The HIE landscape has changed drastically in recent years. For an organization like MHIN that started developing in the mid-1990s, the concept of health information exchange preceded the official term “HIE” altogether. Years later when increasing amounts of federal funding became available to support HIE-type initiatives in the early-2000s, the industry began to define itself. Today, there is at least one HIE (or developing HIE) in every state. Many, like Indiana and Michigan, have multiple regional HIEs that operate together under a larger state infrastructure.
But each HIE has its own guiding principles, its own stakeholder agenda, and its own service offerings. And like every sub-state HIE, every statewide HIE operates differently than the next, and soon the variance of HIE practice will become so complex that it will be difficult to keep track.
So what’s the problem? Must any two HIEs be alike?
In order to reach their full potential, the answer -- to some extent -- is yes.
MHIN operates under the unwavering goal to put 100 percent of the patient’s data in the hands of the provider at the time of care. While reaching that 100 percent seems ambitious, to say the least, it is the guiding light of the best practice of an HIE that keeps us working toward it. When you get right down to it, shouldn’t all HIEs be working toward that goal? We are in the business of sourcing data in the most secure and efficient way possible. So what happens if said patient’s data is in Florida? Or maybe just a few hours away in a few towns over? It’s likely that it’s in both of those places and more. It only takes a minute to consider your own personal healthcare history. Where are all of the pieces to your 100 percent complete medical chart?
Our HIEs have to talk to each other in order to source data across cities and states so that information can be where the corresponding patients are. The technical capability is alive and well. All we need are standards to facilitate the movement.
The federal government has been working to address this issue through a variety of initiatives, and it is promising to see some standardized communication methods coming to fruition. The emerging concept behind the Nationwide Health Information Network may help to alleviate some of the standards issues. As Claudia Williams, director of the State HIE Program at the Office of the National Coordinator for Health Information Technology, defines it, “A national health information network is a set of standards, services and policies that allow information to flow across the Internet in a safe and secure way.” In terms of application, Williams went on to explain during a webinar on May 2 that the federal government will use grant incentives and penalties through other federal programs to encourage health information exchange activity in a certified way. Meaningful use Stages 2 and 3 will likely play a role in that from the provider perspective.
There is also the Direct Project, a set of national standards, policies and services that enables simple and secure transport of health information between healthcare participants who know each other and have undergone an exchange of trust certification. Like MHIN, many HIEs are beginning to embrace the Direct Project by undergoing the process to become a Direct Health Information Service Provider (HISP), which will enable the HIEs to exchange trust certificates on behalf of participating providers in their service region. With connection to a HISP, providers have the ability to message other clinical providers across the nation through an application that functions almost exactly like e-mail with HIPAA and all necessary security measures in place. As HIEs begin to roll out Direct messaging applications to their providers, the convenience of HIE standards may be realized.
While much progress in the HIE industry has been made over the past 15 years, the potential issues that could arise from an industry with effectively no existing standards, no mandatory accreditation process, and no consistency are apparent. We’re advocating for the standards necessary to improve quality of care and reduce costs for the healthcare community. Watch with us as the standards develop nationwide.