Health information exchange in Massachusetts take its next big step last week with Mass HIway demonstrating its ability to streamline the retrieval of a patient’s EHR from four different sources in order to coordinate care more effectively and avoid repeat tests. The successful demonstration shows just how far the state HIE has come since its launch near the end of 2012 in establishing the technical infrastructure necessary to support a robust exchange of patient health information.
What it didn’t show was a potential establishing to provider adoption of exchange services: how EHR vendors are handling the communication of its technology with an HIE. The matter deals with the fees EHR or other health IT companies could change users to send and retrieve HIE data by way of their health information service provider (HISP) services.
“The thing that we did not expect to deal is that we always knew some vendors were going to have their own HISPs, but what was surprising was that there are some vendors trying to have their own HISP and plan to charge a transaction fee for sending and receiving,” says Manu Tandon, Secretariat Chief Information Officer of the Executive Office of Health and Human Services in the Commonwealth.
These HISPs function as an electronic middleman, allowing a particular EHR system to communicate with technology outside of its network — that is, where the real exchange of health information takes place.
While many HIEs have intended to keep HIE participant costs at reasonably low levels, charges issued by this HISP could drive the price of exchange up and potentially impact a provider’s willingness to sign on to an HIE. “That was a downer for us, for lack of a better word, because here we are providing a statewide HIE that doesn’t charge transaction fees. The whole point is to reduce the cost to the healthcare system,” Tandon explains.
On top of the cost, HISPs are likely to vary in terms of how they support HIE and require more work to facilitate the secure movement of patient data from the EHR to the HIE. “Each vendor has its own flavor of HISP. Working with them individually to connect with them has been a bit of a surprise,” adds Tandon.
Despite the presence of HISPs, serious interest and willingness of healthcare organizations and providers to participate remain strong, certainly evidence of the value of HIE to medical community in Massachusetts. And they are expected to increase as Mass HIway moves forward with its next series of implementations: a self-service portal for providers to register for the HIE, additional operational support for the HIE, and the establishment of a quality data repository to support among other things meaningful use and the state’s Medicaid payment model transformation.
Although a conceivable underpinning of other HIEs across the country, the role of HISPs is not a subject discussed outside of the HIE community. However, it could well be a matter if not considered openly and transparently that explains why HIE is not so quickly and widely adopted.