In the opening keynote address to the HIMSS Virtual Conference and Expo on June 6, the CEO of MedVirginia, one of the pioneering health information exchanges in the country, offered up some reflections on HIE evolution and future direction. Among other things, Michael Matthews said that the focus on return on investment is holding HIEs to a higher financial standard than other aspects of treatment.

“Sometimes we talk about ourselves as though we are still in science project mode and not a standard of care,” he said. “We don’t ask if two meals a day is enough for patients in the hospital instead of three,” Matthews said. HIE should be accepted as part of the standard of care the same way that three meals is. “If it is not a standard of care, and if we are not adding value to clinical decision-making, we should fold up our tent and go home. But I don’t think that is the case.”

MedVirginia has been in production for seven years. It was the first HIE on the Nationwide Health Information Network (NwHin), and was the first HIE to connect with the VA and Department of Defense health record systems. The MedVirginia HIE now connects to 15 acute care hospitals and has more than 2 million unique patient records in its clinical data repository.

Here are a few other topics Matthews addressed:

• Leave no patient behind. Matthews said that if only the most affluent health communities adopt health IT, it has the potential to contribute to health disparities rather than alleviate them. He said it is important to keep a focus on meeting the needs of the chronically Ill, rural populations, the incarcerated, the disabled, wounded warriors, and other groups to make sure all patients and providers and all stakeholders are engaged.

• Are providers invited to the consumers’ party? He noted that there is a parallel movementtaking place on the consumer side involving remote monitoring devices, personal health records, mobile health and social media, but so far it is happening separate and distinct from the domain of providers. How that data will be combined with provider health data is still unclear.

• Population health in a patient-focused world. Matthews asked how the objectives of patient-centered medical homes and accountable care organizations could be met in a federated environment. “If all we do is create more data silos, with data captive inside those, what is our ability to look at a population? That is one of our biggest challenges.”

•  Technology has shelf life of a banana. Matthews notes that HIE generations seem to be about two and a half years long each.  “We might make an investment in HIE hoping it would have return over a number of years,” he said, but by the time the investment pays off, we may be into a new cycle of understanding in terms of the latest products, services and policies. “How can we keep moving forward without getting locked into our own technologies?”

Michael Matthews