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LIVE from the CHIME Fall Forum: Interoperability-A New Multi-State Reality?

October 17, 2012
by Mark Hagland
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HIE leaders from both coasts describe groundbreaking progress, at the CHIME12 Fall CIO Forum

The sun had barely risen on Palm Springs, California on Wednesday morning, but already, a lively discussion of broad-based moves towards interoperability in healthcare was underway at the CHIME12 Fall CIO Forum, sponsored by the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME). In a “sunrise session” that began at 7 AM local time at the Renaissance Esmeralda Resort & Spa, the event hotel and conference location, David Minch, president and COO of the San Francisco-based HealthShare Bay Area organization, a health information exchange (HIE) group, and George “Buddy” Hickman, executive vice president and CIO at Albany (N.Y.) Medical Center, delivered presentations on several ambitious HIE initiatives taking place in individual states such as California and New York, and beyond.


David Minch (l.) and George "Buddy" Hickman respond
to audience questions during their CHIME Fall Forum
session Wednesday morning

Most broadly, David Minch brought CHIME12 Fall Forum attendees up to speed on the latest developments in the nationwide initiative known as the EHR/HIE Interoperability Workgroup, a collaborative whose work began in 2010 and which was formally launched in February 2011, that currently spans 15 states (representing nearly 50 percent of the US. Population), 19 EHR vendors, and 18 HIE vendors. As the group’s website notes, “The goal of the EHR/HIE Interoperability Workgroup is to create an integrated marketplace of EHR capabilities, in which the interfaces between EHRs and HIEs will be compatible more easily across and between states.”

The workgroup’s current work is exceptionally timely and needed, Minch pointed out, as the HIEs being launched and expanded across the U.S. are generally working off no particular standards, with significant potential for inevitable roadblocks to broader functionality and interoperability down the road. Indeed, Minch noted, “We found early on that RECs [regional extension centers] weren’t including any language in their contracts around interoperability. So now the physicians adopting EHRs are going to have to spend more money and have another learning curve, when they adopt interoperability tools.” At the same time, he said, referring to the Office of the National Coordinator for Health Information Technology, “The ONC was trying to define some specific implementations, but had developed very narrow use cases. So,” he continued, “what we came out with after about two hours of very good discussion in this initial meeting with states, vendors, and RECs, was a common goal: essentially, we wanted to create plug-and-play connections.”

After having divided the collaborative’s efforts into several specific task groups, which have been working on achieving send-and-receive specifications, developing standardized patient data inquiry services, harmonizing the collaborative’s efforts with the standardization efforts of the ONC, and creating data and metadata standardization around the continuity of care document (CCD), Minch told the audience Wednesday morning that much progress has been made. Among other things, he said that now, “The 17 subject areas within the continuity of care document are very specifically defined. So when vendors come out with their CCD products, it should be extremely consistent. And that should allow for vendor-to-vendor as well as provider-to-HIE communication.” Minch expressed strong optimism that ultimately, the work of the EHR/HIE Collaborative could well be determinative in steering the industry towards a single set of HIE standards that might transform clinical data sharing nationwide.

New York state’s forward progress

Meanwhile, Buddy Hickman noted that important progress and discussions are taking place as the Healthcare InformationXchange New York, or “HIXNY,” moves forward in New York state. HIXNY, which is a collaboration of health plans, hospitals, physician practices, and other entities in a 17-county area covering the northeast quadrant of New York state, has already made significant progress in several key areas, Hickman noted, including portal-based log-on access to contributed patient data (demographics, results, medications, care summaries), HL7-compliant individual object or CCD exchanges, CCD exchange capability among RECs, and e-prescribing, among other areas. What’s particularly interesting now, he told the assembled audience, is the health plans’ eagerness to access HEDIS quality data for quality measurement use and clinical utilization. Crossing that threshold, into ready exchange of information across the payer-provider divide, Hickman said, is going to prove to be an important evolutionary step for health information exchange more broadly.

In addition, Hickman said, “I really believe the world’s going to change in the next five years or so. Why are we doing this so fast and so early?” he asked rhetorically. “I really believe that a key part of success will be physicians adopting HIE out of interest in [the potential to create a new] referral mechanism.” Still, in response to an audience member’s question, Hickman conceded that, while “I think you only need one big technological infrastructure, you need to have different governance structures for different [communities and markets].”


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