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Enter the Next Phase of HIE

March 8, 2012
by Jennifer Prestigiacomo
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Commoditizing directed exchange to then innovate on top

Those in the industry say that health information exchange (HIE) has reached a critical nexus in maturation, whereby the basic, or as some say “directed,” exchange is in the process of being commoditized, making way for the next phase of exchange: true innovation.

“The drive for commoditization of the basic plumbing is hopefully the evolutionary step where we’re at in the marketplace here, and that requires a lot of care and feeding that I think both the government and vendor community are stepping up to the plate [to do],” says David Whitlinger, executive director, New York eHealth Collaborative, in a NeHC webinar, “Implications of a Shifting National HIE Architecture,” this week.

David Whitlinger

Whitlinger said, in the HIE NeHC webinar, that the HIE market is entering an opportunistic phase with both directed exchange and patient record look-up and -pull in the process of commoditization. He said that in New York these two basic capabilities are being used as the basis of health information exchange. “The next stage is how do we get economic growth and stimulus for innovation on top of the plumbing,” he said. “There’s a lot more value that can be provided as the data becomes liquid.”

The industry is in transition where vendors are moving away from proprietary methods of exchange to standards-based exchange. So, next will be how organizations can create value in terms of how they orchestrate, manage, deliver services on top of the standards, Whitlinger added.

“Some organizations that competed on the basics of being able to do [basic exchange] will find themselves commoditized because other people can do it too,” said Arien Malec, former coordinator, NHIN DIRECT at the Office of the National Coordinator (ONC), and current VP of data platform solutions, RelayHealth, in the NeHC HIE webinar. “That is a disruptive place to be in, and I believe that just as we saw in the consumer electronic world, we’ll find the world we create much richer for all of us than the world we left behind.”

Arien Malec

Driving Down the Cost, Real Applications
For true commoditization of those basic exchange capabilities at the primary care provider level, Whitlinger said, the costs of services need to be driven down to a nominal monthly cost, like what consumers pay for cable TV. Only then can innovative services be built on top of that infrastructure, he said.

To aid in cost reduction of exchange, the ONC needs to take the lead, said Malec. “Public policy can consistently focus on reducing the cost of exchange,” added Malec. “And in particular, reducing the costs of basic exchange, which will end up serving every business model and every stakeholder, by allowing more complicated and sophisticated forms of exchange to be built on top of those building blocks.”

In Massachusetts and New Hampshire both states are taking a “phased, incremental approach,” to their HIE efforts, Micky Tripathi, CEO, Massachusetts eHealth Collaborative (MAeHC), told Healthcare Informatics in an interview at HIMSS12; he has worked closely with both states. The first phase that Massachusetts is working on is creating the “Information Highway” via a DIRECT gateway, with a secure routing mechanism facilitated by a provider directory and a public key infrastructure (PKI) certificate management for security.

Micky Tripathi

“There’s a lot of conversation among the providers and stakeholders saying, ‘that’s it? That’s not very exciting,’” said Tripathi. “One of the things we keep pointing out is, it may be relatively low value, but you know what, it’s also low cost. As long as I can get the value higher than the cost, it will sustain itself and builds a lot of [business] trust.”

Phase two will include data aggregation facilitation services, said Tripathi, which includes a set of shared service tools like an enterprise master patient index (EMPI) and data normalization services. Phase three in the plan will include a record locator service because the technical standards have yet to be developed on an industry wide level, says Tripathi.

“In Massachusetts, and it’s very similar in New Hampshire, the EMPI is the next thing that providers organizations are asking for,” said Tripathi. “I think in part because it can be a shared service, so even though you don’t have a repository—almost every organization has to invest in an EMPI—a number of them are thinking that this is a group purchase. ‘I can get the statewide organization to purchase the EMPI, and they charge me my share, so it will be cheaper for me than to negotiate my own contract.’”
CliniSync, Ohio’s statewide HIE, has a phased approach to services, as well, Dan Paoletti, CEO, Ohio Health Information Partnership told HCI. Phase one, which was guided by ONC information notices last year, is facilitating the basic push of information like lab results delivery, ePrescribing widely adopted, referrals management, and direct messaging to help transitions of care between different types of care providers. Phase two, which will likely be ready later this year or by early 2013, will enable advanced query and retrieval of robust discreet data.

Dan Paoletti

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