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“HIE is Dead, Long Live HIE.”

May 2, 2014
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The HIE panel at the Healthcare Informatics Executive Summit. From left to right: Greg Strowig, COO and CTO, TeraMedica; Tony Gilman, CEO, Texas Health Services Authority; Mark Elson, Ph D, Principal, Intrepid Ascent; Michael P. Carbery, AVP HIE, Population Health, Maimonides Medical Center

At one point during the health information exchange (HIE) panel at this year’s Healthcare Informatics Executive Summit in San Francisco, I wanted to get up and ask the four panelists if there was anything positive they had to say about HIEs.

It was starting to sound like a roast.

HIEs are a struggle because of funding issues. HIEs are a struggle because of patient record matching. HIEs are a struggle because of patient authentication and privacy issues.

Getting vendors and providers to break down the walls and share data? That’s a challenge. There are technical limitations with interoperability. There are territorial and participation issues for some, particularly with getting smaller providers on board.

I could go on and on. By the end, I was waiting for Jeff Ross, the world’s most famous roast master, to pop out and insult the HIE’s mother.

What’s a bit scary if you are an HIE advocate is that the panel members came from states that have made significant progress in the exchange of data. Indeed, Michael P. Carbery, the vice president of HIE and Population Health at Maimonides Medical Center in Brooklyn, N.Y.; Mark Elson, Ph D, Principal of Intrepid Ascent, out of Berkeley, Calif..; and Tony Gilman, CEO, Texas Health Services Authority, are  from large states that I’d consider HIE frontrunners.  

Yet, all of them had an open microphone in the panel, “Health Information Exchange: Opportunity and Challenges,” and all of them were more than happy to share their frustrations with the current HIE stratosphere.

My colleague Rajiv Leventhal looked at this issue in-depth in the April/May issue of Healthcare Informatics. In particular, Leventhal looked at the issue of vendor dissatisfaction and quoted a recent report from the Orem, Utah-based KLAS research that found overall provider satisfaction with HIE solutions dropped an average of 8 percent since last year, as provider demands outpaced vendor delivery.

A lot of that has had to do with the high expectations providers had when they began to pop up a few years back and as Dr. Elson put it, “HIE is dead. Long live HIE.” He went on to note that it’s clearly a lot harder to execute the large-scale transmission of data between organizations in reality than it is to dream it up on paper. If you read Leventhal’s article, Micky Tripathi, Ph.D., CEO of the Massachusetts eHealth Collaborative (MAeHC), says that “demand has outpaced delivery,” which reinforces what Elson is saying.

Despite the fact the challenges of HIE are abundant and abundantly clear, the marketplace is not exactly a graveyard. There are plenty of places that are thriving with HIEs, including in New York, Texas, and California. The panelists at the Summit talked about the successes in their respective states. In Texas, Gilman is using the federated model to a great deal of success, ably covering one of the largest states in the union. In one California county, Elson said there is an incentive to share data because a dense network patients move around different clinics and hospital systems, and in that county, "The dream is still very much alive."

It’s not just in the states represented on the panel. Recently, I wrote about the New Hampshire Health Information Organization (NHHIO), which has done a good job in developing a sustainable formula for its members. As I wrote in that article, the way the leaders of NHHIO put it, achieving this sustainability almost sounded easy. Obviously, we know that’s not the case.

I love Elson’s quote because it very much encapsulates the reality of what people think of HIE. HIE is dead. HIE is thriving. Despite what I heard from the Summit panelists, I think the truth lies somewhere in the middle.

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