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A Hybrid Approach

July 20, 2011
by Jennifer Prestigiacomo
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Health Information Exchange Pioneers are Mixing and Matching What Works to Address Individual Data and Services Challenges

EXECUTIVE SUMMARY:

Industry experts and HIE leaders have moved past early “model”-based debates to focus on creating core and value-added services, standardizing the meaning of the clinical data, and simplifying point to point connections necessary for information to flow between the HIE and providers EHRs.

The times are changing in the health information exchange (HIE) world, and changing fast. While the discussions of even two years ago tended to center around “model” issues-in other words, which technical architecture (central repository, federated, or hybrid) to adopt, the conversations have since morphed. Now, they are focusing around which infrastructure in any particular situation might best support core and value added services, which services stakeholders need that will also sustain the exchange's business model, how best to standardize the meaning of clinical data to produce usable analytics, and ultimately, how best to get that data to flow from the HIE to providers' electronic health records (EHRs).

What's more, say those who've been tackling the challenges of HIEs, one thing is certain: no one solution fits all.

Back in the 1990s, when provider organizations were creating the first-generation connectivity collaborations called community health information networks (CHINs), early discussions focused on clinical data ownership, breach responsibility, and which technical architecture to adopt. Patrick Rossignol, principal, technology, Deloitte Consulting (New York), remembers two distinct camps emerging years ago-those claiming a federated model wouldn't work because queries took too long to execute; and those claiming a central repository proved too costly and insecure. Other questions began to emerge pointing to organizations' varying comfort levels for sharing and pooling data, and disagreements around how much, if any, data should be comingled in the center, Rossignol says.

CORE AND VALUE-ADDED SERVICES

What has been learned by many in the industry, especially since the December 2006 demise of the Santa Barbara County Care Data Exchange, is that regardless the technical infrastructure, each HIE service must have a value proposition to benefit participants' bottom line. In the last year, HIE vendors Axolotl (San Jose, Calif.) and Medicity (Salt Lake City), have been purchased by analytics companies, United Health Group's OptumInsight (Eden Prairie, Minn.) and Aetna (Hartford, Conn.), respectively, which proves the market is looking to HIEs to not just exchange data, but to produce analytics, Rossignol says.

The Office of the National Coordinator for Health Information Technology (ONC) has given guidance to state HIEs to offer providers at least one way to meet meaningful use (MU) requirements and solve concrete problems, such as lab interoperability, with operationally viable strategies. Core services, such as provider directories, security services, enterprise master person indexes (EMPIs), and record locator services, are key to the success of an HIE, says Greg DeBor, partner of the Falls Church, Va.-based, CSC Health Services. Value-add services like e-prescribing, medication reconciliation, medication history, continuity of care document (CCD) exchange, and immunization registries are also being discussed as essential for long-term HIE sustainability.

It's important to have an open process with all stakeholders when establishing HIE value propositions, says Gina Perez, president of Advances in Management, a Dover, Del.-based consulting firm, and former executive director of the Delaware Health Information Network (DHIN). She adds that the specific healthcare environment needs to be analyzed, and from those needs a technical environment to support value propositions should be chosen. Perez says that any value-added functionality must support provider goals and enhance sustainability.

Devore Culver
Devore Culver

DHIN chose a measured approach to providing services, focusing on basic services and provider adoption first, before adding value-added services. “A good many years were spent just on developing consensus around what the initial services were going to be,” says Jan Lee, DHIN's executive director. Phase one services were delivering lab results and Admission, Discharge, Transfer (ADT) summaries to providers to reduce the cost of results delivery. Provider query has since been added.

CENTRAL VS. FEDERATED] WAS A BIG DEAL TO PEOPLE A FEW YEARS AGO, BUT THEY'VE MOVED BEYOND THAT. A LOT OF PEOPLE REALIZED THAT EVERYTHING IS HYBRID. - GREG DEBOR

Gina Perez
Gina Perez

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