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11/8/2013
01:01 PM
David F Carr
David F Carr
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Health Information Exchange Needs A Simpler Model

The CEOs of four cloud-based healthcare IT firms express skepticism about HIEs, seeing them as a bureaucracy rather than a workable architecture.

InformationWeek Green -  Nov 11, 2013 InformationWeek Green
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To the cloud generation of healthcare technologists, state-based health information exchanges look like a throwback.

The federal government has encouraged the creation of these state and regional data exchanges as part of the evolution toward an infrastructure that allows secure sharing of patient data among healthcare providers. These HIEs are supposed to connect to providers and to other exchanges -- though there's a good argument to be made that HIEs are failing to provide that connectivity.

The Direct Project is one alternative promoted by the Office of the National Coordinator for Health IT. The idea is to enable secure email between known, trusted participants, each of which has a special email address only available to healthcare providers. Email sent this way can include free-form messages but also patient data in XML --- structured data that an electronic health records system on the receiving end can parse and import.

As our cover story notes, the drawback to Direct is that it's push rather than pull. There's no centralized repository or index to query -- something HIEs are at least working toward. Direct is more of a replacement for faxing records, though at least they're machine readable.

When I spoke recently with the CEOs of four cloud-based healthcare IT firms, they greeted state HIEs with unanimous skepticism, seeing them as a bureaucracy rather than a workable architecture. Here are their quick takes:

Practice Fusion CEO Ryan Howard: Howard points out that EHRs seeking Meaningful Use Stage 2 certification have to be able to demonstrate support for sending and receiving messages over the Direct Protocol, which means they have to demonstrate basic interoperability. "That eliminates a lot of the need for an exchange," he says.

Athenahealth CEO Jonathan Bush: "Health information exchange should be a verb and not a noun. Exchange activity will iterate dramatically over time," Bush says, and he is skeptical that the right structure can be dictated by "some federally sponsored entity." Athenahealth does participate in HIEs anyway because the company wants to be easy to do business with no matter what model wins out.

CareCloud CEO Albert Santalo: "What I am a proponent of is that it should be a national infrastructure," Santalo says. "I don't think it makes any sense for every state to be building something." The Direct approach is "a little better" than navigating the maze of HIEs, but it's "just email," he says.

Girish Navani, CEO of eClinicalWorks: The HIE centralized approach makes it too easy to spend time and money trying to build a perfectly secure system. Meanwhile, nothing happens. "The Direct Project is one practical way of sharing data because it's peer-to-peer," simplifying the security challenge, Navani says. But he thinks the better alternative will be for patients to provide access to their own data -- using a phone or a QR code to unlock a health record in the cloud, much as they access their money with an ATM card.

One way or the other, health information exchange cries out for simplification.

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cbabcock
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cbabcock,
User Rank: Author
11/12/2013 | 6:01:16 AM
re: Health Information Exchange Needs A Simpler Model
Yes, health information exchanges cry out for simplification, but unless they start out with a shared architecture in a single health care cloud, they will inevitably re-mire themselves in complexity. before any exchange gets built, there ought to be a federal requirement for a report, which could be drawn up by any Carnegie Mellon computer science student for $100, that would outline a simple but workable architecture for dozens of state exchanges based in a single, shared cloud architecture.
David F. Carr
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David F. Carr,
User Rank: Author
11/13/2013 | 3:02:44 AM
re: Health Information Exchange Needs A Simpler Model
Or should centralized HIEs truly be centralized -- one national exchange. Is there any good reason for doing this state by state?
MyW0r1d
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MyW0r1d,
User Rank: Strategist
11/13/2013 | 3:07:54 PM
re: Health Information Exchange Needs A Simpler Model
There is one very good reason to do this state by state - avoiding the creation of yet another overstaffed, dysfunctional federal government dinosaur managing peoples PII data like so many failed Federal IT projects. Let the states manage the day to day administration efforts (enrollment, changes, upgrades, etc) but oblige them to use a standardized transmission format to those charged with federal oversight or interstate verification/validation systems (if someone from Texas was in Florida on vacation and a provider needed to verify coverage). Standardized EDX has been a cross to bear for the healthcare for decades (at least 1998 when I worked in an HMO). The secure email and standardized XML reporting have already proven a functional model in a number of European nations and there has been work on an interbank information exchange using standardized xml formats for years. IMHO this discussion however should have been concluded as one of the initial planning milestones after signing ACA into law three years ago.
David F. Carr
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David F. Carr,
User Rank: Author
11/13/2013 | 5:18:54 PM
re: Health Information Exchange Needs A Simpler Model
With government, it's always hard to tell whether decentralization is being used for sound architectural reasons or just as a way of passing out contracts to more vendors.
TerryB
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TerryB,
User Rank: Ninja
11/13/2013 | 6:26:14 PM
re: Health Information Exchange Needs A Simpler Model
From an IT perspective, it doesn't make sense to have 50 states do the same thing independently. And I'm not sure I agree every state's government is going to be better than federal government. But I appreciate your insight on process as someone who actually worked with this health care stuff. Interesting debate topic.
SaneIT
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SaneIT,
User Rank: Ninja
11/14/2013 | 12:47:49 PM
re: Health Information Exchange Needs A Simpler Model
"Athenahealth CEO Jonathan Bush: "Health information exchange should be a verb and not a noun. Exchange activity will iterate dramatically over time,""

I think Jonathan Bush hit the nail right on the head. Having a background that includes passing mortgage data between financial institutions the exchange needs to be a more "active" solution. While I see the benefits of the email solution and having machine readable transactions it's not as if it's incredibly difficult to build a solution that polls servers for each of the exchanges and pulls the files over. We did this 15 years ago to batch mortgage documents and get them to and from the banks we used for funding loans. It's a much bigger project than setting up a mailbox but it would be well worth the effort. The mailbox solution sounds like a first step, I wouldn't be surprised if they have the next version in the wings ready for testing.
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