Achieving HIE Sustainability: Leveraging Information to Realize Success

By Gary Palgon
01:04 PM

The day is rapidly coming when healthcare providers across the country will be able to share information about patients with a few clicks of a mouse. Key to this future, at least initially, is the formation of health information exchanges (HIEs)—entities that electronically mobilize disparate health information and share it among providers, payers, facilities, pharmaceutical companies, biotech firms and a wide variety of other healthcare organizations. 

As we all know, HIEs take data beyond the walls of individual hospitals or physician's offices so that individual patients, larger patient populations and organizations can benefit from compiling, comparing, contrasting, and mining data. Without HIEs, the work currently underway in many healthcare organizations to track detailed patient care metrics loses its potential for more global value.  

Like any business, however, an HIE will only be successful if it is sustainable. That means achieving profitability without relying on grants or public funding. Unfortunately, most of the 255 HIEs that currently exist in the United States have not yet met this criterion; merely 18 have reached the point of sustainability.

There are many reasons for this overwhelming lack of solvency. A recent article in Government Health IT, for example, outlines five potential roadblocks HIEs face—data sharing, patient consent, standards, complexity and competition.  While all these factors certainly need to be addressed for long-term HIE success, the greater problem facing HIEs right now is the cost and relatively slow pace associated with the integration of disparate data sources.

More specifically, the amount of effort required to create a system that efficiently integrates, harmonizes and manages patient data in a usable way can be staggering. The data integration and mapping processes alone are complex and time intensive, demanding a high level of expertise and a long-term commitment to effective management.

Speeding integration: the overlooked need

There is no doubt that healthcare organizations perceive value in patient information integrated from disparate sources across the healthcare continuum. However, it is the speed with which data can be integrated and aggregated that will likely mean the difference between sustainability and defeat for many HIEs.

It makes sense if you consider the idea of “critical mass.” Achieving profitability without relying on grants or public funding means HIEs must find ways to make their data profitable. Healthcare and life sciences organizations—including payers—are most likely to both provide and subscribe to data that: 1) exists in large enough volumes, and 2) is aggregated in usable ways.

By integrating disparate data from across the care continuum faster, an HIE can increase data accessibility as well as analysis for healthcare organizations—which in turn can lead to the achievement of meaningful use (or to secondary use for pharmaceutical companies and bio-tech firms). Easy access to usable data is the way HIEs will attract more paying customers, bring in more revenue, and ultimately realize solvency.
Currently, most HIEs try to accomplish this kind of data integration and mapping in house, relying on internal information technology (IT) staff to do the work. Yet most HIE organizations simply do not have the appropriate expertise, necessary resources, or adequate time to accomplish the best and most effective data integration and management processes. (Other HIEs rely on meaningful use application vendors that often are experts at user interfaces and process flows, but not necessarily integration or data harmonization.) 

The physical resources alone—data centers, hardware, software, and so on—can be a huge drain on an organization's funds. In addition, lack of expertise can lead to processes that unintentionally create bottlenecks which delay and sometimes derail integration. Currently, HIEs that rely on internal resources for data integration and management very often face so many pitfalls that they run out of money before an appropriate system is in place.

Pursuing a shared infrastructure approach

There is an answer to the challenge of timely data integration—a shared infrastructure approach. This involves outsourcing the core data integration task to an experienced third-party specialist that leverages secure cloud technology to facilitate a scalable infrastructure and offer valuable data transformation and translation tools.

There are several benefits to pursuing a shared infrastructure approach. The first is expertise. Because data integration and harmonization are core competencies for Integration Platform-as-a-Service (iPaaS) providers, they understand how to achieve comprehensive data integration much faster than an HIE could accomplish on its own—and without requiring new capital outlays or hiring additional IT staff. An HIE would be able to rely on its partner’s expertise, both professionally and technologically, to efficiently drive integration. 

Not only does this expertise result in a better solution, it also removes the burden of data integration from HIE IT staff. This is vitally important, because it frees them to focus on data informatics and the critical task of running applications that package data for the various facets of meaningful use.

Since recent federal legislation requires hospitals and physicians to demonstrate meaningful use of electronic health record (EHR) data in order to receive incentive payments, many potential HIE customers are interested in working with an HIE that has well-developed applications to facilitate the job. In addition, pharmaceutical companies might be interested in applications that support secondary data use, such as matching qualified patients with open clinical trials. By using a shared infrastructure approach to shift focus from data integration to revenue-generating applications and compliance, an HIE can offer greater service to its customers and attract new business.

A shared infrastructure relationship additionally moves the cost of data integration from a capital expense—data center, hardware and software—to an operational expense. The HIE is now paying for an integration and data management service instead of a technology installation. This allows for better budgeting as well as enhanced cash flow.

Relying on an outside vendor can also help keep HIEs more nimble and adaptable to changing healthcare standards. As new standards governing HIE interoperability, patient privacy and information sharing come into play, a third party specialist is better able to keep up-to-date on new developments and ensure compliance.

Adopting an old concept for new sustainability

The concept of outsourcing projects or systems to providers that offer “best of breed” service is not new. Organizations across many industries, including healthcare, do it every day. Health systems routinely turn to outside experts to develop, implement and manage everything from EHRs to revenue cycle, for example.

To achieve sustainability, HIEs must take the same approach to integration and data management. By taking advantage of the cloud-based integration and data harmonization expertise available outside their walls, HIEs can speed the process, increase their customer base, expand their revenue streams—and ultimately ensure sustainability.

Gary Palgon is the Vice President of Healthcare Solutions for Liaison Technologies, which provides healthcare organizations with innovative solutions to complex integration and data management needs. He can be reached at