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Connecticut to Try Again with HIE. Should They?

May 29, 2015
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For the most part, I’m a firm believer in second chances. Unless you’ve committed a serious crime that warrants a lifetime in prison, everyone deserves the chance to try again at some point in their life.

Whether you’ve flubbed in your personal life or at work, on a small level or with something monumental, no one deserves to be branded a failure for the rest of their life based on one poorly-executed effort. My dad keeps a great inspirational quote in his office about history’s greatest failure.  

If Honest Abe got about 10 second chances in life (I mean, he lost eight elections before 1860!) then why don’t we deserve the same?

Of course, sometimes it is better to stick to your strengths. If I tried out for an NBA team, I probably would not deserve a second chance, nor would I want one. Some people should just leave well enough alone and move along their merry way.

This brings me to the State of Connecticut, my home sweet home. A few months ago, I talked with someone previously involved with the Health Information Technology Exchange of CT, which had been a health information exchange (HIE) in the state up until last year that was run as a quasi-public agency. She (I’ll leave her anonymous for now since I want to write a longer article on the topic) and I talked about why the HIE, which had been given $4.3 million in grant funding from the State Health Information Exchange Cooperative Agreement Program, had so badly floundered and failed.

According to my insider, the HIE became a bureaucratic nightmare with personnel being hired by the state’s administration for the wrong reasons, board members missing meetings because of a “poisonous atmosphere,” poor contracts being written, providers not being recruited at all, and very little HIE services actually being created. The designated vendor (Axway) was blamed by many involved with the HIE, but she said that the problem lay with the contract the leadership drew up. She said the people who ran the HIE “got nothing right” and called the experience an “absolute nightmare.”

In the case that you might think this person has an axe to grind (no pun intended), there have been a couple of independent reports that have basically affirmed that the HIE was indeed, quite the flop.

That was then. According to The Connecticut Mirror, which I heard through our own David Raths, Connecticut Legislature passed a bill that will establish another statewide HIE, overseen by the government.

Here is the specific text within the bill, “It establishes a statewide health information exchange, to be overseen by the Department of Social Services (DSS), and sets deadlines for hospitals, clinical laboratories, and certain providers to connect to and participate in the exchange. Among other changes concerning health information technology, it establishes an advisory council to advise the DSS commissioner on various related matters.”

In some ways, this news is a reason for optimism. Every state needs to push forward a regional data exchange, linking major health systems and provider organizations. Specifically, a neutral third-party is an ideal situation for this kind of HIE. In my mind, it’s imperative in the new healthcare system.

And unlike the last time, this effort may come with more tangible goals, such as the creation of a statewide Direct messaging capability or a provider index, which will allow it to succeed and build momentum. It may also have leadership, similar to Dev Culver in Maine or David Whitlinger in New York, who can provide them with the right kind of technical background and guidance.

Yes, there are reasons to try again, but maybe they shouldn’t.

While the DSS is a different agency than the one that previously that was responsible for HITE-CT, are we really sure that this will mean a wholesale change in the approach to HIE? Will the same bureaucratic problems that plagued HITE-CT not happen again, simply because it’s another agency within the same state government? To me, this would is like me changing my shoes in my effort to make to the NBA and thinking that could solve the problem.

The issues outlined in the two independent reports and by my insider are pretty glaring. Those issues tell me that last time the State of Connecticut was given millions to create an operational HIE, they spent a lot of money and didn’t get much of anything out of it. It’s fair to ask: Should they really be given millions more to try again?

Across the country, a variety of public and private HIEs are succeeding, failing at creating meaningful data exchange across multiple provider organizations. In some states, it’s public HIEs doing the job. In others, it’s private HIEs. There really is no clear-cut model of success. What works in one place, fails in another. It reminds me of what Michael Matthews, CEO of MedVirginia, a regional HIE in central and eastern Virginia, told me during an interview:




Hi Gabe,

Great blog.....Another thing it sounded like the CT legislature was trying to deal with was the rapid consolidation of hospitals and physician practices in the state. On one hand, that might make a statewide HIE less of a necessity if a few health systems control most of the care in the state and can easily send patient data within their own networks. But the legislators expressed concern that these Goliaths would steer patients only within their networks, in effect shutting out smaller practices. Rather than leveling the playing field, technology may be inadvertently creating a healthcare digital divide between large and small providers....Some of the larger players say they provide any physician a way to access info about their patients, but I wonder how well that works in reality....

Thanks for the comment David. I have no doubt that the legislators have good intentions, especially in a state like Connecticut with a few players dominating the market, but I still feel the execution could go awry again. It's hard though because if they don't force this to happen, who will?