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At HIMMS, HIEs Face Uncertainty

By Richard Martin Comments
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Richard MartinEasily the most frequently heard acronym at HIMSS 2011 this week was “HIE." By widespread consensus, health information exchanges have become the cornerstone of a fully connected healthcare environment where providers, payers and patients can have instant access to electronic medical records at the bedside, in the OR, at home and anywhere else.

Unfortunately, there’s also plenty of FUD – fear, uncertainty and doubt – around these exchanges. Based on my conversations here in Orlando with healthcare CIOs and with vendors, there still exists a high level of uncertainty about just what HIEs should look like and how they’ll be implemented.

According to Massachusetts State Sen. Richard Moore, president of the National Conference of State Legislators, who spoke at a briefing on HIMSS public policy goals, all but two of the states have received federal grants to begin planning HIEs, and 17 already have legislation pending to create the exchanges. No fewer than 24 educational sessions, plus a dedicated HIE Symposium, attacked the issue from various angles, and I can attest that I received several p.r. pitches a day from vendors plugging various forms of exchanges.

Some of these, such as the IBM exchange built for the UNC Health Care system, in North Carolina, are unquestionably impressive. Even though each hospital in the system uses a different EMR system, “IBM HIE technology can interoperate with multiple systems," the company noted. The exchange will also allow access to providers from other institutions, at least in-state.

"Our vision is an integrated healthcare system that allows medical information to follow patients," said J.P. Kichak, chief information officer, UNC Health Care, in a statement. The ultimate goal is “a nationwide system of connected care."

That’s a lofty and distant goal. But it leaves unresolved many questions: How will HIEs be funded, and who should be responsible for establishing and overseeing them? What, exactly, constitutes an HIE? How will ongoing state budget crises affect the roll-out of these exchanges? How will the conflict between long-established vendor initiatives around interoperability and the vision of national CTO Aneesh Chopra (who has essentially called for a re-boot of the system in development for more than a decade by leading vendors) be resolved? And so on.

As one consultant said to me, HIEs are “still pretty much of a black box" to many HIMSS attendees. That well sums it up.

Building HIEs on a state-by-state basis often ignores the reality of inter-state care and highly mobile patients. And even the relatively successful pilot projects, such as the one spearheaded by Providence Health and Services in Oregon, have revealed significant limitations and obstacles. Richard Taylor, MD, the CMIO of Providence Health, spent much of his session outlining the challenges the exchange has faced, including the obsolescence of current record-exchange methods (i.e., the fax machine), a highly variable level of “noise" (false or trivial records changes), caregiver resistance, and so on. Some projects  have even fallen prey to natural disasters. There is also the “last-mile problem" – very few HIEs as currently constituted do anything to provide patient data information to mobile devices.

All of these obstacles are surmountable. None of them, though, will be overcome through vendor happy-talk, federal funds thrown at the problem or endless discussions. Hopefully by the time of next year’s HIMSS conference, in Las Vegas, we’ll have some more real-world examples of successful HIEs to celebrate, and learn from.

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