Is Direct Undercutting the Viability of RHIOs?

by | Feb 9, 2012

Last week, a discussion got started on Google + by Brian Ahier about whether or not ONC’s aggressive support of Direct is undercutting many a Regional Health Information Organization (RHIO). What got this whole conversation started was an article in the January issue of JAMIA titled: Shifts in the architecture of the Nationwide Health Information Network. While there is some excellent commentary regarding this article, you may not want to spend your time wading through some 60+ comments on Google + and Vince Kuratis has done a good job summarizing many of them in his own post yesterday.

Seeing as we are in the midst of pulling together a new HIE Rpt, we could not help but chime in to this discussion with the comment that follows:

Great discussion here, albeit at times there seems to be a mix of HIE the noun, HIE the verb, which sometimes even leaves me confused as to what someone is trying to say and I follow this market for a living!

Speaking of which, we/Chilmark Research is in the process of updating its HIE Market Trends Rpt which will be published in March. As part of our research, primary & secondary, countless interviews, etc., we’ve identified a third market, what one vendor referred to as the “micro-HIE”.

The First market, which has been discussed in detail here, is the public market (we group both RHIOs & SDE and their HIE initiatives into this pot). By and large these have been and will continue to be Exchanges (the noun) that will struggle to find relevance. Over time, we see these exchanges being tightly linked to other critical needs at the State level, chief among them, their Medicaid programs. Problem we see here though is that most states have woefully underinvested in IT for their Medicaid programs so will their HIE efforts suffer the same fate? We at Chilmark have never been big fans of these “public” HIEs for they are most often poorly managed, mired in political infighting and rarely have a clue on how to run a business (deliver value that is greater than risk) for their intended market/customers.

The second market is what we refer to as the enterprise market. Folks, this is where the action is and while last year’s report showed a significant number of vendors focusing on the “public” market, this year virtually all HIE vendors have turned their sights upon the enterprise market. It is here where we will see the greatest advances, the greatest innovations, as there is a clear and compelling case for organizations to use HIE (the verb) to facilitate care management processes across care settings in a future where reimbursement will be increasingly tied to outcomes.

The third market, the Micro-HIE, is one that unlike the previous two markets, does not have a central sponsor of the HIE. It is more ad hoc in nature, self-forming, self-organizing. This is a market where Direct will be prevalent and for those who want a tad more in the way of services, physicians may subscribe to the new Surescripts Clinical Interop solution or a similar offering, albeit coming from the claims side, NaviNet. Medicity is also making a play here with its still nascent Inexx platform. This market is still very much a work in process, but may be the ultimate solution to connect the last mile, if these solutions can deliver value.

And that, at the end of the day is really what it is all about, yes? Delivering value that exceeds risk to the end user whoever that end user happens to be is the fundamental precept of any successful program, initiative or business. That has been the operating principle for the U.S. pretty much since its founding, should it be any different for the HIE market.

So in answer to our original question in the title…

Yes, we do foresee lightweight, micro-HIEs that use Direct or something similar to provide physicians an easy mechanism to securely collaborate will threaten many a RHIO and even SDE-HIE. Here in the Commonwealth of MA, the HIE workgroup has from the beginning been looking at a “network-of-networks” model for delivering a statewide HIE. Those discussions are now increasingly focusing on using Direct as the key underlying technology to make that happen. Will it work? We shall see. But one thing is certain, the days of big and glorious public HIEs and the associated political fiefdoms to support them may be coming to an end as their value has rarely exceeded their risk..

1 Comment

  1. ddormer

    Excellent discussion. We’ve been struggling to find the right words for the changes in what you call “enterprise HIE” and what we’ve called “private HIE.” Your introduction of the term “Micro-HIE” is not only appropriate, it is also enlightening as we modify our strategy to bring care-unit focused patient engagement solutions to this important part of the market–leveraging Direct along the way.

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