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Oct 17 2012   10:58AM GMT

State HIE: Where are we going with this, anyway?



Posted by: DonFluckinger
blasphemy, HIE, state HIEs

In Massachusetts style – which usually involves muskets going off and other shot-heard-round-the-world noise – Gov. Deval Patrick launched his state’s HIway health information exchange Tuesday by sending his own data from Boston to Springfield  in a ceremony filled with pomp, circumstance and actual golden spikes.

Congratulations, Mass. A state HIE is something worthy of celebration, as opposed to other phony-baloney stuff that happens in the state government such as keeping a law on the books punishing blasphemy with a year in jail and a $300 fine. (Anyone sitting in the stands at Fenway can attest that enforcement on this one’s rather lax.) State HIEs, on the other hand, are a cog in the nation’s budding network of electronic health data that eventually, we hope, will help save lives and enhance patient care by giving physicians access to data now marooned in proprietary software systems. Or worse, paper.

Massachusetts isn’t the first state HIE, and it won’t be the last. A quick glance at the ONC’s national tracker shows that some states like Indiana and New York already have robust HIE happening, with many other states setting up significant chunks of HIE such as e-prescribing networks and directed exchange.

But storm clouds loom. Just days before the golden-spike ceremonies, in a candid interview Massachusetts eHealth Collaborative founder Micky Tripathi – whose handiwork is all over the Massachusetts HIway – said he believes that ultimately, most publicly funded state HIEs won’t survive, because they aren’t sustainable from a business point of view. State HIEs are highly dependent on EHR adoption, he points out, and some states just haven’t hit the saturation point yet.

All that federal taxpayer investment in state HIEs will not be in vain, though, he quickly added, because the great experiment of funding even failed HIEs will show private enterprise the roadmap to success, giving them long lists of do’s-and-don’ts from which to devise their own HIE infrastructure. In effect, present state HIEs will take some of the hard knocks of early adoption so others won’t have to.

In California, HIT leaders are playing hot-potato with their state HIE, hoping UC Davis Health System, the latest recipient of the project, will be able to just get it off the ground at some point. Not good news for a state known for health IT innovation and investment in massive public projects.

So yes, Massachusetts, take a bow. And congratulations to Beth Israel Deaconess Medical Center CIO John Halamka, MD, whose behind-the-scenes efforts helped hook up the network along with those of his peers like Tripathi. But state leaders should also understand, now that the switch has been flipped, the much more difficult – and crucial, for the state’s patient population – work of sustaining the state HIE has just begun.

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