The notion of Health Information Exchange as a discipline is something that we all know needs to happen - yet despite the multiple millions of dollars that have been spent on HIE efforts and organizations, the results are sporadic at best. Why is the goal of removing friction out of the healthcare process so elusive when most agree on the benefits?
The key to success for trusted and meaningful health information exchange, as an action, lies in delivering key clinical data at the point of care - yes that means providing the physicians with information to improve care gaps and outcomes. There is near universal agreement on this as a desired outcome - so why is it proving so difficult to get there?
The matters of governance, adoption and funding, on the other hand, evoke much more passionate responses. Why is that?
Granted, the healthcare information technology and information management landscape is quite complex but there is no absolution in this claim. Integration and information management technologies that can handle the volume, velocity and variety of data are readily available and continue to evolve at a torrid pace. Many organizations in financial services, telecoms and omni-channel retailers handle complex data, require large scale integration, workflows and business rules. The business of healthcare must continue to capture the experiences, leverage best practices and interleave them with the domain specific requirements that make the healthcare imperatives unique.
This is not merely a shift in the paradigm of how we access information, but also how we normalize the integration of the data.
Governance is one of those terms that I'm not overly fond of because its meaning varies dramatically - in essence it's about making sure the right people have the right information and that nobody gets the information they shouldn't have. One of the more common concerns to using an HIE is that patient information will get into the wrong hands and 'customers' will get poached. Good governance makes sure that can't happen - but really, if you're looking at patients as customers, shouldn't the differentiation come from quality of care, personalized service and convenience? Has HIPAA and PHI become the sword of Damocles?
Adoption of EHR is a critical aspect to true health information exchange yet it too is sporadic as is the all to common blind faith that the EHR vendor and HL7 are going to solve all integration woes. Although the efforts put forth by the ONC around interoperability and standardization of formats is commendable, cooperation and standardization amongst EHR vendors seems a reluctant exercise and results in patient information trapped in silos because the cost of integration is complicated and thus expensive.
The fact is there are plenty of reasons to have an information management strategy independent of your EHR vendor. Analytics are top of mind for us but patient relationship management, portals, vendor neutral archive and other use cases support a sound information management strategy.
Analytics and the subset of clinical and business intelligence systems that help predict outcomes, improve care gaps and drive patients to be more involved in their healthcare require disciplines for extracting and transforming clinical data from EHR, HIE and myriad systems including data source that exist outside the four walls (see 'Open Data as part of your Healthcare Analytics Strategy').
Finding a sustainable revenue model for an HIE organization is a complex topic that needs to be solved if they are expected to survive and add value - a key component to economic sustainability. One of the paradoxes is that the value of an HIE is radically diminished in the abscence of an EHR system. Moreover, interoperability is hampered by numerous interpretations and implementations of the various standards that are published an in use.
This topic clearly carries complexity but it's not insurmountable - many of the issues have analogs in other industries and cross over is starting to happen; we just need it to happen at scale. If the expectation is for individuals to participate in health and wellness management, information needs to flow trusted and freely. Only then can we begin to tackle some of the grander issues around continuously improving healthcare.