Ten years ago, health information exchanges (HIEs) were failing. Complex governance and a plethora of standards in technology and financial sustainability challenged organizations to share data. It was unclear whether there would be a role for community HIEs in the future. Some organizations invested heavily in HIE platforms to encourage “stickiness” with the community providers. Others considered performing a modest results exchange with a community provider or submitting registry data to their state exchange, but many did nothing.
Fast-forward to 2012 and the regulatory requirements of meaningful use Stage 2, which mandated the use of HIEs. New terms appeared, such as HISP, and the federally funded data exchange introduced direct addresses for sending and receiving standard clinical care records. Hospitals wanting to participate in government incentive programs or avoid penalties for electronic health record (EHR) adoption began looking for HIEs.
But it isn’t so easy.
- Most of the EHR vendors have proprietary solutions, adopting different versions of “the standard.”
- These solutions not only require license fees for the software, but many carry license and maintenance fees for each individual interface as well as per transaction fees.
- Governance is still complex. Funds flow and financial responsibility are problematic.
- Work flow is not intuitive or requires logging into another system. Clinicians feel like data entry clerks as they comb through records in search of useful information.
So what should you do?
- Embrace your EHR vendor solution, even if it’s not perfect. The embedded work flows are the easiest and therefore will have the highest adoption.
- Create your own standards for connectivity. Rather than having only one way of connecting, perhaps there’s a menu of three or four options, depending on the type of connectivity.
- Don’t let governance get in the way. Connectivity for the hospital is part of a broader strategy, so you should plan and budget for this expense. These exchanges also have a return on invest-ment, such as lessening the administrative burden on the HIM department, avoiding the IT burden for Citrix or other direct connectivity, and eliminating manual tasks and endless phone calls.
- Take the time to assess the work flow as part of an optimization exercise, particularly in the emergency room or primary care office.
How do I get started?
Connectivity is not an easy problem to solve and requires strategic and tactical planning:
- Identify the connectivity “use cases” or problems that you are trying to solve.
- Array those requirements in order of priority. Which gets you the biggest bang for the buck?
- Be open minded around the best way to solve the problem. Use the investments you’ve already made before looking for an outside solution.
- Create a multiyear budget and secure the funding.
Data sharing and HIEs are not going away, and an increasing number of options will become available. Accountable care and business partnerships, mergers, and acquisitions will drive an expanded need for data sharing, and organizations must be creative in making these exchanges successful.