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.
… in reality, it’s really a health information broadcast, right? Because the clinics, in most cases, are not sending information back. It’s like an HIB as opposed to an HIE.
… as we got into it, it was really a mile wide and an inch deep.
“We’ve got to do this now. The writing is on the wall. Our patients are coming to us saying we need this information shared.”
GUERRA: When you say Siemens and Meditech aren’t doing anything, that doesn’t mean they’re not on one end of an HIE connection that’s facilitated by Axolotl or Medicity, for example.
HESS: Yes, exactly. That’s why I wrote, “This should not imply that their customers are not participating in it.”
GUERRA: You also wrote that a couple of the vendors facilitate unidirectional information flow, but that both of them are working on bi-directional information flow. Can you expand on that?
HESS: That’s interesting, this acute to ambulatory notion, that’s obviously a hospital pushing data out to a clinic. In terms of them actually receiving information back, we’re not seeing a lot of that yet. So in reality, it’s really a health information broadcast, right? Because the clinics, in most cases, are not sending information back. It’s like an HIB as opposed to an HIE. But where do you categorize that today? Well, let’s look at who’s even doing one part of the equation, who’s actually pushing lab data out to the clinics, or results on radiology exams, things like that, who’s pushing that information out in any kind of a broadcast format. Were we going to call the segment an HIB? No. It’s an HIE, but I think we wanted to be pretty clear that in the case of a Medicity or others, it’s basically funneling lab results to these reference labs and to these ambulatory sites, and that’s really the extent of it today. Although Medicity will tell you that the bi-directional piece is coming.
So I think it’s a matter of just trying to measure it — that’s what is so hard. When I jumped into this, I thought we’d have six to 10 vendors, a robust segment with scores. And as we got into it, it was really a mile wide and an inch deep. That’s what was so hard about this — where do you really draw the line about what an HIE is. It’s not like you can go to one particular vendor and say, “Well, here’s this wealth of best practices and live customers that you can talk to.” Certainly, there’s a couple of those, but everybody else has one or two or three, and so it’s really hard to say, “Here’s the complete story of what’s going on.”
I think what this will tell the providers is, “Look, you’ve got to be careful about believing all the hype out there that there’s just tons of these live.” From our vantage point watching commercial products, it’s really wide and skinny today.
GUERRA: Regarding GE, you mentioned that people were not happy with the “complex contracting process.” I would imagine most of these contracts are quite involved, but GE specifically is having some issues?
HESS: All I can say is that was brought up repeatedly.
GUERRA: You didn’t mention competitive issues getting in the way of HIE collaboration. I was surprised not to see that.
HESS: It didn’t come up nearly as much as I thought it would either, which is pretty interesting. That really was the challenge with the CHINs in the ’90s, right? I mean, the fact that you didn’t have the Internet, so you didn’t really have a strong infrastructure for being able to share that data. Look, CHINs failed because there was no incentive for me to want to collaborate or share information with the competing health system down the street. But now you’ve got this double-edged sword that I talked about with stimulus, with ARRA, that federal money is coming. Yes it slowed the sales process but, at the same time, overwhelmingly, people are saying, “We’ve got to do this now. The writing is on the wall. Our patients are coming to us saying we need this information shared.”
So when you talk about the drivers to do this, it’s improving patient care, it’s making the patient data available. But it was interesting that competition didn’t come up as a big challenge. I think if we’re going to move to a national health information network, that’s going to require cooperation among these different health systems that are competitors down the street from each other.
GUERRA: What advice could you give CIOs that are getting their feet wet with HIEs?
HESS: First off, I have to mention there are other HIEs out there that we ignored, that are homegrown or don’t have a commercial product. Some of them are facilitating real exchange of information, so the advice I would give these CIOs is to use the expertise of vendors that are doing this or have relevant knowledge, not necessarily the technological aspect of exchanging information, but the business case. CIOs should say, “Help us understand how we can effectively build this and sustain it financially. How would you solve the question of privacy challenges?”
If KLAS’s report validates that privacy and governance are challenges, they should ask, “Can you, as the vendor, share with us best practices about how we can do this?”
So it’s not just, “Come in and show us your solution and how you can technologically pull everything together,” because that’s just one side of it. Frankly, that came up again and again as the easy piece. The hard piece is: who’s going to be in control of this, where’s the money going to come from, is this going to be a patient opt-in or opt-out? Well, in our particular state, we need to do a patient opt-out. So ask, “Do you have customers that have done patient opt-out scenarios, and what does that mean? How do you handle this HIPAA compliance issue with data, who’s in charge of the data once it’s shared?” It’s basically relying on the expertise of vendors that have done this to help you through that process.
I think that’s where the best practices will come from. It was just all over the board. So it’s pretty tough to be able to say, “Here’s 10 HIEs that are doing it, and here’s the common theme that we saw.” I suspect we’ll be able to paint a picture of that better in time, when we have five or six or seven of these built out with an install base of six to 10 apiece. At that point, we can really start to form some kind of criteria around what the best practices are.