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Health Information Exchanges: Highway to heaven or a lost road….?


One of the core premises of a digitized healthcare world is that patient information should be as mobile as patients.

One of the core premises of a digitized healthcare world is that patient information should be as mobile as patients.

If you arrive semi-comatose at the Emergency Room (ER) with just your driver's license to identify you, the ER staff should be able to go to a computer, find you and a high-level medical profile, such as current meds, problems, allergies, and recent labs, before they administer therapies.

However, for most of American healthcare, patient information is not easily moved around. It is either locked in paper charts or buried in a potpourri of electronic systems that do not easily communicate with each other.

Over the past 10 years, the government has appropriately been trying to change that through a number of ambitious programs including data standards initiatives, electronic health record (EHR) incentives for both hospitals and physicians, and the development of health information exchanges (HIE).

Conceptually, an HIE is pretty simple. It basically consists of a service/technology where patient information can be easily “moved” between institutions within a community so that providers have the information they need to deliver effective and efficient care. To use the example above, an ER with a connection to a health information exchange would be able to electronically retrieve a patient summary sheet from his primary care doctor’s EHR before administering care. In the ideal HIE, all the players in the patient care ecosystem are both contributing and taking patient information to support care.

HIEs are also great for helping ambulatory physicians aggregate patient information generated by clinical reference labs, hospitals, imaging centers, and other data sources without having to build costly, and difficult-to-maintain, point-to-point interfaces. Doctors tap into the exchange and populate their EHRs through a single “universal” interface. The net result is that providers have more complete records and can make more informed decisions.

This all sounds good-so why isn’t there an HIE in every community? There are a couple of reasons that immediately come to mind:

a) Regional healthcare is competitive and getting arch-rivals to collaborate on a data-sharing platform doesn’t happen over afternoon tea. Predictably, some of the communities that have been successful in establishing HIEs are those that are anchored by a single dominant hospital with no major competitors. This competitive inertia will probably only be solved by some sort of either local or federal government fiat-health exchanges are not very effective unless everyone plays.

b) HIEs require a lot of work, time, and money to build, and there is not a clear business model (besides government grants) that has been presented that will ensure sustainability after the government grants run dry. This is not too much of a surprise-HIEs are still maturing from a functionality perspective. Trying to monetize HIEs is like asking drivers to pay a toll on a highway that is not yet completed. As a result, most HIEs will be dependent on external grants until the “highway” is finished and providers can’t live without it. Then everybody will be chipping in.

HIEs, like roads, are an infrastructure project. And, like many important and complicated infrastructure projects, they will involve a fair amount of local bickering, will require a lot of taxpayer money, and will take longer to finish than predicted-but in end they will make patient care better and more efficient for all of us.

Bruce Kleaveland is a paid correspondent through Intel’s sponsorship with Physicians Practice.

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