6 tips for HIE sustainability

By Michelle McNickle
09:12 AM

The widespread development of health information exchange is happening quickly, and with it comes worries about confidentiality, privacy and security. But its benefits far outweigh potential concerns and include improved quality of care and reduced healthcare costs. 

Despite HIE’s reserved reception among hospitals and practices nationwide, many have said it will play a significant part in meaningful use stages down the road. And since there’s no time like the present to get a jump start on beneficial programs, Rob Brull, product manager at Corepoint Health, suggested six tips to make HIE implementation last.

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1. Keep it simple. According to Brull, HIE can do a lot when it comes to improving the quality of patient care. However, he thinks it’s best to focus on a few aspects of HIE that will have the biggest impact. “If the HIE tries to be everything to everyone too soon, it may never be able to establish the foundation that it can grow upon,” he said. For instance, Brull said the HIE could potentially concentrate on exchanging CCDs, lab results, and radiology results first, leaving things such as electronic referrals, home monitoring, or disease registries for a second phase. “Also, data doesn’t have to be completely interoperable from day one,” Brull added. “Maybe a portal is used to view results, instead of the results delivery being completely integrated with the EMR. Interoperability can be something that is enhanced over time, given financial constraints and needs.”

2. Understand your revenue sources. Brull argued that to achieve sustainability, a business case must be defined before the inception and implementation of any HIE. “The major part of that is understanding where the revenue sources are going to come from,” he said. “The business analysis has to show the annual revenues are sufficient to cover the operating costs.” Brull continued by saying possible sources of revenue include labs and imaging centers that want electronic connections to physicians placing orders within the HIE. “Historically, physicians have resisted the concept of paying fees for connectivity. It must be clearly understood what the participants are willing to pay, and the HIE must act as any company trying to sell a product; they must justify the coast based on the benefits received.”

3. Estimate the costs. Similar to revenue analysis, the HIE must forecast their upfront and continued operating costs the same as any for-profit business, said Brull. According to him, the “due diligence” of estimating the costs ties back to the idea of keeping it simple. “The present value of any grants plus the continued revenue sources must not exceed the present value of the costs,” he said. “High hopes of implementing a feature-rich HIE from the start can put a severe strain on the cash needed to procure the most advanced functionality.” And the more complex the system is to implement, the more expensive it will be to maintain. “Keeping the structure simple will keep the costs lower and allow for more sustainability,” Brull added. 

[See also: HIEs and stimulus funding: Don't wait; implement now!.]

4. Foster alignments with ACOs. “Discuss with the providers in the HIE to understand if they will be participating in an ACO as well,” said Brull. “If an HIE infrastructure can be utilized to support an ACO, then ideally the shared savings of the ACO could be used to help fund the operating costs of the HIE.” In addition, by understanding the requirements of the ACO, the HIE can make better upfront decisions as to what functionality is included. “Although an HIE should limit its upfront functionality to the critical features, supporting the needs of the ACO will help drive the revenue stream needed for sustainability,” said Brull. 

5. Ensure patient privacy. According to Brull, “nothing will cost more headaches, lose the trust of the public, drive up costs, and reduce revenue like a patient health information breach.” A major requirement that must be done correctly is privacy and security, and accomplishing that should include open communication with patients to make sure they understand their rights to opt out. “The EHR certification process provides detailed criteria for privacy and security,” said Brull. “HIEs must ensure they follow those specifications as well as follow the processes outlined by HIPAA.”

6. Start with a federated model. Brull said there are many advantages to starting with a federated model, which allows patient data to be housed by the providers. “This model is simpler and easier to implement, keeping down initial upfront costs until a foundation for the HIE is established.” Brull continued by saying the second advantage is having privacy and security requirements largely at the provider level instead of the HIE level since there is no centralized repository of data to protect. “Of course the interoperability is not as efficient, and the location of data is much harder to track,” said Brull. “But this approach makes the business case much easier to justify and ultimately will give the HIE a better chance of sustainability."