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Health information exchange critical but suffers from complications

Brian Eastwood | April 2, 2013
Efforts to expedite the adoption of health information exchange in the United States face a bevy of technology, management and financial questions. There are no easy answers, since HIE organizations are as different as the regions, the populations and the healthcare providers they represent. But there are some lessons to be learned.

Next-Generation HIE Should Behave Like Facebook

For that to happen, the industry needs what HIE leaders are calling HIE 2.0. This suggests that data exchange needs to move beyond secure messaging and patient data look-up in order to succeed-and, under stage 2 of meaningful use, the government program to encourage EHR adoption, it must. In order to attest for meaningful use and receive government incentives, healthcare providers have to demonstrate that they are exchanging patient records and incorporating that structured data into an EHR.

According to the eHealth Initiative, most HIE organizations are, in fact, doing that. Of the 88 responding HIEs that described themselves as operating, sustaining or innovating-collectively, in eHealth Initiative parlance, "advanced" HIEs-more than 80 percent are exchanging laboratory test results, inpatient data, outpatient data and care record summaries. Fewer than one in three, though, are sharing public health reports, which is a key meaningful use measure.

There's more to be done in other areas, too. Joel Ryba, COO of the Health Information Xchange of New York based in the Hudson River Valley, has identified 16 rules for effective HIE, which he deems the "minimum acceptable level" of functionality that an HIE vendor should have if it's trying to sell to HIXNY.

These rules describe the basics of how data should be delivered, abstracted, located, consolidated, aggregated and made available for auditing and clinical reporting purposes. In addition, Ryba notes, an HIE should include a provider directory, maintain data integrity, provide role-based access control, monitor users' adherence to business rules and support interoperability with native EHR environments.

Few products hit the mark, Ryba admits. As a result, the organization has built a lot of its own health data exchange technology, taking a SOA approach. Before joining HIXNY, he built a similar information exchange for the criminal justice system. The concept is similar, he says-putting disparate records in a single XML resource. "You're just creating person-centric histories from multiple sources," he says.

The key is providing abstraction, which HIXNY does with a loosely coupled common information model. This helps in two ways. One, the data model isn't tied to the outbound consumer of the data. Two, it reduces the number of "adapters" necessary to foment data exchange. With, say, 20 hospitals using 50 different EHR systems, a tightly coupled data model would need 1,000 adapters to exchange data. Loosely couple the data, though, and you need only 50 adapters-which means your nonprofit HIE organization can spend less time building new adapters and more time maintaining the ones it has, Ryba says.

In this sense, Ryba equates HIXNY's work not with HIE 2.0 per se but, rather, with a third generation of electronic HIE. The first pushed data to consumers; Ryba likens it to email. The second let consumers pull data and subscribe to notifications; this mirrors the functionality of websites and search engines. The third generation brings push and pull together and adds secure messaging; this is like Facebook, he says.


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