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HIE Expert: ‘Most State HIEs Won’t Survive’

October 11, 2012
by Jennifer Prestigiacomo
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Micky Tripathi argues that the failures of statewide HIEs will inform and spur private HIEs

Micky Tripathi, founding president and CEO of the Massachusetts eHealth Collaborative (MeHC), participated in a state health information exchange (HIE) panel on Oct. 3 at the Department of Defense/Veterans Affairs iEHR and HIE Summitat the Carnegie Institution for Science in Washington, D.C. Senior Editor Jennifer Prestigiacomo caught up with Tripathi after the panel to get his thoughts on the struggles of statewide HIEs and what steps Massachusetts is taking to break the mold.

What are some of the major learnings from the panel you were on?

What I said on the panel was that what Dan [Porecca] has done in Buffalo [Porecca is the executive director of HEALTHeLINK, Western New York’s clinical information exchange]is an absolute perversity in the market, and I don’t mean that in a bad way. What I mean is that it’s a very unique situation, and there aren’t that many places in the country that have that capability, and it’s going to be a challenge for most places to get to that.

Certainly, in Buffalo, Indiana, and Cincinnati, a lot of them go back to an organization being founded a little more organically. It wasn’t a federal program or something from the outside saying, ‘You have to do health information exchange. Here’s some funding; now try to put it together.’ It bubbled up from the bottom-up with provider organizations saying we have this problem we need to solve, and let’s get together and try to solve it. That’s how NEHEN was started. Part of what Buffalo, Indiana, and Cincinnati have in common is that they really emerged organically from the bottom-up many years ago, so they have a certain durability.

How is Massachusetts coming along with its phased approach? The last time I spoke with you, you mentioned a three-phase approach, starting with Direct messaging in Phase 1?

Oct. 16 is when it is going live. Originally, we were set to go live Oct. 15. We had our only program slip from Oct. 15 to Oct. 16, because we actually want the governor to send the first transaction over the network, and he wasn’t available on the 15th. At Massachusetts General Hospital, he’s going to push the button to send a secure record to Baystate Medical Center in Springfield, Mass. Then there are about 10 organizations, including mine, who are also going to be sending our first transactions over the health information exchange to demonstrate a variety of use cases. In my case, Beth Israel Deaconess will be sending us clinical records for quality measurements. Tufts Medical Center is going to be sending a record to Network Health for the demonstration of the use case of data going to a health plan for claims adjudication.

What is the Massachusetts  statewide HIE going to be doing in Phase 2 and Phase 3?

The function that we want to be able to get to is the ability to query systems, which is the ultimate use case that physicians care about. So the question is what components do we need to put in place to enable that ability to query systems in a secure, privacy-protected, permission based, yet automated way that’s clinically viable. So the first thing in Phase 2 we need to do is to create a statewide master patient index (MPI) and record locator service. The second big component is a centralized database of consent preference, so that you can do it in automated way. The third piece is the technical standards for doing the queries. For now, the meaningful use certification standards only get as far as Direct. They haven’t tackled how you query other systems. Part of why we’ve phased this is because we want to piggyback on national standards.

You’ve talked about the over-architected HIE in the past. Do you think that is the cause of some of the state HIE shutterings like Tennessee, California, and Kansas? Is that the main challenge that states are running up against—trying to do too much?

In general, I certainly think there is something to that. I think there are a certain number of local drivers that are very specific to the states. I think that one common thread across them is there was a sense of a big bang, a do-it-all-at-once type of thing, and a presumption that if we build that type of thing, that a) you can build that in short order and b) the market will value that; they’ll want to connect to it; and want to pay for those services to sustain it going forward. I think a number of them have that issue, along with the other local issues. It is partly driven by the way the federal program was designed, the grants very much called for organizations to direct states to create those types of plans. In part they were responding to what the people giving the grants were asking.

Do you think the Office of the National Coordinator (ONC) has been doing enough to support state HIE efforts?