Find out why the state HIE should be your first stop for interoperability.

October 2015

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WISHIN Connections, the monthly e-Newsletter from the Wisconsin Statewide Health Information Network (WISHIN).  We will keep you up to date with WISHIN activities, news on health information exchange (HIE) and new product developments.
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HIE Should be Your First Stop 
for Interop
Don Lee, Vice President, Algonquin

One of the biggest hurdles to Health Care interoperability is that there are so many people working on Health Care interoperability. Every IT department in every practice group and hospital is spending time on it. They're all "rolling their own" and it isn't sustainable. The answer of course is collaboration, but there are lots of flavors there too. CommonWell, FHIR/Argonaut, and the Sequoia Project are all great efforts but are still effectively in competition, and are focused on the national scale. Most care and coordination happens in a pretty finite regional area. So it stands to reason that we should collaborate accordingly and statewide (or regional) Health Information Exchanges (HIEs) are the best place to do that.

Admittedly, its been a bumpy road for many HIEs and some have failed. Keep in mind that it's a relatively new concept and these groups have been making it up as they go. When you throw a whole bunch of grant money into uncharted waters, some of it will get lost. No surprise there. There's a whole other class of HIEs that started with strong community support and sound business models that are thriving today. They're moving past the base purpose of exchanging data and beginning to offer value added services that really make this all worth-while. By focusing on this group, the case for regional HIE becomes strong.
We Need Focus
This is what HIEs do. Instead of asking overtaxed hospital/practice IT staffs to learn and support interop with many partners in between their other tasks, let's have them integrate once with the HIE and then focus on getting stuff done within their own four walls. Let the HIE work all day long to perfect the art of interop. This will also clear the EHR vendor log-jam in the process. Today you've got 100's of local players all asking the EHR vendor for custom interop help to do the same thing in a slightly different way. If we only ask the EHR vendor to connect to the HIE, then their queue shortens and wait times will come down.
Context Will Always be an Issue
All methods of interop have issues with context. Sure there are codes and standards, but most have flexibility in how fields are used. And even if they don't, people re-purpose fields to meet their needs all the time. Let's say one practice identifies high-risk patients from some category by indicating they are from Mongolia. All of their patients are regional and everyone in the practice knows this "business rule", so it works for them. Now connect them to 100 trading partners... 100 trading partners have to deal with this data issue. Go through the HIE and it can be dealt with once.
Too Many Middle Managers!
We've got ACO, DSRIP, TCPI, Bundled Payments, etc. All of these programs require data sharing for care coordination and quality reporting. Each of these groups represent a type of redundant "Middle Manager" when it comes to interop. Like that poor corporate drone in Office Space, providers are being asked for the same things from all of their middle managers. To make it worse, they're asked to provide the data in different ways at different times. Why are we all doing the same thing separately? It's a huge waste of time, effort, talent and money. Enough already! Send your data to the HIE and let them format it and report it to the middle managers for you. Then when the next value based program starts in 5 minutes, ask them to format that for you too.
No one actually cares about Interop
We care about using the data to achieve the triple aim. To do that, we need to connect the data and then make it useful. Good HIEs are beginning to do this by offering ADT Notifications, Care Coordination tools, analytics support and more. If individual practices and systems continue to invest in basic interop (and its subsequent technical debt), then they'll run out of resources before anything meaningful is done. Let's commoditize basic interop by treating it as a public utility at the HIE. Then let's take advantage of the value added services they are able to provide. Finally let's take the internal resources we've preserved to differentiate our business in more meaningful ways.
Bottom Line
Like it or not, we're all working together on one big project to connect Health Care. We've just got a dysfunctional team staffed with a lot of "think for yourselfers". We're wasting time, diluting the funds meant to improve care, making our overworked-staff cram-in uninspiring work and we're creating a mountain of technical debt in the process. We can't afford to continue to compete on interop. Let's work together to solve this issue and then compete by using it to provide the very best care that we can. To put it another way:
Instead of trying to see who can spin their wheels fastest in the mud, let's push each-other out and have a race.
This article originally appeared on Algonquin's blog, The Roundtable.
Wisconsin Statewide Health Information Network | Company | (608) 274-1820 | | | PO Box 259038 | Madison, WI 53725-9038