HIE: Exchange rates

HIE (the noun) has evolved in many ways in the past 10 years. HIE (the verb) will be more important than ever in the next 10.
By Mike Miliard
12:00 AM

The term "health information exchange" has been around for a while. It's traceable in the media at least as far back as June 24, 1977, when the Windsor (Ontario) Star described Canadian health officials agreeing to "set up an inter-provincial health information exchange to encourage and support a study of the results of coronary artery bypass surgery and to support action in the area of occupational health."

One of the first mentions in these pages was back in 2005, in a story with a headline that still rings true: "Health information exchange efforts increase, but funding challenges remain."

The story referred to a survey of 109 state, regional and community-based HIE initiatives, finding that 65 of them reported being "in the advanced stage of development, meaning they were addressing the technical, legal and financial issues needed to exchange data." Of those, 25 said they were "fully operational" and were exchanging data.

"We were pleasantly surprised to see how far along these groups are," said Jennifer Covich Bordenick, then vice president (and now CEO) of the eHealth Initiative. "They are solid, multi-stakeholder groups that are collaborative."

Compare that early optimism to where things are today. "We continue to struggle," is the verdict of HIMSS Analytics/directory/analytics" target="_blank" class="directory-item-link">Analytics executive vice president John Hoyt. (See "Benchmarks," page TK.)

Certainly we've come a long way from where we were just a decade ago. And we've seen many shifts in strategy and nomenclature along the way as many different exchange mechanisms – from the national NHIN Cooperative/NwHIN Exchange/eHealth Exchange, on down to any number of regional and local HIEs – try to find their way toward stakeholder value and sustainability.

But there's also no question that many once-vaunted HIEs are struggling to stay viable. As Noam Arzt, a San Diego-based health IT consultant, told Anthony Brino, associate editor of our sister publication Government Health IT, in 2012, “Many HIEs are community efforts. Their funding ranges from moderate to unstable to precarious."

That's why there's been a shift in thinking, epitomized by a pithy tweet from erstwhile National Coordinator Farzad Mostashari, MD: "HIE is a verb, not a noun."
This has led to an evolution in recent years, as federal funding has dried up, with much more of a localized, private sector approach to data exchange.

As Pam Matthews, RN, senior director, regional affairs at HIMSS, told Healthcare IT News in 2012, one trend that's "very progressive right now" is hospital networks and integrated delivery systems exchanging patient data among themselves and "calling themselves an HIE."

That, said Matthews, "a lot easier in many ways – in that you're not having to deal with the sustainability issues, and some of the others challenges you need to with a RHIO, but it's still an HIE."

Or take a more basic approach such as the Direct project, accessible to academic medical centers and two-doc shops alike. It was described in these pages, in 2011, by now U.S. Chief Technology Officer Todd Park (then CTO of HHS), as “a classic, fantastic, soon-to-be-legendary example of how the public and private sectors can come together in a collaborative, entrepreneurial explosion of mojo to improve and advance healthcare in America.”

Spearheaded by the ONC, Direct, a secure, scalable way to email medical data between clinicians, came together in short order after a slew of vendors –  eClinicalWorks, Epic, GE Healthcare, IBM, Intel, Siemens, and others – worked to develop and comport to its specs at the government's behest.

Even as many state HIEs (the noun) continue to go full steam ahead, that sort of private sector collaboration may be the way forward for HIE (the verb).

Consider the CommonWell Health Alliance, which has seen Cerner, McKesson/RelayHealth, Allscripts, athenahealth, Greenway, Sunquest and CPSI put aside their competitive differences in the spirit of enabling integration, interoperability and data exchange.

McKesson chairman and CEO John Hammergren called the organization an "industry-led approach" to one of the thorniest problems in health IT. "One of the key challenges we face is not just automated healthcare but connected and together care."

That was at the alliance's unveiling in March 2013. This past month, CommonWell announced its first exchanges, taking place among hospitals and ambulatory clinics in Chicago and North and South Carolina.

Right away, participating providers saw the value, said Cerner exec Scott Stuewe, who leads CommonWell's program management committee, in an interview this past month.

"Since everybody is making their own connection to the network, it means there isn't a custodian of the data – there isn't an organizational construct that has to be trusted. The data is flowing more or less peer-to-peer between the organizations. And because of that there isn't a middle man that needs to be trusted the way a state HIE has to be."

The past 10 years have seen a lot of growth and change on the HIE front, and there's probably plenty more yet to come. As Matthews put it, "There are various flavors that are materializing. Each state has its geographic market drivers, as well as political drivers. The states have to look at what their market and political environment will bear."

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