Experts at a Blueprint Healthcare IT discussion last week warned that the Field of Dreams strategy of “build it and they will come” won’t necessarily work when it comes to physician adoption of a health information exchange (HIE).
Lack of physician usage of an HIE portal was the No. 1 pitfall when it came to HIEs that was mentioned in the webinar, “Top Ten Ways an HIE Can Go Wrong”. Many organizations believe incorrectly that physicians will naturally use an HIE if it is built, so not enough attention is paid to incorporating HIEs into physician workflow to garner adoption, says John Moore, founder and managing partner, Chilmark Research, a Cambridge, Mass.-based analyst firm focusing solely on the healthcare IT market. He emphasized being clear about the goals of the exchange and doing the necessary strategic planning to drive technology architecture and vendor roadmap decisions.
Attendees were surveyed in advance on their top three concerns or experiences on how an HIE can go wrong, and a top 10 list was compiled from 86 responses by Blueprint Healthcare IT, a Cranbury, N.J.-based software provider and consultancy.
Education is another key piece that gets glossed over when it comes to HIEs, says Neal Ganguly, vice president and CIO, CentraState Medical Center in Freehold, N.J. More time is spent on the technology of the transport method than marketing and educating users in the value of HIE. Also, workflow changes are a tough sell to providers until they know an HIE’s potential value. “There is an educational need here that we all struggle with,” Ganguly adds. “Physicians often don’t understand the potential value. We have to deliver that value and explain it properly, and I don’t know that we do that today.”
Kate Berry, CEO, National eHealth Collaborative (Washington, D.C.) was quick to bring up e-prescribing as what she calls an example of a successful form of HIE. E-prescribing took a number of years to gain physician adoption, but it now exceeds 50 percent of all U.S. physicians, Berry says.
The second most frequently mentioned way an HIE can go wrong, according to the Blueprint Healthcare IT survey, was viewing HIE interoperability as just a technology issue. Tracy Rue, senior consultant, Health IT Transformation, BluePrint Healthcare IT, says interoperability is a huge resource issue, with organizations struggling to marshal the right people, tools, and vendors to get the necessary work done.
Chilmark Research’s Moore is seeing in the market now a lot of HIE implementations of results and orders delivery going into rip-and-replace mode. “I think now we’re getting to another level of interoperability in the market, and we’re looking at really trying to drive those patient records to get that true longitudinal record together to drive a higher level of care and quality,” he adds.
Other HIE pitfalls named by respondents were security and access management issues, as well as syncing priorities and technology architecture and setting clear goals. HIEs that span state boundaries and hospitals with non-employed medical staff can only exacerbate these challenges, says Ganguly.
As was documented in the NeHC HIE Roadmap, to avoid some of these pitfalls, great care needs to be taken in the visioning and strategic planning of the HIE and its initial roadmap, which needs to be revisited on a scheduled basis. “Building stakeholder trust and achieving ongoing alignment around the vision and objectives is critical, especially given potential conflicts inherent among stakeholder groups,” the NeHC report stated.
Berry emphasizes that HIEs can’t sustain on grant funding alone, and the real driver for compelling change in the market will be the move toward value-based payments. In order to survive, HIEs must have a strong business orientation, in which all stakeholders who are getting value are also contributing financially to its sustainability, she adds. Subscription-based fees have seen more success in the industry, rather than transaction fees, which have the tendency to discourage use, Berry says.
BluePrint Healthcare IT’s Rue notes that even though an HIE’s vision can change over time, strategic goals should drive technology decisions and not the other way around. One mandate does not fit all when it comes to a strategic roadmap, but any new technology or service offered needs to coincide with that vision, he says.
“[An HIE’s roadmap] is evolutionary,” Ganguly adds. “You have to continually revisit and make sure the vision remains consistent, or that as appropriate regulatory drivers are changing the landscape, that you reshape the vision. It’s important to establish metrics as well to demonstrate the value and prove you have attained the vision objectives that you set out to obtain.”
Ganguly says his organization funds its own private HIE and has been using a physician affinity strategy to give clinicians information and tools that other nearby hospitals can’t.
Moore says the affinity model of ambulatory physicians pushing orders and referrals to the hospital sponsoring the HIE is one of the many business drivers fueling the private HIE market. “It’s about building that affinity with the ambulatory practices out there that could potentially push business [to the hospitals],” says Moore. “And you build that affinity by, when the orders come in, you turn around and quickly provide the lab results back to that referring physician, so the next time the patient shows up, they have those lab results right in front of them.”