportable point-to-point interfaces. Consider the Technology dimension as width. A broad set of proven capabilities are important to ensure relevance, usability, security, scalability, and regulatory compliance. Without sound Technology, utilization is muted, stability is jeopardized and liability is increased. The Technology dimension, therefore, is significant to ensure a working system is in place, built on a solid, scalable foundation, protecting all stakeholders from the risks inherent in communicating patient health information – legal and clinical.
To truly operate within the Service dimension, HIE must wrap Service around deployed technology. Community outreach support and strategic utilization consulting are vital components. Visualize the Service dimension as the depth – the extent to which and sophistication with which HIE permeates a community. Without such depth, HIE languishes, left unused, neither deriving nor generating benefit.
The Care dimension is lost on most vendors, as it requires a true understanding of, appreciation for, and empathy with the criticality of the ultimate mission – providing quality patient care. The Care dimension introduces the human element to provide what I equate with length. Every patient, every piece of information, every clinician, and every episode of care is critical in its own right and must be treated with a keen sense of urgency and worth. HIE can’t do this without a human element that expresses understanding, appreciation, and empathy.
The Economic dimension is best viewed as time. I’ve previously written that an economic model based on self-interest’s “invisible hand” is important to ensure sustainability. While some cooperative models have succeeded, they are, unfortunately, the exception: those that have proven successful are directed by passionately committed strong leadership able to place benevolence above self-interest in a manner that provides sustainability.
Generally, however, without competitive market pressures, HIE falters with inadequate funding, structure, and incentives. While altruistic cooperative purpose is noble and achievable, our economic activity is predicated on the notion that such altruism is achieved through self-interest. Community good is realized when individuals (e.g., healthcare organizations) achieve what is good for themselves. Competition, therefore, must precede cooperation. As the market matures, however, cooperation inevitably evolves. Consumers lean heavily against healthcare’s regional nature, forcing providers to cooperate to ensure quality care.
There you have it; HIE in 4D. If you want to know how HIE works, use 4D lenses. Those dimensions missing will become apparent, and corrective action can be taken to adjust appropriately.
Refreshing perspective. Thanks.
[...] can weave together these Enterprise networks (say, using the NHIN specifications). Done properly, which requires all four dimensions of HIE, you can get to the community-wide, holistic solution faster than ”waiting for Godot” – [...]