Healthcare IT Insights

If it walks like a duck and sounds like a duck, then it is probably a duck…

Federal government programs under ARRA for healthcare have created a lot of energy around extending the reach of electronic medical records through provider incentives via Medicare and Medicaid.  Subject to an affordable budget at the state and federal levels, these seem like solid programs.

The efforts around HIE and the infrastructure to support the sharing of data among providers in the community while sound at first glance are sounding all too familiar.  Remember the Clinton version of Healthcare Reform?  Remember CHINs? Remember RHIOs which were only recently bogging down with such commonality that they changed their names and reopened for business as HIE?  As Yogi Berra would say, this is a déjà vu all over again situation.

As I have shared in other posts, I am an advocate of the HIE solution – but I am more of a capitalist than a communist. There are solid vendors out in the market who can help provider organizations in a number of ways including:

• Patient safety through a more complete collection of CCR components such as active meds, allergies, chronic conditions from disparate sources
• Capture of physician referrals from within the owned and affiliated physician groups
• Reducing the cost of reporting to external entities

Vendors in this space include Medicity, Axilotl, dbMotion, Wellogic, MedSeek, etc. just to name a few.  In my view, a health system focused HIE program can make a lot of sense and have a strong ROI.

What causes my eyes to roll back in their sockets is the “RHIO like” obstacles I hear associated with planning efforts around HIE – in anticipation of ARRA funding.  http://www.emrandhipaa.com/emr-and-hipaa/2009/04/08/simplification-of-health-information-exchanges-and-ehr/

Based on my experience, the following represent some of the most commonly encountered barriers to effective RHIO/HIE:

• Governance/Ownership – who controls the organization?
• Data Sharing/Security – consent for sharing patient information
• Sustainable business model – after the grant funds run out, how do you keep the doors open?

In the absence of government funding, RHIOs were on a slow death march largely due to the absence of a sustainable business model. The most successful models are those who received grant funding from public and private sources – but grant applications are not reliable as a primary source of revenue generation.

The challenge in broad-based RHIO efforts, is the huge disconnect between stakeholders who have the need for shared information and those who have the funds to contribute to RHIO operations. Government funding of HIE/RHIOs only masks this challenge.  How long will it be before government budget problems drive cuts to public HIE funding?

How different is the picture in considering the value propositions of other stakeholders across the healthcare continuum that might have funding to support operations of an HIE such as:

• Large health systems
• Payor organizations
• Pharmaceutical/medical supply companies
• Life science/medical device companies

Clearly, there are potential strings attached in aligning with these stakeholders but are there not also strings attached to government funding?

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Health Information Exchange (HIE) is a term used to rebrand the collaborative efforts in communities and regions across the country, formerly known as Regional Health Information Organizations (RHIO).   1,2,3… 4 - yes RHIO is a 4 letter word. HIMSS states that there are more than 600 Regional Health Information Organizations (RHIOs) or “RHIO type” projects underway across the country; however, according to a recent eHealth survey, only seven are truly operational.

Why has it taken so long for RHIOs to take off? Think about the challenge of integrating clinical information across your own health system—from owned and affiliated entities with various vendor platforms to the boards of directors and physician practices involved. Now include competitors, payors, pharmacies, commercial labs and individuals. Multiply that challenge by infinity and remove the cogent business case that links the capital investment to realized benefits.

While interoperability is still a future state vision, Health Information Exchange (HIE) is happening now. HIE is easy to understand and apply to your organization because it takes the massive organizational dimension (regional, read multi-entity, inclusive) out of the picture in the near term. Today, proven platforms and vendors exist to assist you in achieving integration of clinical information within your own health system. An HIE solution can make sense for your organization even if you have adopted and implemented a common vendor platform, since HIE solutions serve support clinical information hand offs among independent practices, payors, pharmacies, lab companies and patients.