One-on-One w/KLAS Clinical GM Jason Hess (II)

Before the term HIE appeared in the pages of HITECH, many CIOs didn’t pay it much attention, preferring instead to focus on getting their houses in order. While that’s still a great strategy, healthcare informatics leaders now have no choice but to dip their toes into the murky waters of inter-organizational information exchange. While many exchanges are being supported with homegrown technologies, a number have gone the vendor route. In a recently released report, KLAS broke down the vendor landscape, finding a wide gulf between marketing and concrete results. Recently, healthsystemCIO.com editor Anthony Guerra spoke with the report’s author — KLAS Clinical Research GM Jason Hess — about trends in this rapidly evolving niche.

(Part I)

BOLD STATEMENTS

If I could name one factor for success, I think it’s that there is no shortcut; you just have to take the time to make sure you’re in compliance and all your legal ducks are in a row.

… this whole ATM notion that Dale (Sanders) talks about is exactly right. I mean, I don’t see where patients can see the benefit yet.

When you talk to Eclipsys sites about participating in an HIE, they’re going to refer to that Medicity relationship, but that’s about it. Siemens and Meditech, nothing.

GUERRA: We were talking about whether clinicians would take action off of data found in an HIE. I supposed you’d need some very clear policies about how that data stays current. Have you seen best practices around that?

HESS: Certainly there are cases out there where they are successfully doing it. We asked the question: “Do you have a patient opt-in or opt-out scenario in your particular HIE,” and a lot of times that’s mandated by the state. There was really no rhyme or reason as to how that came out.

Yes, certain HIEs do exist where they’re successfully doing it, but I don’t know if I can point to any specific key things that they’ve done, other than maybe just having worked at it longer, so they’ve been able to work through some of the bruises. I mean, many of these conversations take hours and hours and hours (and years in some cases) of working with attorneys to make sure all their ducks were in a row, and that’s how they handled all the legal compliance, governance and privacy issues.

If I could name one factor for success, I think it’s that there is no shortcut; you just have to take the time to make sure you’re in compliance and all your legal ducks are in a row.

GUERRA: Do you know if anyone has figured out the revenue model?

HESS: Essentially if you’re relying on government money, it’s still unclear what happens when that money goes away. There’s less worry if your funding is from private sources.

GUERRA: What do you mean by “private sources?”

HESS: From participating providers, hospitals, a per-fee kind of charge to look at a record. There are lots of different practices around that, where the providers are paying to see the data or participate.

GUERRA: Are the payers getting into the act?

HESS: Payers would be part of that as well.

GUERRA: Right, and what about the patients?

HESS: No, not the patients. So this whole ATM notion that Dale (Sanders) talks about is exactly right. I mean, I don’t see where patients can see the benefit yet. Now, one thing I will say is we’re kicking off a study right now on personal healthcare records (PHRs). So now you’ve got a way where all the information can be shared regionally, and you’re seeing best practices of that. Now, how can the patient then be able to see their information? Well, that’s the PHR component, and maybe that’s going to be the entry point for the patient to actually pay for access to their data. But today, I don’t see a real strong reason why a patient would want to have that. I mean, they’re basically saying, “Look, you’re taking care of me, you should be able to see my data.”

GUERRA: Let’s talk a little bit about Epic. It’s an interesting situation you talked about where Epic has quite a few HIEs they have built, but only connecting Epic customers. It doesn’t sound like they are exchanging data with any non-Epic hospitals.

HESS: Not yet. So really, the umbrella is Care Everywhere and under that are two subcomponents. One of those is Care Elsewhere and that’s where Epic can tie in with a non-Epic site, and that’s not live yet, although they suggested that’s coming. Based upon past history, when Epic says they’re going to do something, typically they deliver on that. But in time for this report, no, we weren’t able to validate that. There was a lot of discussion as to whether we should even include Epic in this report. Because yes, they have seven Epic to Epic HIEs. Well, in theory, that’s one big HIE. So if you’re an Epic site in the Midwest, you in theory can talk to the Epic hospital in Florida. But for the purposes of our report to break this out, we essentially looked at all the individual participants in that, and there were seven of them, but that’s why we put in parenthesis “Epic to Epic.” So this is not referring to Care Elsewhere — Epic to Cerner or Epic to GE, for example — though we anticipate being able to measure that at some point.

It was kind of a tough one because they’re really not apples to apples comparisons. Somebody said to me, “Look, if everybody is Epic in the country, we’d have the NHIN built, because if I’m Epic, I can talk with any other Epic site with this product.” So we’re watching it.

GUERRA: When do you anticipate an Epic to non-Epic HIE integration?

HESS: I think they were saying later this year.

GUERRA: Their competitors will probably jump on this to say it shows a lack of interest in integration.

HESS: I’ll tell you what some providers have told me. Some of these Care Everywhere sites that are sharing Epic to Epic have said basically, ‘What Epic has told us is all they need is an EMR on the other side that is basically CCHIT certified or a meaningful use-certified version” and then they can share data with that particular vendor product. So that’s what providers have told me, and I didn’t go to Epic for an official position on that, simply because my position is that I don’t bother digging into it until it’s actually real. I don’t want to market for Epic, but if providers are telling me that it’s coming, like I said, Epic is typically pretty good at delivering on those promises.

GUERRA: It seems from your report that Eclipsys, Meditech, and Siemens are not doing much, but I don’t see why they should have to be. I mean, there are vendors out there specifically doing this HIE integration. So perhaps they just say, “This is not a market we need to be in.”

HESS: Well, Eclipsys has a partnership with Medicity. I’m not aware that Siemens or Meditech have anything up and running yet. But that’s why we say they’re missing in action. When you talk to Eclipsys sites about participating in an HIE, they’re going to refer to that Medicity relationship, but that’s about it. Siemens and Meditech, nothing.

Part III