The vast majority (92 percent) of CIOs say local, state, regional and national HIE initiatives are duplicating efforts/work, according to the November healthsystemCIO.com SnapSurvey. As such, it’s not surprising more than 60 percent describe their state’s HIE situation as a “confused mess.”
A large portion of the blame for such a state of affairs falls on ONC, with none describing the organization’s leadership in this area as “very good” and only 3.8 percent finding it “good.” The largest response when answering this question (46 percent) termed ONC’s work “not so good.”
When asked about the technical side of HIE — referring specifically to standards — the CIO community is split, with 23 percent answering that the standards are ready, 38 percent prognosticating they will be ready within two years, and another 38 percent saying even two years isn’t enough time.
Finally, in what will likely be good news for proponents of HIE, almost 70 percent say they are, or will be, exchanging patient information with a health system that could be described as a “direct competitor.”
(SnapSurveys are answered by the healthsystemCIO.com CIO Advisory Panel. To see a full-size version of all charts, click here. To go directly to a full-size version of any individual chart, click on that chart)
1 Is your state’s HIE situation a confused mess?
- Yes, but starting to get some clarity.
- DC…enough said.
- There are many regional exchanges with limited connectivity.
- Yes – unless you ask the vendor that was awarded the state HIE contract (Harris), who would no doubt disagree.
- The HIE in our state is also an REC, so there are too many projects which get in the way of the core HIE mission.
- I am a bit more optimistic with the recent change in leadership, yet we are a large barely governable state. Couple that with the rush for HITECH funds and it is like the Gold Rush.
- Financial sustainability is the biggest issue.
- We are just now getting traction. Six months ago, I would have replied yes.
- The HIE space has to be, at best, “organized chaos.” There are many approaches, issues and political matters in play when setting a direction and executing on the same. I’m glad to say that the “smoke is clearing” to a degree in NYS as our NY HIT v2.0 plan is aligning with other states and ONC directions.
- I would not say a confused mess. but NJ has a direction absent many details.
- We have a single statewide HIE…so, it’s not a mess, but the value of HIE is difficult to quantify, and a generic approach across all health entities may water down some of the benefits of interoperability across healthcare organizations. However, the HIE for the state is organized and proceeding in a professional manner.
- Texas is doing a pretty good job.
- I’m in Indiana.
- We have good leadership and strong involvement across the industry.
2 Are local, state, regional and national HIE initiatives overlapping and duplicating efforts/work?
- Yes, but we are trying to develop a strategy on how service-area HIEs can help advance the state plan.
- This is especially challenging for national organizations that treat people from across territories. In a free enterprise world, where economic scale will challenge business models that don’t demonstrate sustainability, I believe this will sort its way through.
- Although to be realistic, this is probably unavoidable and inherent to the way HIEs are structured.
- CHIME’s StateNet is trying to manage this, but there are too many models and vendors (i.e public, private, hospital owned, etc.)
- With no roadmap.
- Clearly, however again I feel this is sort of the natural state of understanding new ideas and how we learn.
- Some but not much. All the regionals appear to be working well together
We don’t have any regional efforts in AZ. Only a statewide effort and some private HIE.
3 Rate ONC’s performance on laying out a rational HIE framework and funding mechanism:
- I understand the rationale but wonder how this will help with efforts to improve quality and reduce costs, since healthcare is typical local.
- There is not enough focus on true interoperability standards. CCD is a great start, but falls well short. Direct is only a short term patch.
- No real baseline to compare to; I think, given the unknowns, the effort likely average.
- 1) Almost no funding that matters to local HIEs. 2) ONC is sending mixed messages regarding true data exchange between disparate parties versus use of the “Direct” encrypted messages.
Not so good
- It was proposal-based and shotgun in deployment. It did not have a refined target.
- Unlike MU, they have not provided good guidance.
4 Are existing standards up to current HIE expectations/needs?
- But HISP to HISP standards need to be addressed very soon.
- Yes but need to be improved. Evolution not revolution is needed. Need to quit changing the games via reports like PCAST.
- There are plenty of standards that have been promulgated by Integrating the Healthcare Enterprise (IHE) and endorsed by the ONC Standards Committee, but the vendors are slow to adopt them.
No, but should be ready within the next two years
- This is better today than 2 years ago, not where it needs to ultimately be, and likely will be in a more finalized state in 2 years.
- Oh how great it would be to have some real, accepted standards…now THAT would be tremendous use of Meaningful Use!
No, and will likely not be there within the next two years
- The lack of a common patient ID strategy is the biggest barrier.
5 Are you currently (or do you plan on) exchanging patient data with a health system you would describe as a direct competitor?
- It’s all about the patient.
- We are exchanging data; however, not through an HIE interface. We find that other institutions are not ready to share data in a common format.
- Not immediately, but within 1-2 years.
- We are not considering the exchange of information as a “competitive” matter. The exchange of information between local providers is for the benefit of all “shared” patients in community.
- My personal belief is you NEVER compete with people’s health information!
- This is the best for patient care and only makes sense to participate.