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Should healthcare providers choose a state or community HIE?

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- Should you hitch your wagon to your state or community HIE and why? That is the question many healthcare organizations and providers are considering as pressures growing for health information exchange (HIE).

As providers prepare for Stage 2 Meaningful Use, there is a greater focus on data sharing. In the first phase of the EHR Incentive Programs (i.e. Stage 1 Meaningful Use), the focus was really on implementing and using an EHR for patient care and documentation. Now that data has to be shared with other providers and also with patients, the need arises for a data sharing infrastructure.

In most cases, the EHR itself is not equipped to do more than publish and consume documents that summarize the patient encounter as well as including a summary of key medical information about the patient from the past. EHRs depend on an infrastructure external to themselves for actually transporting and delivering those documents to others.

The need is there to share information not just with providers within one’s practice, or even within the wider organization in the case of integrated delivery network (IDN)-owned practices. The need is, or will be, to share information more broadly with all those in the provider community comprising members of the patient’s network (as defined by insurance plans). In order to share with all of these providers, it is safe to assume the patient record has to cross EHR boundaries, between vendor systems, and across the border of legally distinct provider organizations.

For this to occur effectively, it is important to consider joining an HIE. HIEs have been in existence for a few years now and are designed to connect disparate entities and their EHRs (as well as labs, pharmacy, and other providers) within a geographic region.

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There is federal funding to establish HIEs at the state level, and many states have worked to stand up a state-wide utility that can address the data-sharing needs of all providers. In parallel, many community-level HIEs are also in operation, spurred into existence to serve a variety of goals — ranging from business-driven HIEs that serve IDNs or accountable care organizations (ACOs) or other well-defined networks to “public good” HIEs that were established as a service to the community as a way to enhance connectivity and thereby patient care quality. All of these will likely be on the table when you look at your options.

Our recommendation is to examine the following factors: governance (how well managed and financially stable the HIE is), membership (who else is on board), technology (what data they are capable of sharing, which EHRs are connected, what interoperability standards they support, etc.), and service (how well they will support physicians as users and at what cost).

All things being equal, the community HIE is probably a safe bet because it will be most likely driven by local practice patterns and needs, have governance known to you (in case of difficulty), and be more responsive to local market costs and drivers.

The state HIEs are a mixed bag. Some of them are really excellent, pushing the envelope nationally on what is possible in data sharing, and investing in the right strategies and solutions. Others are simply there to spend the federal grant money that came to the state but doomed to wither away once that grant money has been spent. Additionally, these state-level HIEs are not usually well positioned to actually serve the entire state — they have regional roots, loyalties, and capabilities that don’t scale well across the entire state.

For that reason also, the community HIE, if it is well established, will be your preferred entry point to data sharing — and from there, that HIE should already be in a strong position to connect to the state HIE for sharing data more widely. In reality, the need to share patient data outside the community will be a fairly rare occurrence, given that most care takes place within a defined service area, not statewide.

There are always exceptions to every rule, and the above information is a general guide that needs to be weighed against the specifics of your situation and your community. Thoughts, comments, and experienced feedback are always welcome.


Blair Butterfield is President, North America, of VitalHealth Software, which was founded as a collaboration between Mayo Clinic and the Noaber Foundation to combine the best practice clinical knowledge with deep IT knowledge and entrepreneurial experience.













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