Posted by: adelvecchio
CommonWell Health Alliance, HIE, public HIE
Guest post by Greg Chittim, senior director, Arcadia Healthcare Solutions
State, regional, and local commercial HIEs are reaching a tipping point. Some are succeeding wildly and the regular exchange of data is becoming a core part of their healthcare IT landscape. Others are failing due to lack of participation caused by unclear value propositions and returns on investment. In the latter case, data standards are often the key stumbling block preventing effective and efficient HIEs. More specifically, the problem is a lack of viable and implementable data standards.
How have some HIEs overcome the data standards issue while others have struggled? Most successful HIEs are those that built up a foundation of quality data early on. They used that data to overcome the chicken-and-egg problem of encouraging adoption when there’s not enough value (in the form of data for specific physicians’ patients) to sign up. Those with the smallest hill to climb in this sense are those HIEs built around a dominant health system on a single EHR platform, or a health plan with claims data supported by a majority market share. In these cases, a valuable data asset can be built up quickly then additional stakeholders have a fixed target for a predictable set of interfaces to fill in the margins of data not met by the dominant player.
But what about those statewide or regional public HIEs that do not have the luxury of a dominant commercial player supporting the baseline? In these scenarios, there are a number of national efforts underway to unite government and commercial entities to build viable data standards. The Consolidated CDA is one potential solution, but that requires EHR vendors with divergent strategies and fierce competitive tendencies to implement a shared standard. This has proven a challenge, especially given the lack of clarity in meaningful use measures as to how continuity of care documents must be formatted and what vocabularies must be used. The unfortunate tendency has been for EHR vendors to work in their own silos, doing what is best for their particular market segments, and taking a “wait and see” approach to more specific national standards.
Emerging groups such as the CommonWell Health Alliance present a very real opportunity for a vendor-driven set of standards. If vendors (Epic in particular) manage to find a way to cooperate with the rest of the industry at least on the subject of data standards, it could present a strong solution. In the meantime, the presence of providers who are truly EHR vendor agnostic and can efficiently do the mapping, integration, and reporting on data from many different vendors will be critical in the absence of universal data standards. This investment has proven difficult to sustain for public HIEs whose stakeholders are reluctant to support standards but are eager to support real data and analytics.
The long term solution remains to be seen. However, the private successes point to an answer for struggling public HIEs. That solution is to do whatever possible to build up a baseline of key data — even for a limited use case — and then provide the incentives (or when necessary, penalties) to comply with a well-defined, detailed standard that can be met both in part (for specific use cases) or wholly (for a complete solution) with minimal room for interpretation.