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Building Your HIE as a Business: Yea or Nay?

November 12, 2014
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Is an HIE your local restaurant or your local power company?

Is it a business or is it a public utility? Is it something that should include value-added services for participants or something that should be mandatory for the greater good? Is the answer somewhere in between?

That has been my train of thought for the past month. I wrapped up my four-part interview series with health information exchange (HIE) leaders this past Friday. I also wrote a long feature on a failed HIE that was published in September. It’s been interesting to look at the inner workings of successful and unsuccessful HIEs.  

It’s a subject that interests me because as I’ve written a few times, HIE is at a crossroads. This year marked the end of federal funding of state-designated HIEs. Some HIEs that used funding from the Cooperative Agreement have shuttered while some have been a resounding success. Others are somewhere in the middle. Meanwhile, technology challenges derived from a lack of EMR vendor cooperation are still hampering many data exchange efforts.

How can organizations interested in data exchange, which is most of them I’d wager to guess, overcome those vendor challenges? Plus, where will funding come from, if not the government? Will regional HIEs merge together, like what happened with Doug Dietzman and the folks at Great Lakes Health Connect? Will there be an answer to the age-old debate: opt-in and opt-out?

In case it wasn’t clear, the questions on HIE still seem to very much outnumber the answers.

I spoke with the leaders at private and public HIE entities to see if I could get a better idea of where they think HIE is headed. I also wanted to know what had made them successful. Here were a few recurring themes that I saw: long-term vision, serious stakeholder engagement, trusted data governance, and value-added proposition and services.

In many ways, what’s made those guys successful is where HIE is headed. Adopting or failing to adopt the philosophy of those leaders is why different HIEs will succeed or perish. The HIE I wrote about basically flopped on all four. It may sound harsh but it’s the truth.

I especially think that last one, value-added proposition and services, is vital. That’s creating a sustainability model if you weren’t sure. The way these guys talk about their HIE, you’d think it was a restaurant. Dan Paoletti, CEO of the private nonprofit, Ohio Health Information Partnership (OHIP), which operates the public Clinisync HIE, even said outright that he had to run it like a business. Here’s what Dietzman said when I asked him how Great Lakes built a model of sustainability:

The old fashioned way. When you build a business, you say what services are needed and how can I provide those services at a price someone is willing to pay for. Many HIEs are running after the theory of health information exchange and what the book tells you have to have. “We need a master-patient index (MPI), so we’re going to build one.” “What are you going to do with it?” “I don’t know but the book says we have to have it.” They end up with this stuff built from millions of dollars of funding and then they ask if someone wants it and no one does.

So if that’s the case shouldn’t HIEs be considered a business? Sadly, the answer isn’t that clear. As Michael Matthews, CEO of MedVirginia, a regional HIE in central and eastern Virginia, said:I don’t think that most view this as an enterprise that can make money for investors. If they have that expectation, they’ll be sorely disappointed. It happens to be a private sector activity in some cases, but most people recognize it’s HIE is done for patient good and public good.”

Some HIEs, like the very successful Statewide Health Information Network of New York (SHIN-NY), act as more of a public utility. SHIN-NY connects regional HIEs. Yet, it has value-add too like a patient portal. HealthInfoNet in Maine, another successful statewide HIE, also considers itself a public utility, but also has value-add.

It’s confusing and we seem to have conflicting views. Public utilities don’t operate like a normal business, with value-add services to create sustainability. ConEd isn’t calling me to see if I’m interested in buying a value deal on power. The water company doesn’t want to know if you are interested in special water (whatever that is).

That’s where I’m having a tough time framing an HIE as a public utility. Down the line, HIEs may be a public utility for providers. However, right now, in order to survive, they have to be a business. There may be exceptions, but mostly they have to provide services that make providers want to join and pay. There can’t be an expectation that providers will join. Even if it’s not making money, it has to operate as one that’s trying to do just that.

Please feel free to respond in the comment section below or on Twitter by following me at @GabrielSPerna