Written by John Tempecsco, Chief Marketing Officer at ICA Informatcs
There are many reasons why HIEs have not historically thrived. During the CHINs of several decades ago, there were four major barriers to success. First, the prevalence and acceptability of the Internet had not emerged, and the infrastructure to connect healthcare organizations within the community cost as much or more than the solution itself. Second, there were very few clinical applications being adopted within the medical community to even capture clinical data, let alone share it. Third, there were not any standards designed to share the little data that was available. And lastly, there really wasn’t a value proposition to commit to the expense associated with the on-going operation of a CHIN.
Fast forward a couple of decades and we have a ubiquitous, reliable, speedy and inexpensive Internet capability with connections literally everywhere including untethered capabilities powering mHealth devices. In addition, Meaningful Use has driven the fastest adoption of EHR in both the acute and ambulatory setting, astonishing even the biggest skeptics (including me). However, standards are still in their infancy. IHE and Direct protocols are being adopted within EHR products as rapidly as possible, but wide-spread deployment of this new standard within operational products is just now being realized. But that is only the tip of the iceberg. There are thousands of ancillary and diagnostic clinical systems in need of upgrades within the acute and ambulatory space for true interoperability to occur. And, although EHRs are making progress complying with the latest IHE and Direct protocols, few have been able to incorporate this interoperability in a meaningful way within the workflow of their products. Stabilizing standards for interchange so that vendors have time to incorporate them within their deployable products in a way that is transparent to providers at the point-of-care will be required before HIE is neither costly nor time consuming for the provider community.
Accomplishing infrastructure, clinical system deployment and standards-based transfer among acute and ambulatory settings only solved half the equation. As Paul Harvey would say, “the rest of the story” will evolve when the same progress is made in the post-acute setting. Having rehabilitative, skilled nursing facilities, home healthcare and hospices all connected will be the next evolution in health information exchange necessary to meet the final challenge of value proposition. To date, HIEs were established in a “build it and they will come” mentality. The Federal Government has been under the impression that there is an intrinsic value in health information exchange which everyone will not only recognize but will be willing to pay for. In a paradigm of largely fee-for-service healthcare delivery, that value has not materialized.
Wide spread adoption of a value-based reimbursement model with healthcare will be the final impetus for adoption of health information exchange. However, it will require health information exchange to occur as a verb not a noun. Individual providers, especially in highly specialized functions, will belong to more than one accountable care organization requiring them to exchange information with multiple competing entities. If there are HIEs in the future, they must evolve into clinical data clearinghouses that support a paradigm of value-based reimbursement rather than 501c3 organizations with an altruistic mission statement of improving the health of a community. Once this occurs, all four barriers to HIE adoption will be overcome and there will be no need for a governance structure for obsolete community-wide or state organizations.
I believe that healthcare would be better served if the federal government did not waste time or money on governance and focus on improving standards and public-private collaboration efforts to drive adoption of technology, standards and payment reform.
What are your thoughts? Should the federal government focus its efforts on improving standards vs spending time and money on governance?
Article first appeared on ICA Informatics HITme Blog