Welcome back to the HIEWorks blog. We took a bit of a hiatus during the summer months. We’re back and ready to comment on the state and direction of health information exchange.
For some months leading up to the summer, we learned of numerous stalled and failing publicly funded health information exchange (HIE) initiatives. After speaking with numerous organizations and personnel in the HIE market, including the ONC, it became clear that large, publicly funded HIE initiatives financed with government subsidies and constructed around the delivery of a single technology option for HIE is rapidly falling out of favor. As we’ve written before, lack of sustainability is the primary issue facing publicly funded HIE initiatives. Moreover, such initiatives often follow geographic boundaries dictated by the public funding sources such as those specific to a particular state, and not the needs of care communities. As a result, public initiatives have been weighed down by considerable challenges and unfortunate entropy. State patient privacy and regulatory compliance, patient consent laws and regulations, financial and regulatory considerations for inter-state healthcare systems, and Medicaid reporting disparities between states are among the myriad issues that arise from bounding HIEs using arbitrary geographic determinants.
Here’s the good news. A clear change is underway in the HIE marketplace. Current and planned standards emanating from the ONC and other widely accepted standards committees indicate a strong preference for interoperable exchanges designed to serve individual enterprises, Accountable Care Organizations (ACO), medical referral regions and local care communities – i.e., those communities that serve a logical and well understood population of physicians and patients. And, through established and evolving standards such as NHIN CONNECT and NHIN DIRECT, the HIE market direction is to support a network of networks (or exchanges) linked together through a common, open source architecture, promulgated by the ONC and other recognized standards bodies.
The sustainability and practicality of monolithic, publicly funded HIEs that do not provide for “on-ramp” connectivity from established and planned exchanges is precarious at best. The ONC has made it clear that all HIE initiatives should, at a minimum, make provisions to support connectivity between disparate exchanges. That is the very purpose of the standards, and that is the only way to encourage innovation while leveraging past and planned investments.
It is no secret the healthcare landscape is littered with failed public HIE initiatives designed to deliver a single-source solution to an arbitrarily determined collection of care providers and patient populations. Simply put, such initiatives are not guided by the free market. Rather, they are subject to the whims of annual government budget cycles, grants and misguided governance. So, what do we do? I believe publicly funded initiatives must facilitate and encourage interoperability between HIEs built on sustainable models that support logical healthcare communities – communities built around natural provider-patient relationships, referral patterns, and accountable care organizations. In doing so, these initiatives (i.e., public initiatives) have an opportunity to add value, properly leverage public funds, and help lay down the necessary infrastructure required to facilitate the network of networks that will someday be known as the Nationwide Health Information Network (NHIN).