OK, I admit it, I have been negligent.
Since that brief holiday greetings post a couple of weeks back, I have not written a single thing for this site. Even before that post, my writing, or at least frequency thereof, had fallen precipitously. It is not that there has been nothing to write about – far from it.
But it is not that I have not been writing, it’s just that I have had my head down focusing on getting the long awaited HIE Report (now in final edit and layout stage) done. And this has not been easy as the market has been extremely fluid and the definition of what an HIE is and is not is becoming increasingly elusive. This led to one conclusion in the forthcoming report: Five years from now there will not be an HIE market as we will have moved beyond “information exchange” and to higher level services/solutions.
Now I really do not have time right now to write new, original content on some aspect of the market for you dear reader. But I have something else that I hope you will at least satiate your appetite in the short-term until I can dedicate more time to writing thoughtful posts for this site. Below is a clip directly from the HIE report (Chapter 2 to be exact) that will provide you something to chew on till that HIE Report is finished (unless of course there is some big announcement that demands my attention, e.g, the Medicity-Aetna deal).
And in closing, thank you for your patience and look forward to seeing many of you at HIMSS’11.
Analytics & Reporting Move to the Front
Analytics and reporting can be characterized as the “ugly duckling” of the HIE market. Until very recently, analytics and reporting capabilities of HIE solutions in the market were not much more than simple usage and transaction audits. These capabilities are used to improve physician recruitment/use of the HIE and assessing fees to subscribers of an HIE respectively. A number of recent announcements coupled with acquisitions will take this long-overlooked area and rapidly bring it to the forefront of competitive differentiation among HIE vendors.
Analytics and reporting will see strongest adoption among enterprises seeking to improve operations. While most HIEs being deployed today are focusing on Stages 1-3, (Note: for the report Chilmark Research has created a five stage maturity model for HIEs) early adopters of enterprise HIEs will be looking to move to Stage 5 in advance of future bundled payment models. Not unlike other sectors of the economy, these proposed payment models will begin paying ACOs based on value delivered (quality vs. cost). This will require a far higher level of operational knowledge and understanding than what most ACOs operate with today. A hybrid HIE with a transitory CDR and deep analytics capabilities can provide the ACO with a deeper understanding of operations, including where specific quality and operational metrics are below target(s) identifying areas for future improvement.
While the strongest demand for such analytical and reporting tools will come from the enterprise market, we also foresee a future for such in the public HIE market. Within this sector, these tools will primarily be used to address public health reporting requirements. The public HIE market will likely be a distant follower to the enterprise market in their adoption and use of more sophisticated analytics and reporting tools as this is not a core requirement at this time, nor is there a pressing business justification for their adoption.
Of the 21 HIE vendors profiled for this report, few offer analytics and reporting capabilities beyond the aforementioned transaction and usage audits. Table 2.14 provides a brief overview of those HIE vendors that have some analytical capabilities. Even among these vendors, many of the solutions are still immature and necessitate closer evaluation.
Thanks for the brief email on your HIE report. It seems like the value and importance of hie has INCREASED as it relates to the transactional push business for many reasons. The community wide patient centric clinical data model or business should have stalled now and may not recover because of the challenges to the sustainability model, the difficulty getting commercial lab data,medication history(due to Surescripts cartel), and the limited physician practice based data being “contributed” to the central or federated data base. Not clear to me based on the state and regional HIEs I have been involved with whether the fractional portion patient clinical data services will be of value or whether there will be the motivation/incentive/regulation for those not participating in the community/regional Clinical data base approach to do so.
Other enterprise or commercial ACO support organizations however may find the justification and plan for sustainability to implement such a system with the corresponding push hie functions for orders,results, referrals and other essential process support tools.
Medication transactions will still be difficult to capture, route and control with the PBM and Surescripts cartel restricitions, unless of course you use their “hie” functions.
Why do folks refer to Surescripts as a cartel. Isn’t there some way to include the regional HIE in the ePrescribing transaction on the outbound side from the physicians order and get the Pharmacy or PBM to send the fulfilled script or order back to the HIE and to the physician who ordered the script. Does the Surescript service cost the physician money now? Would an inquiry to the Surescript system by an ER, or a medical home or a specialist cost them money? Would those query results be interfaced into their EHR? Of course the new NWHIN DIRECT will allow physicians to send scripts directly to pharmacies on the national or state or other provider directory wont they? Does the Surescripts service restrict the direct communication by emrs or from HIEs to the pharmacies or because they created and/or funded Surescripts will the big Pharmacies just refuse to allow direct electronic scripts to be sent or interfaced? Which Pharmacy companies own or founded Surescripts?
Interested in reading your report when it comes out!
Considering the issues mentioned around sustainability, the upcoming ACO needs, and my own frustrations with with a narrow view of the exchange, I suggest we not limit our definition to just clinical data. There are other data that could be shared of a business nature (e.g. billing) that brings value to both the practice and business of medicine.
Agree that there is value in sharing other data types, but these data types will be secondary to clinical data exchange as driving quality and efficiency improvements begin here, especially under future ACO/bundled payment models that are coming.