Why HIEs Struggle and How They Can Improve

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There are many different models of Health Information Exchanges. Some successfully share data between systems, and may provide valuable services on top of just data warehousing and distribution. However, almost all still struggle to make participation in their programs worthwhile to a significant portion of their region.

The most widespread cause of HIE failure is the actual exchange of useful information. The EMRs, EHRs LISs, RISs, that make up a region’s medical information landscape very rarely conforms to a single method of data interchange. Recently, most HIE vendors have pursued the exchange of information via IHE Profiles. Of these, PIX – Patient Identifier Cross Referencing and XDS – Cross Enterprise Document Sharing are most common. These two profile sets do give a robust foundation for patient matching and document exchange, but they come with some major difficulties.

These standards require well-established metadata definitions and facility identifiers. The SOAP interchange that also comes with this standard and the security protocols associated require networking specialists to efficiently establish secure endpoints at each facility. This is not an issue for a well-prepared site who happens to have an EMR already configured to handle this protocol, but these sites are few and far between. Even those with a major EMR vendor continue to struggle to match up protocols and get IHE interfaces stood up efficiently. Even if this kind of communication is established, the end result is an exchange of documents with no one point of storage usable for any kind of reporting, data mining, or consolidation of patient records.

The answer is for HIE technologies to become more flexible in communication methods and data storage. Document sharing via IHE Profile can be an excellent method when available, but what about the facilities not interested in handling some new integration method? How do we get an entire region to buy in to connecting? First, use what each facility already has available for integration. Meaningful Use means that almost every site has HL7, and more recently, some form of CDA output.  Find which method each site can quickly and efficiently exchange data, use that method, then move on to the next site. It is far too easy to extend what should be a simple integration project with current technologies into a 12 month quagmire with extensive concept discussion, proposed development, environment upgrades, security configurations, etc. Second, store this data in a usable way. Display of documents in a portal is nice, but prepare for real value for the HIE participants. This means well organized and audited data, but also data parsed into usable data points.

The key is quick onboarding. The more sites that are sharing data, the more value a Heath Information Exchange can provide. Potential participants will see a smaller barrier to entry and more potential value if they see other sites easily connect. This will result in a snowball effect that will quickly end in exactly what a HIE is meant to be – a single point of contact for every facility in a region. Then, the purpose of the HIE may be realized.