Most health information exchange networks continue to struggle with financial sustainability. Reports come out on nearly a daily basis highlighting the issue: fewer than 10% of the HIEs in eHealthInitiative’s 2010 HIE survey proclaimed financial viability. Harvard’s recent report found less than a third of the HIEs they spoke to had it.
I think I know why.
My colleagues and I were just talking about a regional HIE presentation we saw. It was like many others, presenting their nice architecture, their nice volumes (x hospitals, y patients, and z patient records), their nice support of standards, and nice plans to drive up adoption.
Towards the end they dedicated one slide to financials. The first bullet, right at the top, said they were still working on achieving financial sustainability. Then they had the usual nice ideas of charging the 3 P’s: providers, payors, and maybe even patients. Classic “build it and they will come.”
To me it is clear why they’re not sustainable. They can describe their nice technology, they touch on their nice service, but they cannot describe their value.
To me, especially given that many HIEs are funded with state and federal tax dollars, the lack of demonstrated value is an absolute crime in our industry.
How do providers use their service? How is care improved? How can real people/organizations save real money? How about some examples? …and please, don’t use the overused and generalized “unconscious patient presents in the ED and the ED doc is going to take a few minutes to look up records in the HIE.” That doesn’t work (and guess what, this presentation included that as their one and only scenario – very “HIE 101″)
Value begets money. Money begets financial sustainability. Follow the chain.
When Vince Offer pitches his Shamwow wonder towels he pitches value exclusively. He compares it to a wimpy paper towel. He shows how you can save your brand new white rug from your overindulgent friend’s gravitationally-challenged red wine. He makes it clear that not only is Shamwow better, faster, and stronger, but using it is faster, easier, and more effective than pretty much anything else you’ve laid your eyes on. Value, Value, Value.
He does not get into the exact measurement of the Shamwow. Or list the ISO certifications achieved by its manufacturer. Or tell you how many he has at his house. Those details might be intellectually interesting, but would never entice the mass market to part with their $19.99.
The HIE market needs a lesson from Shamwow: figure out how using HIE makes healthcare delivery faster, easier, and better… delivering measurable value.
I can pick on the sustainability of established HIEs, but that is water flowing under the bridge even as we speak. What about folks in the market for HIE today? Can they be saved with a nice dose of value?
We’ve responded to dozens of HIE RFPs. We chat with the industry analysts working to help buyers of HIE services. They all have checklist after checklist asking things like:
- Is your HIE architecture hybrid?
- Do you have a clinician portal?
- Do you have a patient portal?
- Do you support standards like IHE, NwHIN, Direct, HL7, XYZ?
- Is your system secure?
I know many think of us as “evil vendors”, but really now, we’re not that dumb. We’ve done our homework. We’ve invested and built our products out. And we are prepared to answer “yes” to pretty much any of these questions. If we can’t say “yes”, we’ll say “yes, with a partner” for sure.
The problem is these questions don’t get into value, and the buyer/analyst cannot truly assess the value potential of one solution over the other. Value is more than technology widgets, it is how the technology widgets are deployed and used in the real world.
At first one might consider adding a few things that are less technical, like
- What is your deployment model (site-installed, hosted, SaaS, all)
- What is your support and training model (helpdesk for end users or just train-the-trainer)
- What is a typical implementation timeline (how long to install connectivity between 1 hospital and 3-5 practices, for example)
These questions are points that HIE vendors still have different approaches on, and hopefully buyers understand the impact of each difference.
Ask vendors how their solutions are improving healthcare.
I’m not an expert at how to do this, but at least I have the excuse that I’m not an analyst.
If you were to ask me how my company, MobileMD, demonstrates HIE value, I would roll out a bunch of facts and figures (backed up with client phone numbers) that illustrate the impact with have in our client sites today.
- Trim 15% off ALOS in California
- Bring in $2.3M of lab business in Pennsylvania
- Reduce ED utilization by uninsured frequent fliers by 20 visits per day, also out west
- x thousand of page views per day (that’s pages individually requested by human end users, not pages sent by an automated computer system)
- y physician users added to the system monthly (who have logged in more than 5 times – it is easy to add users to a system, a little more challenging to get them to logon at least once [maybe entice them during a training session], but 5 logons begins to differentiate)
We just lit up a connection between a hospital and a home health agency. We think this will have a real impact and set the stage for real ACO/P4P case management, though honestly it is too soon to measure quantitatively.
Much of the value I list is to the benefit of a single given provider. That’s fine… as you, our loyal HIEWorks blog reader knows by now, our approach is to fill the healthcare landscape with enterprise HIEs that are valuable and sustainable, reliable and secure. Then we weave the “private” enterprise HIEs together into a public exchange fabric with technologies like NwHIN and the Direct Project: fed by the rocket fuel of competition before the fruits of cooperation. I’ll avoid digressing by referring you to our other posts, including this one that contrasts public and private HIE viability.
This, to me, is the ultimate “secret sauce” in HIE – how do you use this sometimes vague, nebulous, and often misunderstood technology to improve healthcare, streamline operations, and improve patient and provider experiences? If we do that we can show value, and we can quickly solve sustainability.
Unfortunately it isn’t as easy as just applying the latest IHE standards profile!
