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At iHT2-Denver, Discussion of HIE Turns to Cultural and Business Issues

July 21, 2015
by Mark Hagland
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At the Health IT Summit in Denver, discussion of health information exchange inevitably turned to the cultural, strategic, and business issues around data exchange

At the Health IT Summit in Denver, discussion of health information exchange (HIE) turned strongly towards strategic, business, and cultural issues on the opening panel of the conference, entitled “Strategies for Advancing Interoperability,” as the Summit kicked off on July 21 at the Sheraton Downtown Denver. The Health IT Summit is being sponsored by the Institute for Health Technology Transformation (iHT2), a sister organization to Healthcare Informatics under the Vendome Group, LLC corporate umbrella.

Tuesday’s opening panel on interoperability, which was moderated by Steve Hess, CIO at the University of Colorado Health, also included Dana Moore, senior vice president and CIO at Centura Health; Joe Preiss, chief technology officer at Evans U.S. Army Hospital; Jeff Messer, chief development officer at CORHIO; Justin Gesso, director, business development, at BETSOL; and Jeff Garland, vice president at Relay Health.

In a wide-ranging discussion of all things interoperability and HIE, strategic, business, and cultural issues kept cropping up as major areas to tackle, as provider organizations move forward to exchange data and information to improve care quality and clinician workflow and control costs.

Panelists discuss cultural challenges in interoperability

Still, things are moving forward. Asked how he views the current landscape of data and information exchange, CORHIO’s Messer said, “I think the HIEs across the country are in a similar spot where we’re beginning to get a handle on exchanging data. Most HIEs are doing that fairly well, at least from the inpatient setting out to the ambulatory setting, and all of us are now wrestling with how we become value partners to bend the cost curve, improve care, improve outcomes. A lot of the HIEs across the country are now banding together,” he added. “We’re connecting together and have joined organizations like the Mid-States Consortium, where we’re beginning to help each other move beyond just sharing data. We need to get to the place where HIEs are beginning to connect with each other. And at CORHIO, we’ve been able to connect with KHIM, the Kansas Health Information Network, to share data across both Colorado and Kansas. So we’re starting to achieve some of the things we’ve been working on for years.”

Relay Health’s Garland said, “One of the things that’s key for us as a country when we think about the transformation of those care processes, is that that has to be thought about as a core element in what we do. There’s clearly value in having data follow the patient; we’ve got to find a way to make that a fundamental part as opposed to a bolt-on.”

“We see a lot of large systems acquiring small systems; and system consolidation seems to fly in the face of the need for HIE,” said the University of Colorado’s Hess. “Joe, how do you see those market forces playing out?”

“You’d think that DoD [the Department of Defense] would be advanced; we’ve actually had an HIE for more than ten years, and we can follow the treatment for a wounded military member from the battlefield through to ongoing care,” said Evans U.S. Army Hospital’s Preiss. “But the silos of Army, Air Force, and Navy, have been silos. And the Defense Health Agency is trying to take that next, serious step, to create something more comprehensive. We’re also about to take on a new EHR, which will be announced next week. What I’m finding, though, is that the technical issues are one thing; but the cultural things end up being the most challenging, in trying to figure out how to get the Air Force to give up their control and partner with us, and vice-versa. These DoD issues easily translate to the civilian side,” Preiss emphasized. “Whoever has more resources will probably try to take control; and whoever has fewer resources probably will feel more threatened. So part of what I have to do is to help manage the cultural change issues. It’s a big culture change for them—the Air Force folks—and if you’re in that role, working with a smaller health system, keep that in mind. If you thought it was all going to be about the technical challenges, keep the cultural and human dynamics elements, in mind.”

Centura Health’s Moore said, “There’s this theory that if consolidation proceeds to a certain level, there’s no longer a need for HIE, or the need diminishes. But in fact, now that we’ve acquired a hospital in Kansas, we’re no longer purely Colorado-centric. Also, with minute clinics and pharmacy-based care sites, the landscape is changing. And how do we get information exchanged? So yes, consolidation will help insofar as the number of connections on the acute-care side is concerned, but HIE will continue to play a vital role.”

Is accelerating consolidation making HIE easier? “It does make it a little easier, because instead of having to connect to 12 different hospitals, 15 different hospitals, sometimes, we’re working with just one hospital system,” said CORHIO’s Messer. “It allows us to spend more time with long-term care, with all the other connections. I was at a conference this summer in Washington, DC, and everyone was talking about social determinants factors. How do you connect across all the many elements that are outside the traditional healthcare system? That will continue to expand out the needs around information exchange.”