Now that the Notice of Proposed Rulemaking (NPRM) on Stage 2 of meaningful use specifies that health information exchange (HIE) will need to occur outside an organization’s vendor-based systems, more vendor interoperability collaborations will likely be seen, say industry experts. However, some in the industry caution healthcare organizations on proceeding down the collaborative path when standards are not a part of the partnership.
Before the passage of the American Reinvestment and Recovery/Health Information Technology for Economic and Clinical Health (ARRA-HITECH) Act, there was no real incentive for vendors to collaborate in most areas, says Joe Marion, founder and principal of Healthcare Integration Strategies, a Waukesha, Wis.-based consulting firm.
The Centers for Medicare & Medicaid Services (CMS) has proposed an increase in the summary of care record threshold, requiring that summaries be provided in 65 percent of transitions, 10 percent of which will need to be electronic, and at least some electronic transmissions will need to occur with providers that support a certified EHR from a different vendor and have no organizational affiliation—though the extent of this aspect of the requirement is unclear—said Robin Raiford, director, research and insights, at the Washington, D.C.-based Advisory Board Company, in a recent memo on the proposed rule.
This key Stage 2 inclusion will be a motivating factor for vendors, says Fran Turisco, a director with Pittsburgh-based consulting firm Aspen Advisors. “Vendors want to collaborate because in the grand scheme of things, as you start to build statewide initiatives like New York and Montana, you are going to be dealing with disparate systems; and if you don’t know how to play in the sandbox, you’re out,” she says. “It’s a huge incentive because they don’t want to be left out if they can’t make their system work within these interoperability guidelines.”
One vendor/state collaboration example is the Multi State EHR/HIE Interoperability Workgroup, whose goal is to develop standards for “plug and play” connections between EHRs and HIEs by working in collaboration with vendors and states. In a presentation at the HIMSS12 HIE Symposium, David Minch, project manager, John Muir Health and president and general manager, HealthShare Bay Area, said this group had the potential to influence the development of nationwide standards by creating a quorum of participants to leverage existing standards across multiple states and regions.
“One of the points the vendors made when we all got together was, ‘we’re doing one-offs all the time,’” Minch said in the symposium. “We can’t afford to continue to doing one-offs. We have all this work we now have to do with meaningful use, and we’re now devoting a lot of our efforts to just moving our product forward to be able to achieve meaningful use. ”
However, not all are inclined to join these types of collaboratives. Micky Tripathi, president and CEO of the EHR and HIE implementation consulting firm Massachusetts eHealth Collaborative (MAeHC), applauded the collaborative work of the Interoperability Workgroup, but said that he was dubious that it was leveraging Integrating the Healthcare Enterprise (IHE) profiles to move forward. “The concern we have with that is that those are not yet standards because IHE is not yet a standards body,” he says. “We’re not sure how much traction that’s going to get, and we’re concerned about going down the path the vendors made.”
Tripathi says that MAeHC focuses on following the Office of the National Coordinator’s (ONC) Standards and Interoperability Framework and Direct specifications. “One of the lessons we learned in the Mass eHealth Collaborative pilot projects was there’s a real danger in trying to over-architect ahead of where the technology and where the business processes are,” Tripathi says. “And we ourselves suffered from that when we tried to place these heavy repositories models with search and retrieve, consent management; and it was assuredly wrong. The industry evolves over time. You’re sitting here making a guess that four years from now the industry is going to be right there, and it’s a big gamble.”
Marion agrees that it is a huge risk to move forward with a non standards-based approach. “It’s one thing to say you support a certain standard, but it’s another thing for it to have meaning or value,” he says. “I think that is where some of these organizations are providing some resistance because to make a huge investment in something that is not standards-based, but nothing else supports it, what good is it?”
Another step in the direction of vendor collaboration was the recent launch of ICAetc, an open sandbox for software vendors to test HIE program interoperability, from the Nashville, Tenn.-based interoperability vendor ICA. ICA is based on technology developed at Vanderbilt Medical Center, which long had the philosophy of linking best of breed systems by technology to view patient information, says Turisco. “What we’ve found is it’s not that every data element needs to be viewable by every provider and every situation,” she says. “What you need to do is build the business scenarios and the care scenarios that are going to be part and parcel of your collaborative. Those are the areas you focus on.”
“I always look at what’s the business case for these interstate collaboratives,” Turisco adds. “I think it’s important to be able to technically do it, but I think the reason you’re not seeing a lot of it because ‘where’s the need? ” However, Turisco and others admit that will all be changing with Stage 2 meaningful use.