John D. Halamka, M.D. wrote an excellent article recently in Mass Device about how Steve Jobs principles can be applied to health information exchange in Massachusetts. When Apple had lost market share to Microsoft in the ’90s, Jobs laid out a five-fold plan to get his company on better footing:
1. Board of Directors
2. Focus on Relevance
3. Invest in Core Assets
4. Meaningful Partnerships
5. New Product Paradigm
I was taken by how these directives are extremely similar to what the industry experts and HIE leaders I spoke with for my August cover story on health information exchange were addressing as they were focusing on creating core and value-added services, standardizing the meaning of the clinical data, and simplifying point to point connections. And these mandates were also echoed in the National eHealth Collaborative (NeHC) sustainability report, which shared HIE success stories of alternate revenue streams and payer buy-in.
Getting a multi-stakeholder board is something I hear over and over from the successful HIEs I talk to. Three of the HIEs profiled in the NeHC report, Quality Health Network (Grand Junction, Colo.), Availity, and Rochester RHIO, drew much of their success from incorporating the payer community as a key stakeholder, leader, and revenue source from the beginning. These HIEs convinced payers of the benefits of the HIE’s services in terms of cost savings achieved through reductions in services utilization.
Like Dr. Halamka said in his article, HIEs can do everything under the sun from secure messaging to population management, but that doesn’t mean they should. Like Jobs’ advice organizations should focus on what’s relevant to the population and invest in those assets. Delaware Health Information Network (DHIN) invested in core assets like delivering lab results and Admission, Discharge, Transfer (ADT) summaries to providers to reduce the cost of results delivery and provider adoption first, before tackling value-added services. “A good many years were spent just on developing consensus around what the initial services were going to be,” says Jan Lee, DHIN's executive director.
Pam Matthews, R.N., senior director, regional affairs, at the Chicago-based Health Information and Management Systems Society (HIMSS), agrees and recommends that HIEs focus on what services they will provide to customers and how this will translate into financial sustainability. Only then should they figure out the technical underpinnings needed for the HIE architecture, and in turn, what solutions need to be sought from a vendor.
More and more these days HIEs are embarking on meaningful partnerships with local universities to collaborate on expanding health IT curricula. This is extremely important as we face a physician shortage estimated by the Association of American Medical Colleges to be 50 percent worse than originally anticipated prior to the passage of comprehensive federal healthcare reform, and as we try bridge the health IT professional gap. Physicians and IT professionals need more time-saving technologies to meet these challenges, and also need the necessary training to do their ever-increasingly technical jobs. Some examples of HIEs partnering with academic institutions are: Michiana Health Information Network (MHIN), based in South Bend, Ind., which announced a partnership with Indiana University School of Medicine-South Bend last summer, and Nebraska Health Information Initiative (NeHII), which plans to continue partnering with Metropolitan Community College in Omaha on its HIT curricula and adding a cyber security course in the future.
HIEs should only develop alternate revenue streams that they can support and will appeal to their customers. For example, HealthInfoNet, Maine’s statewide HIE, is building is a statewide medical images repository to house its average of 1.8 million studies a year. The exchange is in the process of reviewing the seven vendors that have responded to the RFP. HIN will set a per study fee, which will benefit healthcare organizations, Executive Director Dev Culver says, by driving cost down because of the benefit of volume. Culver also sees other direct economic benefits including organizations having access to DICOM standardization in a vendor-neutral architecture, which will aid access and give organizations a more holistic patient view.