Trying something new here – soliciting your collective input, the proverbial wisdom of the crowd.
As you may have read in yesterday’s post, Chilmark is quickly approaching publication of the Health Information Exchange (HIE) report. One of the last tasks is final editing/polishing of report. Am now in the process of creating a definition for HIE that clearly articulates what the primary purpose of an HIE is, but also keeping that definition loose enough to reflect what a market that is evolving so quickly that in five years time, there will not be an HIE market as we know it today.
So, with that in mind, here’s the HIE definition for the report.
Definition of an HIE:
A Health Information Exchange (HIE) is a technology network infrastructure whose primary purpose is to insure the secure, digital exchange of clinical information among all stakeholders that are engaged in the care of a patient to promote collaborative care models that improve the quality and value of care provided.
Does this make sense to you? Does this definition resonate with your own view of the market? Any and all comments welcomed, but please be quick to get them in as we are on a fast track to have this report done within the week.
John,
Your definition should stop after “stakeholders.” The rest is redundant.
There has been a great deal of debate on whether to refer to Health Information Exchange (HIE) as a verb or a noun. HHS and most states working on HIE efforts have decided that HIE is a verb and the noun is Health Information Organization (HIO).
Health Information Exchange is defined as: The electronic movement of health-related information among organizations according to nationally recognized standards.
A Health Information Organization is defined as: An organization that oversees and governs the exchange of health-related information among organizations according to nationally recognized standards.
(see: http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_10741_848133_0_0_18/10_2_hit_terms.pdf)
These definitions are pretty much universally accepted and used for guidance, including privacy and security and HIPAA. HIE is the movement of information and an HIO is an organization that facilitates exchange.
(see: http://www.hhs.gov/ocr/privacy/hipaa/understanding/special/healthit/introduction.pdf)
I dont agree with Brian that they are universally accepted.
The government–who ever that is has not made that much of a contribution except to confusion in some cases.
Carlos, thanks for responding and while someone very knowledgeable in the HIT market would agree with your statement, I’m not convinced that it is universally understood that HIE is to promote care coordination to improve quality/value.
And Brian, your definitions make sense (I already did review those) but they do not address the technology, which is the purpose of the HIE Report – looking at what vendors are providing today and where the market is headed.
Another thing that really gets me miffed with the definitions I have seen in doing secondary research is that they universally refer to exchange as just that which occurs between and among physicians and HCOs. Where is the patient/consumer? What is their role in all of this? That is why I purposely avoid any reference to such and have instead used the term “stakeholders.”
Your point on patient involvement is well taken and one which has been emphasized in our state’s HIE planning meetings. I like the idea of using the term stakeholders…
I’m afraid to forward some more fundamental reflections on the definition. But I’ll keep it simple;
First of all, Health Information Exchange is not as much a network as “information” is not “informing” let alone would scure that a person is informed. That is to state: it is as unsure that a patient or a stakeholder is “informed” with data, as a network infrastructure insurers that stakeholders exchange the information when data about a patient are to be found on an infrastructure….
To be short: it needs more than putting data on an infrastructure before relevant professions will take steps to be sure that they will find, look at, and process data about a patient on an infrastructure so as to be informed before acting on the patient’s condition…
And so on and so on..
Rob Halkes
It really bothered me in my consulting days to see colleagues selling services on trendy issues they couldn’t define, or as the case with KM a decade ago– refuse to define. They were part of the problem, not the solution (self-accredited too), but still a global force. Reminded me of similar structural and cultural problems in healthcare and education.
In our diabetes use case you can clearly see that the patient is the driver, which isn’t the case in the vast majority of networks and exchanges. What I see primarily — including through federal and state efforts, is manipulation of the system for the purpose of protectionism, not credible reform.
The path of including stakeholders in reform of failed systems is of course self-destructive. When they become as powerful as the entrenched are today, it feels like a requirement most of the time, but reform rarely occurs that way, and if we don’t reform the U.S. will default on debt– that is a mathematical certainty. We’ll see reform one way or another– question only whether it will be like Greece, UK, or some other.
I think your definition is fine. In my own work, we’ve extended beyond IT to organizational management, combining the operating system design of both, for without full consideration of one, the other will fail (see our new paper on semantic enterprise OS)
Mark Montgomery
Kyield
Mark,
Agree with you on virtually all points, especially that in the last paragraph, a subject that is address within the context of the report and one of the primary reasons that in five years time there will not be an HIE market.
Looks very good. short and to the point.
John,
I like to think about it in terms of “ensuring access” rather than exchange. A longitudinal record can live in multiple places, and the HIE enables users to access appropriate parts of the record based on policies, consents, et cetera.
Keith,
That is an excellent point as many systems today are not much more than an aggregator with a web-based physician portal front-end.
John, I like it. I had to read it a few times and think if I understood your reference to “technology network infrastructure” rather than “Data Network”. I get it, nice.
Keith, Good point on access, federated systems are usually designed with the Get/pull of data.
Jeff
Although the word ‘meaningful’ has become almost trite in the past year – I think it needs to be included in the definition. Simply exchanging information is almost useless – that information has to be exchanged in a manner that enables clinical decision making in a quick effective manner – i.e., fits into the physician workflow, is resented in a way that is intuitive to the physician and their speciality etc.
I was afraid someone would bring up the term “meaningful.” Sarah, I thought long and hard about the use of that word and decided against it within the context of this definition as it is a word that is far too loaded at this point and is easily misconstrued.
John,
Your definition of an HIE seems to be dominated by the PROVIDER perspective and thinking. My sense is that the real value of the exchanges is to benefit CONSUMERS. Perhaps HIE’s should / will evolve more toward broadened focus on the HEALTH issue rather than just supporting the delivery of Health Care Services.
I suggest that you consider the HIE as a concept… with many possible instantiations. With that in mind, a definition that speaks more to the BENEFITS of the information to CONSUMERS rather than just the technology that enables the information to be distributed / shared may be more appropriate.
Actually John, the whole reason I used the word “stakeholder” and care team was to avoid the use of any clinician type term and purposely keep it open-ended. Go out there and do a search on HIE definition and virtually all of them refer to information exchange among providers. Even the leading analyst firm, in a recent HIE report of their’s, recommends that those putting together an HIE not consider the consumer/patient.
Frankly it is a travesty that begins in DC (ck out some of the minutes from mtgs of the HIT Policy workgroup for HIE) and has reverberated throughout the industry/country.
Hopefully, states and some forward thinking HCOs will recognize the valuable role that the patient/consumer can play and begin considering them in their planning processes.
I would make it much simpler. “An HIE is an organization dedicated to the seamless movement of electronic, medical information among unaffiliated entities.”
1. Information must be in electronic form
2. Must cross institutional boundaries
3. Wevdon’t discriminate between the technology, the organization and the verb ” exchange”
4. We also avoid getting into the weeds with terms like “infrastructure”
Hello John.
Your HIE definition is very good and works for me!
The only addition I would make is to include the exchange of ANY information, not just clinical. Behavioral, process and financial information exchange will also be critical to improving collaboration and enabling sustained behavior change.
Take care
Paulo
Do you mean to include administrative data exchange in your definition? Some HIEs include administrative data (http://www.nehen.org/products/home.aspx).
Jonathan, there are some HIEs exchanging admin data but this is by far in the minority today, thus the reason I used the term “primary purpose” for this definition is also used to define scope of HIE Report that looks at 21 HIE vendors.
That being said, exchange of admin data, while remaining secondary to clinical data, will grow in the coming years.
Your definition is good as far as it goes, but is incomplete. Exchange is only one part (a large part) of what HIEs can do. There are additional value added services that might turn out to be more important than the basic exchange function.
Data source identification
Clinical Decision Making services
Drug Utilization checks/reviews
Prevention of redundant procedures and tests
Nathan, you are absolutely right but as I stated in my reply to Jonathan, I used the term “primary purpose” and this will continue (btw, data source identification is part a parcel with info exchange). Beyond clinical data exchange, the other services/functions you mentioned are being deployed to varying degrees with some HIE vendors offering these capabilities while others are not quite there yet.
Admin data is needed too.
I was thinking more along the lines of patient activity info that HCPs need to manage a patient’s treatment plan/consumer’s wellness plan. ie. Did the patient get his labs done, fill his Rx, complete the on-line education module, etc.
This is a really good video from Dr. Kevin Fickenscher of Chief Strategic and Development Officer, Dell Healthcare Services, spoke to “Changing Face of Personalized Health Care: Here, There, Everywhere, Anywhere.”
Good insight on HIE. We may not want to mandate the technology.
http://oninformatics.com/?p=584
Well, since I sit on the Board of a RHIO, which is implementing a HIE for 2+ million people in the Tampa Bay Area, I have additional insight you need to consider.
We are already exploring how we can leverage an HIE to assist in a common eligibity program for indigent services within the community.
Much the way we think of an HIE reducing the need for patients to request records to take them to there doctors, or we discuss importing administrative items, ‘demographics’ or PHR’s directly into doctors EHR systems, we could do similar for the public health programs.
Imagine a person going to apply for food stamps, and their information is entered into a common-eligibity system, and it responds with other FREE or Public health programs that the individual may qualify for, and prints out the forms. What if we tie that in with an HIE, and allow the storage of pertanant documents that are required to apply, so that when they contact the other agencies, the required documents are already scanned and available.
Can an HIE expand beyond just clinical?
Makes you think.
Charles
Thanks Charles for chiming in and providing your perspective direct from the front-lines. I agree with you and others that an HIE will, in all likelihood expand its services well beyond just clinical data exchange. In fact, within the report we actually rate the 21 HIE vendors we profiled on both their ability to manage and exchange clinical as well as administrative data.
But I still keep coming back to the same conclusion, that HIE, whether it is publicly sponsored or a private enterprise HIE has, at its core, the primary purpose of exchanging clinical data. Beyond that, what an HIE does, what types of services it provides and data it may exchange will vary across HIEs depending on what the core objectives are for the sponsoring organization. We come to this conclusion after extensive primary & secondary research where we have found that today there is no consistent set of data exchange services beyond clinical data.
That’s not to say we aren’t thinking about the variety of services that may be offered ad you’ve provided some excellent ideas.
Two thoughts:
1) I would have a definition for HIE as both a verb and a noun. The action of a healthcare information exchange could be encapsulated in an example such as a referral use case. Granted, this is a bit novel and not the industry standard, but it’s a good “outside the box” way to think about HIE.
2) I don’t like the use of “an infrastructure” at a “network” layer, HIE is an application-layer phenomenon. I would speak instead in the noun definition about HIE being “the orchestration of multiple geographically dispersed healthcare information management solutions across disparate providers bound by an information sharing agreement into a single coherent application affording practitioners and patients a holistic, longitudinal record across varied clinical units such as laboratories, EDs, outpatient facilities, long term treatment facilities, and hospitals.”
…or something like that
Defining “health information exchange” (HIE) as a noun is to minimize the most compelling value inherent in the phrase. Instead, PatientKeeper defines HIE as a verb: the act of moving electronic patient information securely around a community of care, beyond the boundaries of any single institution or provider organization. Because most healthcare is delivered locally, the key participants in HIE are the community hospital and its affiliated physicians, local PCPs and other clinicians.
Of course, a technical infrastructure is required to accomplish HIE – specifically, an infrastructure that provides “meaningful connectivity” by:
1. Connecting to information across the community in real-time, providing the latest, most complete patient health information available which physicians and patients need to make key clinical decisions about care.
2. Integrating with current systems and/or provide access for those without systems today. Any solution should meet current system investments both inside and outside the hospital where they are rather than requiring an expensive rip and replace policy.
3. Being secure and enabling patient consent models for sharing information. All constituents involved in patient care are sensitive to the privacy and security needs of patient health information. Any solution selected must support multiple security and trust models within the local community.
4. Integrating information into physicians’ workflow including support for collaborating with other physicians in a patient’s circle of care. A solution which simply moves health information from system to system will not meet the critical goal of exchanging health information which is supporting physician/patient interactions.
5. Supporting compliance with current and future government regulations. There are a myriad of regulations and incentives which are changing in health care. Any solution must support compliance with these while empowering physicians to focus on delivering care.