For years now we have been talking about HIE as if health information exchange (the verb) is happening across health information exchanges (the noun). This is wrong for the simple reason that true, full health information exchange is not occurring.
Then what is being exchanged across these HIE networks that public and private entities are spending a fair amount of money to make happen?
Typically, it’s fairly limited clinical data-sets (lab results, discharge summaries, referral documentation) delivered as an HL7 message, ala CCD, or more recently CDA – data sets that rarely embed themselves into clinical workflow where they are most likely to be used. This is not to say that the HIEs that are being stood up today do not provide some level of value – certainly they do and numerous studies point to decrease in duplicative tests, identifying frequent flyers to ED, etc. What I am saying is that the healthcare industry is in a rapid state of transformation and the future need to transmit an ever wider range of health-relevant information across a distributed network will be critical to the success of a healthcare organization.
Advocate Health in Chicago has been working closely with Cerner on the development of “Smart Registries.” In speaking with their CMIO last fall I asked him if he was using their HIE to assist with the data aggregation and information distribution needs that are required to power Smart Registries (their instance taps over 50 data sources). He said no, the HIE simply does not/cannot provide sufficient data nor can it deliver the information they want to present to a physician practice.
In a briefing with one of the largest population health analytics vendors, Optum, who also happened to have acquired an HIE vendor (Axolotl) a few years back, I asked if they were using any of their HIE capabilities to aggregate data to power the new Optum One analytics platform? They said no, the HIE does not deliver rich enough data to do the type of analysis and ultimately deliver the value that Optum One offers.
Last week I met with a vendor CEO to discuss our latest research on CNM. He pointed out that they are seeing a huge need for HCOs to meld clinical and transactional data (claims, PBM, prior auths, etc.) to drive better care coordination across a community. They are now working with a payer and HIE vendor to enable such capabilities to better support ambulatory practices within that payer’s provider network. The HIE alone was not enough.
The currently limited capabilities of many an HIE will not serve the needs of tomorrow. This belief led us to our research on Clinician Network Management (CNM), which is a visionary look forward on how healthcare organizations need to rethink their dated, and now misnomer of an “HIE strategy” a strategy that has very little to do with the need for a more complete information payload delivered at the point-of-care to enable population health management.
As we found in our CNM research, exceedingly few organizations have come to this realization, though we are seeing glimmers of hope with those on the leading (bleeding) edge such as the aforementioned Advocate. Will others follow? Yes, of course as the transition from fee-for-service to value-based reimbursement will demand it. The real question is when and when they do, will they have the leadership to make it happen? This is a journey not for the feint of heart.