Thursday, March 29, 2012

Private HIE’s, dialing back the clock 15 years?

Courthouse, Denton TX a small town
of about 120,000 inhabitants,
which will most likely see 3 HIE's:
two private and one public
The definition of an HIE (health information exchange) is generally accepted as the electronic mobilization of healthcare information across organizations, within a region, community or hospital system. Unfortunately, there has been an important piece left out of this definition, i.e. to do it using open, well-defined and/or accepted exchange standards. There are more than 50 so-called “public” HIE’s funded by the American Recovery and Reinvestment Act (ARRA), which has handed out more than US $548 million as of January 2012, but there are about an equal number of private HIE’s appearing as well. A private HIE is typically set up by a single provider or provider chain that is creating a central repository and/or registry for patient documents and related information.
In my opinion, implementation of private HIEs defeats the purpose and does not meet the main objective of what we are trying to achieve in the US: the exchange of patient information to eliminate redundancy, improve efficiency and ultimately improve the quality of patient care. It is very similar to the scenario we have been going through with PACS installations over the past 15 years where we could not easily exchange images between two systems from different vendors. More and more institutions are migrating their information to a Vendor Neutral enterprise wide Archive (VNA) to disconnect the image management from proprietary vendor solutions. These systems are now able to exchange information because a true VNA is able to exchange the images and related information in a standard, vendor neutral manner.
Today, institutions are trying to interconnect their EMR’s and exchange information among them. If this is done through a private EMR, with an interface, which is customized to a particular EMR vendor and/or institution, we are in the same situation as we were using PACS systems 15 years ago. In other words, we just dialed the clock back 15 years. Note that it is not only important to standardize the interface protocol and transactions, such as used for querying for patient demographics and exchanging documents, it is even more important to standardize on the content, and its encoding. Otherwise, the receiving system is not able to interpret the information electronically and/or automatically update its EMR with the imported input.
As a case in point, I am involved with a small clinic in my hometown, Denton TX. It treats patients who could have been seen at either of the two hospitals in town, who are competing and have their own HIEs. Therefore, to exchange the information we would have to connect to both private HIEs, in addition to the public HIE through which we might need to access any information from local specialists. This does not seem to make sense to me. When our own Chief Technology Officer, Farzad Mostashari was asked the question during his HIMSS 2012 keynote speech about this issue, he answered that we chose “capitalism” and therefore we apparently have to deal with it. Well, sometimes we need to sacrifice a bit of our capitalistic ideology to achieve a healthcare system that is competitive with other western countries, which are able to treat their patients much more effectively and safely at less cost. If we fail to get our healthcare costs under control, we will find ourselves at a significant cost disadvantage in competing with other industrialized countries.
What will happen to the HIE connectivity of our clinic in our little community in Texas? Time will tell; I will keep y’all posted.