50 States, 50 HIE Data Models
Improving HIE to the point that it's as easy as logging onto Facebook won't easy, given the number of connections that an individual organization must make and the challenge of viewing that often-proprietary information once it arrives.
There's no one-size-fits-all solution, either. Five state HIE efforts examined in a recent report by NORC, an independent research organization affiliated with the University of Chicago, present different approaches to setting up an HIE infrastructure.
Maine and Nebraska use a centralized model, in which participants push data to a central repository; in both cases, this statewide infrastructure predates the HITECH Act of 2009. Washington and Wisconsin, however, uses a more decentralized data model, which the NORC report says is typical for states where private HIE entities (often found in urban areas with large hospital systems) were already in place. Texas, with its mix of private HIEs and large, underserved rural areas, has opted to support the existing HIE entities and focus on adding services only where they are lacking.
A centralized approach, which requires significant investments in IT infrastructure, can be more expensive and take longer to implement than a more lightweight data model, which needs only messaging capabilities and provider directories, NORC notes. On the other hand, a centralized data repository makes for better data analysis, which is important in light of federal care quality and public health reporting mandates.
Plus, Ryba adds, organizations can use these rich data sets to "orchestrate higher-level business services." One example is a single, consolidated version of a patient's Continuity of Care Document, of which HIXNY now has more than 1.4 million CCDs on hand.
Another example comes from Vermont, where state healthcare reform places an emphasis in part on the patient-centered medical home; here the central data repository gives all physicians caring for a patient access to his or her EHR data.
An HIE Without Stakeholders Is Unsustainable
Providing such business services is impossible, though, if an HIE entity is unsustainable. According to the eHealth Initiative survey, a majority of advanced HIE entities get more than half of their funding from a single source, though the organizations also remain bullish about remaining sustainable and operational in three years' time, when HITECH Act funding for HIE initiatives will run out. Meanwhile, each of the five states that NORC studied was "universally concerned about sustainability, especially in a rapidly evolving market."
Besides government grants, the most likely funding source for an HIE entity is membership fees. For that to work, the eHealth Initiative notes, an organization must engage multiple stakeholders. This also makes good business sense, since a wider variety of participants means more data and a better picture of a patient's overall health.
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