Health information exchange: E pluribus unum?
The state of health information exchange (noun and verb) is complex, to say the least. The past decade-plus has given rise to a patchwork of approaches: public and private exchanges; statewide, regional and local networks; national vendor-based interoperability groups such as CommonWell and Carequality. And more.
If it's a bit of hodgepodge – and far from the seamlessly interconnected "learning health system" aspired for in ONC's Shared Nationwide Interoperability Roadmap – this cobbled-together system is a whole lot better than the shelves of dusty manila folders that represented the health data ecosystem in the not-too-distant past.
But there's always room for improvement. John Kansky, president and CEO of the Indiana Health Information Exchange, said there's a better way forward from the existing conflicting and confusing state of HIE in the U.S.
On one hand, Kansky said the fact that there are myriad current frameworks and strategies for data exchange is eminently understandable, even encouraging. The way things are now is necessarily big and complex, just the way a large undertaking such as this has to evolve – especially given such relatively quick uptake of digitization and fast data growth happening.
"I actually find the new proliferation of approaches a sign that we are making progress," he said. "Health IT is finally beyond the point that exchanging data between organizations is limited to a few 'unusual' markets. This is the American way of figuring things out: Try a bunch of different things and let smart people and the markets determine what works."
"I've been in the HIE business 10 years, and no year has ended like it started," he explained. "The words we use to refer to what we're collectively trying to do for healthcare have continued to change."
That's not to say, however, that he foresees the existing patchwork necessarily slimming down into some sleek and efficient unified national network.
"I believe healthcare will figure out an ecosystem that works to move and use data in the best interest of health and healthcare," he said. "I don’t think it will ever be 'a uniform whole' – it will be a diverse, complex, messy whole that works."
Even that, said Kansky, is a bit of a way off. "I don’t see it yet: We are still in the segment of the curve where new approaches are being offered."
Does that mean that the years ahead represent a challenge that's best left to the technology vendors, healthcare providers and other private sector entities offering those approaches? Or does the government still have a role to play? ONC, after all, has put nationwide interoperability at the very core of its mission.
"The government has a key role to play using policy as a lever to drive healthcare to more economically rational reimbursement, like value-based care," said Kansky. "But I don’t feel that health IT solutions can or should be driven by government. Policy should not be used to specify how information technology supports care. Let innovative humans figure out how best to support health and healthcare."
At HIMSS17, Kansky will examine the ways these different approaches differ with regard to sustainability and stakeholder involvement. He'll take stock of the role geography and provider mix play in HIEs' services. And he'll spotlight the opportunities and challenges of these differing strategies, assessing how business and clinical roles can better unify, toward a framework that's able to manage value-based imperative while keeping the patient at the center.
Kansky will present "Health Data Exchange - Can There Be ONE National Model?" at HIMSS17 in Orlando, February 20 from 3 p.m. to 4 p.m. in room 311A.
HIMSS17 runs from Feb. 19-23, 2017 at the Orange County Convention Center.
This article is part of our ongoing coverage of HIMSS17. Visit Destination HIMSS17 for previews, reporting live from the show floor and after the conference.