Janie Tremlett is senior vice president of strategic and clinical consulting at the Chelmsford, Mass.-based consulting firm Concordant, which specializes in health information exchange (HIE) development and related areas, and is currently working with numerous HIE initiatives nationwide. Tremlett spoke recently with HCI Editor-in-Chief Mark Hagland regarding her perspectives on HIE development. Healthcare Informatics:
What is the general landscape of HIE development like right now?
Janie Tremlett: What we’re seeing is that you have different states in different stages—Vermont, Maine, Maryland—all these statewide HIEs that have actually been around for a while and have now gotten new life because of the HITECH grant money that’s been awarded under HITECH [the federal American Reinvestment and Recovery Act/Health Information Technology for Economic and Clinical Health (ARRA-HITECH) Act]. But there’s still high anxiety regarding sustainability. The HIEs have been living grant by grant. And everybody’s been feeling that we’re reaching the end of that era. Altogether, the figure is in the hundreds of millions of dollars in funding for HIE support under HITECH; but one of the requirements for receiving the funds is for the HIEs to document how they’ll be sustainable. So each state is in a different stage, but the commonality among everyone is to try to figure out the sustainability. My view is that if you compare this to other industries, you’d be hard-pressed to find businesses being created in other industries around exchanging data, per se. Meanwhile, a lot of the most successful HIEs have been established by hospital organizations creating their own HIEs. In Maryland, CRISP [the Chesapeake Regional Information System for our Patients] triumphed as the statewide HIE. In that case, the state of Maryland decided to build on the foundation of one of the successful private HIEs already in existence. So every state is addressing this differently, with a different focus. Sure, everybody wants to exchange patient data. But how are they doing it, and are they clinical data warehouse reporting-focused, or transaction-focused? The strategies are all over the place. And this industry is really screaming for some kind of standardization of process. So it’s very interesting, and everybody is trying to grapple with how they’re going to go forward.
HCI: What have been the critical success factors for HIE sustainability, in your view?
Tremlett: Number one, the leaders of the successful HIEs have stepped back and looked at their care community, and they’ve modeled their HIE to respond to the needs of that care community. So it’s incorporating the natural care communities involved and how they want to connect with each other; and it might sound very simplistic, but that’s not how a lot of these are being built, in fact. So if patient care organizations are already processing lab results, don’t re-create that. So, number one, understand what’s already going on in the care communities in your state, and don’t duplicate that. Meanwhile, all the ID locator issues—that again is a process issue that many organizations have already addressed before. So I recommend that HIE organizations outsource that issue to data clearinghouses that have already addressed that issue. And the third thing is, and again, this sounds extremely simple, but I’m not seeing a lot of people do it—and that is to really get down to the nitty-gritty of how the core processes are actually going to work. So if you’ve determined that a discharge summary is the critical thing that you need to start off with, then if you have five hospital groups, work with them, get their buy-in, and work through that process. The buy-in happens on a policy level, but not on a detailed process level. There needs to be that real, detailed-level, execution level. And with Maine’s Health InfoNet, the leader of that HIE got together all the stakeholders together from across the state, to agree on what they were going to do, how they would pay for it, and how they would get it done. And they created a single record and got to it relatively quickly.
HCI: What key steps should CIOs take as they evaluate whether to participate in the development of an HIE?
Tremlett: I think they have to start out with their own plan. How are they going to create their own mini-HIE within their own world? And then how does that fit with other health systems in their region and in their state? I believe this is a bottoms-up kind of initiative, so start with your own world of hospitals and affiliated practices and clinics, and so start with your own world, and then figure out how you’ll create the next layer. Because this is so big, and people are trying to take on pieces that are too big; they need to start with executable pieces. I used to be a CIO for years, so that’s my focus.
HCI: What is going to happen in the next couple of years.
Tremlett: I think what’s going to happen is that a lot of the hospitals’ and health systems’ HIEs will pop up first. We’re involved in many engagements on mini-HIEs. And I think the statewide HIEs will naturally evolve out of those.
HCI: In fact, the successful HIEs so far have been in small and rural states.
Tremlett: That’s right.