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It’s Time For A New HIE Model

Posted on April 25, 2016 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Over the decade or so I’ve been writing about HIEs, critics have predicted their death countless times – and with good reason. Though their supporters have never backed down, it’s increasingly clear that the model has many flaws, some of them quite possibly fatal.

One is the lack of a sustainable business model. Countless publicly-funded HIEs, jumpstarted by state or federal grants, have stumbled badly and closed their doors when the funding dried up. As it turns out, it’s quite difficult to get hospitals to pay for such services. Whether this is due to fears of sharing data with the competition or a simple reluctance to pay for something new, hospitals haven’t moved much on this issue.

Another reason HIEs aren’t likely to stay alive is that none can offer true interoperability, which diminishes the benefits they offer. Admittedly, some groups won’t concede this issue. For example, I was intrigued to see that DirectTrust, a collaborative embracing 145 health IT and provider organizations, is working to provide interoperability via Direct message protocols. But Direct messaging and true bilateral health information exchange are two different things. (I know, I’m a spoilsport.)

Yet another reason why HIEs have continued to struggle is due to variations in state privacy rules, which add another layer of complexity to managing HIEs. Simply complying with HIPAA can be challenging; adding state requirements to the mix can be a big headache. State laws vary as to when providers can disclose PHI, to whom it can be disclosed and for what purpose, and building an HIE that meets these requirements is a big deal.

Still, given that MACRA demands the industry achieve “widespread interoperability” by 2018, we have to have something in place that might work. One model, proposed by Dr. Donald Voltz, is to turn to a middleware solution. This approach, Voltz notes, has worked in industries like banking and retail, which have solved their data interoperability problems (at least to a greater degree than healthcare).

Voltz isn’t proposing that healthcare organizations rely on building middleware that connects directly to their proprietary EMR, but rather, that they build an independent solution. The idea isn’t incredibly popular yet — just 16% of hospital systems reported that they were considering middleware, according to Black Book – but the idea is gaining popularity, Voltz suggests. And given that hospitals face continued challenges in integrating new inputs, like mobile app and medical device data, next-generation middleware may be a good solution.

Other possible HIE alternatives include health record banks and clearinghouses. These have the advantage of being centralized, connected to yet independent of providers and relatively flexible. There are some substantial obstacles to substituting either for an HIE, such as getting consumers to consistently upload their records to the record banks. Still, it’s likely that neither would be as costly nor as resource-intensive as building EMR-specific interoperability.

That being said, none of these approaches are a pushbutton solution to data exchange problems. To foster health data sharing will take significant time and effort, and the transition to implementing any of these models won’t be easy. But if the existing HIE model is collapsing (and I contend this is the case) hospitals will need to do something. If you think the models I’ve listed don’t work, what do you suggest?

FHIR Adoption Needs Time to Mature

Posted on January 7, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In John Halamka’s look at Health IT in 2014 he offered some really great insight into how regulators should look at standards and adoption of standards.

Here’s one section which talks about the lesson learned from meaningful use stage 2:

“Stage 2 was aspirational and a few of the provisions – Direct-based summary exchange and patient view/download/transmit required an ecosystem that does not yet exist. The goals were good but the standards were not yet mature based on the framework created by the Standards Committee.”

Then, he offers this money line about FHIR and how we should handle it:

“We need to be careful not to incorporate FHIR into any regulatory program until it has achieved an objective level of maturity/adoption”

There’s no doubt that FHIR is on Fire right now, but we need to be careful that it doesn’t just go down in flames. Throwing it into a regulatory program before it’s ready will just smother it and kill the progress that’s being made.

eFax in Hospitals

Posted on January 23, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Over the years, I’ve had the chance to interact with basically all of the major eFax services out there. I’ve even had a number of them as advertisers. This largely makes sense since healthcare it still the haven for fax. I won’t go into all the reasons why fax is still so popular in healthcare, but it’s still the most trusted form of interoperability in healthcare. As an eFax vendor pointed out to me, fax is great because it produces an unalterable document. Sure, it’s not impossible to alter, but it’s pretty difficult.

I am hopeful that fax will one day be replaced by true interoperability in healthcare. Although, I’m more hopeful that Direct Project will get us there even sooner. Fore those not familiar with Direct Project, it’s like fax, but with meta data attached to it and securely sent over the internet. Both true interoperability of data and Direct Project still have a long ways to go though. So, don’t hold your breathe on those taking out fax….yet.

A trend I have seen happening is organization replacing their current fax solution with some sort of eFax option. In many cases this shift has been driven by issues with fax when you’re in a VoIP environment. Yes, I know that many of the VoIP environments can support fax, but it takes work. In fact, it takes just as much work getting it to function as it is to just implement some sort of eFax solution.

The other real benefit I’ve seen many consider when looking at eFax is the cost structure of eFax. Instead of having to invest in faxing hardware all up front, many organizations like that the eFax can be bought on a pay as you go or usage based plan. If indeed faxing is starting to go away in favor of some other electronic transfer of data, then your organization can save money on faxing as your fax load is reduced.

There are a few trends I’ve seen with eFax in healthcare. What trends have you been seeing in your organization?

Is There Such A Thing As Too Much Patient Info Sharing?

Posted on July 12, 2012 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Today, when I was skimming my tweetstream, I caught a message that stopped me dead in my tracks:

We spend a lot of time on these pages mulling over the best ways to get information from one provider to another, be it via the Direct Project approach, EMR integration across sites or HIEs. And all of this discussion is predicated on the notion that more sharing is largely a Very Good Thing.

And we have good reason to do so. For all of the bitterly skeptical things we can say about EMRs, in the rare cases where they’re humming like a fine ‘Vette they can improve care and avoid patient harm in a long list of ways.  They can also serve as a repository for data which can be manipulated, studied, and learned from for both commercial and public health purposes.

But I had never taken a moment to stop and think how ease of sharing patient records might come with downsides of its own. I’m not sure which ones Dr. Trainer had in mind, but my guesses would be:

–  HIPAA mistakes become much easier to make and much harder to fix, as data tends to stay where its sent.

–  Clicking one button and sending 600 pages of information may be easier for the sending provider, but it may be far more data than needed, which can actually distract from finding the right information.

While security is of course a top priority for the business, making it simple for doctors to send just what’s needed isn’t at the top of the charts for EMR vendors to my knowledge.  Maybe it should be.

Hospital Mergers Make HIE Integration Even Tougher

Posted on February 8, 2012 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

In the fantasy world of shared healthcare data, all hospitals will gradually join HIEs, share data regionally and then nationally, and patient care will substantially improve. Or at least hospitals will be in a better position to avoid errors due to critical missing information.

Sure, that’s already happening in some regions of the country. For examples, check out the list of rock-solid HIEs identified by the National eHealth Coalition, including Rochester RHIO, MedVirginia and Availity, all interesting in their own way.

But at the same time, hospitals continue to merge and sell out to larger health systems, in some cases at an almost manic pace. I don’t have the space to list even a few of the mergers that are dominating business coverage, but I’m sure you know of one in almost every market where you work or have business.

These mergers will frequently bring together different EMRs, or even the same EMR configured differently. Not only that, within each hospital, in all likelihood the EMR will have been integrated with internal departments and systems differently. In other words, even two Epic systems aren’t going to marry up easily.

What’s more, when a well-funded hospital buys one in desperate financial straits, which is often the case, what’s the odds the smaller will have a costly Epic or Cerner or Meditech system in place? Not very high, I reckon. So the systems integration problem is even worse. Now, doubtless a large, well-funded system will ultimately put their system of choice in place eventually, but that won’t happen overnight.

So, as merger activity proceeds apace, it’s creating islands of discord and disconnected data. And my best guess is that those hospitals won’t be HIE-ing anytime soon, though I may be off base here.

I do have some hope that the Direct Project will be able to work around some of these obstacles. Though it’s still at the pilot stage, and participants are sharing only a small subset of clinical data, it does seem promising. I’m particularly intrigued by the notion of a HISP (Health Information Service Provider) which helps to push information from one provider to another.

Let’s hope that models like the Direct Project continue to emerge. Otherwise, the Tower of Babel we’ve got is likely to keep babbling.