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Feb 21 2012   4:51PM GMT

HIE lessons learned: Health information exchange in action

Posted by: Jenny Laurello
health information exchange, HIE

Guest post by: Ruby Raley, Director, Healthcare Solutions, Axway

Even though the ONC started the HIE process in 2009 after the HITECH Act was enacted, it has taken time for RFPs to be answered and the implementation process to begin. Here at Axway, we were honored to be selected for several HIE initiatives, and in the hopes of offering you some insight into your own HIE plans for 2012, I’d like to reflect on key themes learned in 2011 that are important to consider, whether you plan to join a state HIE, build a private HIE or use the Direct Project approach to exchange health records. Actually, these are more than themes – they are critical success factors.

But before I jump into these themes, it might surprise you to learn that I am not going to discuss sustainability in this post. Granted, it’s an important, and global, topic. But I believe the most useful discussions about sustainability are local in nature, because the value and rationale for creating or joining an HIE can only be determined by a community member, not an outsider. Every community is at a different level of health care IT maturity and meaningful use achievement, and every community must make its own business decision about how and where to acquire health record exchange capability.

With that as preface, here are the four critical success factors gleaned as a result of real-world HIE implementations carried out by Axway, a company with a long history of building high-volume, hub-and-spoke models and facilitating internal application-to-application messaging and ad hoc file transfers:

  1. Communication builds community. Trust is the foundation. You must engage your community of interest early and often in order to build awareness, coordinate strategic plans and ensure that you can deliver the right value. Trust is critical – each provider CIO must achieve meaningful use while maintaining acceptable clinical processes. CIOs are aware of and worrying about HIE sustainability, the number of HIEs and RHIOs that have closed their doors, and escalating HIPAA data breaches – so they cannot rely on an unknown HIE to move critical health records. Communicate and collaborate to build awareness and alignment.
  2. Resource constraints matter. Remember: Even willing participants often have a large IT backlog and suffer from limited IT resources. Not surprisingly, vendors are equally stretched, given the double-digit growth in EMR implementations we saw in 2011. Sign up community members early, and create a schedule, so that IT leaders can integrate HIE connectivity projects with enterprise connectivity projects, and re-prioritize and/or re-plan accordingly.
  3. Test data is gold. The fact is that health care standards are not standard! You should expect a number of variations in both the use of fields and the reliability of data values in those fields. Help your community by proactively developing canonical guides that describe the structure and content of the documents to be exchanged. Build conformance test tools and expose those tools to community members so that they can self-test document structures.
  4. Obey the KISS principle. Complicated policy, cuttingedge concepts and early-adopter use cases can reduce interest and discourage partners. Select use cases and connection patterns that are well understood and supported by the community – simple use cases that mirror common yet valued health record exchanges are the best place to start. Avoid more challenging concepts, such as opt-in consent models and real-time response protocols that support mobile first responders.

Your HIE goals for 2012 may seem daunting, and rightly so. But if you keep these critical success factors in mind — and work to understand the unique and delicate balance of technology and humanity that a quality HIE initiative demands — you’ll finish the year ready to compete in 2013.

For more information on Axway, please visit

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