Expectation Setting For Health Information Exchange - Including the NEHRS. Are We Hoping For Too Much?

The following very interesting perspective appeared a little while ago.

Friday, June 22, 2012

The Dangers of Too Much Ambition in Health Information Exchange

by Micky Tripathi

For those of us who've been toiling in the trenches of health information exchange for a number of years, we're finally living the dream. According to a 2011 KLAS report and a more recent Chilmark report, the HIE market is poised for spectacular growth over the next couple of years. Most of this growth will be driven more by "private" HIE efforts (enterprise efforts usually driven by a hospital system and/or physician organization) than by "public" ones (cross-organization regional or state collaborations usually seeded with government funds), but, regardless of what is driving it, the reality is that HIE is sprouting all around us.

I'm delighted that we're moving rapidly in this direction, but one concern keeps nagging away at the back of my mind, and that is the propensity to pursue over-architected HIE solutions.

This history goes back to the ill-fated community health information networks (CHINs) of the 1990s, continued through the highly-publicized failure of the Santa Barbara Care Data Exchange, the difficulties experienced by the Massachusetts eHealth Collaborative pilot projects and many of the regional health information organizations established by New York's HEAL-NY program. And it continues into the present-day with the demise within the last year of CareSpark (Tennessee) and the Minnesota Health Information Exchange, and the recent challenges experienced by Cal eConnect. Many of the HITECH-funded HIE programs carry this same risk.

What is an over-architected HIE? Put simply, it's one that tries to do too much for too many with not enough money and time. It tries to establish an all-encompassing infrastructure and service to meet multiple, heterogeneous current and future requirements of multiple, heterogeneous current and future customers. It tries to do all of this with a shoestring budget and staff. And worst of all, it focuses more on long-term potential "big-bang" value at the expense of short-term, realizable, incremental value. Or as one HIE organization's promotional material put it, the value proposition is to be a "one-stop shop for Clinical and Administrative Information."

The counter to the over-architected HIE is the incremental or phased HIE, which focuses specifically and radically on concrete, discrete, value-generating and self-standing steps and does not tie its fortunes to a specific future end-state whose horizon is further than the range of our ability to navigate. I was recently describing my concern to a health care system executive, and he said, "Yes, well, but we just want to jump to the end." By that he meant, build the final solution infrastructure and services right away to solve the big problem of creating a "one-stop shop," and assume that by-products of that long-term effort will keep everyone motivated along the way. My concern reached new heights after that conversation.

It's totally understandable how this happens and, interestingly, both "public" and "private" initiatives are led down this same path, albeit for different reasons. For many public HIE efforts, "waste" in health care spending feels like low-hanging fruit. Don Berwick says that 30% of health care spending is "waste", and the CEO of Geisinger recently stated that 40% of health care spending is "crap". 

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MORE ON THE WEB

• "Best Practices: Establishing Sustainable Health Information Exchange" (Dunbrak, IDC Insights, March 2012).
• "Health Information Exchange Roadmap: The Landscape and a Path Forward" (National eHealth Collaborative, April 2012).
• "Health Information Exchange: Sustainable HIE in a Changing Landscape" (eHealth Initiative, October 2011).

Lots more here:

http://www.ihealthbeat.org/perspectives/2012/the-dangers-of-too-much-ambition-in-health-information-exchange.aspx

It seems to me that Health Information Exchange (which is what the NEHRS is some half-hearted attempt at) is a fundamental and invaluable tool in the provision of safe, properly co-ordinated patient care.

The warning that one can try to do too much too early I find very resonant to our present situation. Had the NEHRS program aimed low and simple while it started I suspect we would have seen a much better and probably even quicker attainment of the desired end point. This stuff is really a classic circumstance where we need to adopt the KISS principle and ‘hasten slowly’!

A very useful discussion in my view.

David.