What are the biggest pain points when it comes to data exchange?
This is universal to the field, but physicians and their staffs are incredibly busy. They are running as fast as they can to get through their clinical day with their patients, do the reporting, processing, and billing. To ask them to stop, get out of their workflow, look up data and act on data is cumbersome. So as an industry, we’re figuring out how to fit that information seamlessly into the workflow so it’s not something different. We want it to add to their efficiency, not detract from it. That’s our biggest concern right now.
The funding is also a challenge, as always. Most revenues in healthcare go to providers, they don’t typically go into infrastructure that allows those systems to interoperate and communicate. In this country, who pays for the roads, electrical grids, sewage and water systems that allow our economy to flourish? Think about if each business had to create some kind of interoperable electrical grid to connect and share power with others. It seems silly, but it’s what we expect in healthcare, to fund that infrastructure when a lot of it is for social good.
It’s very hard work—the technology is hard enough, but there’s the cultural piece, which involves engaging stakeholders, and the financial piece, as you need to be creative. Any one of those, if not done right, can result in the failure of the HIE. Challenges can be too difficult to overcome in some cases.
Has the role that the feds have taken been good enough so far?
I think they have done a lot to contribute; they were the incubator for the eHealth Exchange, and got the Nationwide Health Information Network off to a great start. There is still a meaningful role they can play in standards development and establishing rules of the road. One of keys will be proper engagement of public and private stakeholders. This is not an industry that needs to be over-regulated, and I think the private sector can come up with valuable solutions like we saw in the banking industry 10-15 years ago off of the ATM backbone.
What is most critical to get to that the state of interoperability we have seen in other industries?
The biggest thing is to demand the vendors support their desires to become interoperable. There is conversation on the Hill about information blocking, and you saw ONC’s report. That’s one of the things that health systems can do. I would say that there is a lot of mischaracterization going on and a long ways for everyone to go for interoperability. The industry needs to be more collaborative. There are a number of initiatives that are paving the way for that. Healtheway and Carequality are examples of those. You can’t be in isolation in healthcare, as we are all trying to figure out what business model is best with collaboration and competition.
Do you think Epic is collaborating as much as it needs to?
Epic is a participant in Carequality, and they’re a good, strong partner there. I don’t see them being as isolated as some of the media portrays them to be. There are more Epic hospital customers hospitals on the eHealth Exchange than any other single vendor. I think they have done a lot, but like anyone else, they can do more. I wouldn’t single them out like others have though.
How do you see the next few years playing out regarding HIEs?
If you’re trying to measure effectiveness of HIEs, we need to move from users to usage to usefulness of information. In the first days of HIE, everyone touted their users, then it was about how much usage, now is that information useful? For HIE to achieve its ultimate success, it has to be viewed as a standard of care by the physician medical community. If it is, then let’s get about the job doing it as effectively and efficiently as possible, and get these tools to providers at the point of care so they can care for their patients. If it’s not a standard of care, it’s all a waste of time, money and effort. I do believe physicians can make better clinical decisions with that information available, and that puts the burden on folks like myself to make sure they don’t go chasing around for it all day.
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