Last week we reported on a 2013 eHealth Initiative survey of health information exchanges that highlighted the challenge and expense of creating interfaces. Of 199 organizations that responded to the survey, 68 organizations reported having to build 10 or more interfaces with different systems, and more than 140 cited interoperability as a pressing concern.
Rather than just bemoaning the situation, some health IT leaders are trying to do something about it. Last week, I interviewed Alesha Adamson, project director of the Open Library of HIE (OLHIE), which is creating an online ecosystem that will allow the creators of HIE-related assets to collaborate and perhaps re-sell some of their efforts. Although a primary focus is interfaces, OLHIE is also looking at policies, toolkits, forms, and model contract language to encourage government-funded assets be contributed to the library.
Adamson says the idea for OLHIE grew out of her work on the Texas Health Services Authority Board. She remembers Stephen Palmer, now director of the Office of e-Health Coordination at the Texas Health and Human Services Commission, warning that the state’s many HIEs were looking at developing a lot of expensive, custom interfaces. When the State of Texas established policies for HIE grant funding, it required that software development work paid for with state and federal dollars be contributed to an open source repository. The idea was that it was reasonable that the community HIEs pay only once for an interface and that it be applicable across various installations.
“We started thinking it would be nice if there were a place to store these assets,” Adamson said. The Office of the National Coordinator for Health IT and the California Health e-Quality (CHeQ) program both thought this was an interesting enough idea to fund its early development. (California has a lot of small HIEs that would like to share assets, she said.)
Adamson noted that HIE leaders in Vermont estimated it would take them five years to write all the interfaces they would need. That is a lot of work for such a small state, she said. After spending time meeting with HIE leaders across the country to assess the level of interest, OLHIE developed its vision statement: to accelerate the rate and decrease the cost of connecting with HIEs by facilitating the widespread reuse of HIE interfaces, documentation and other assets, especially those developed with federal or state funding.
Adamson admitted that one huge challenge to sharing interface information is the contract language many vendors put in place to block it. And because they were in a hurry to get going on HIE development, most state HIE organizations did not consider including re-use clauses in their contracts. “We believe that model needs to change,” she said.
OLHIE has interest from 13 states and an impressive steering committee, including CHEQ Technical Director Rim Cothren and Mark Jacobs, CIO of the Delaware Health Information Network.
But like the HIEs themselves, it now faces the challenge of finding a sustainable funding source. OLHIE has no funding past Jan. 31, 2014, Adamson said. But it is looking at several possibilities for revenue, including membership dues, subscription service fees, ongoing grant funding, and conference/ workshop fees.
We’ll check back with OLHIE in 2014 to see if it can sustain the momentum for this admirable effort.