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What's on tap for health information exchange at HIMSS 2011

Health information exchange is at a crossroads -- public versus private, federated versus centralized. The HIMSS 2011 conference will help light the road ahead.

Heath information exchange (HIE) can be defined two ways: It can be the act of two physicians exchanging a patient record either on paper or electronically, or it can be software that enables and automates electronic exchange.

Theoretically, a good chunk of the funding in the Health Information Technology for Economic and Clinical Health, or HITECH, Act will foster a nationwide network of health information exchange, in which patients can access their medical records from anywhere in the country. How close is the U.S. health care system to achieving that?

"It's still a pipe dream," said John Moore, the lead author of Chilmark Research's HIE Market Report: Analysis & Trends, released late last month. "There are countless hurdles before we get to that point, so we won't be seeing that for a decade at least."

The impediments, Moore said, are many and varied, from funding issues to technology problems and policy, and start with inconsistent state laws governing how patient information must be handled.

That said, private HIEs -- run by hospitals, groups of hospitals and even integrated delivery networks, or IDNs -- are where the action is, Moore said. Publicly funded HIEs lag far behind. With new reporting mandates for meaningful use compliance and would-be accountable care organizations, it behooves providers to move forward with their own HIEs, he said. Those mandates give providers commercial reasons to set up internal HIEs, which eventually will plug into each other and finally, into state HIEs.

HIMSS 2011 will be a health information exchange watershed

The upcoming Health Information Management Systems Society's HIMSS11 show in Orlando will be a good yardstick to measure the progress of health information exchange in the United States, Moore said. HIMSS 2011 also will offer a snapshot of what's next in a rapidly expanding health IT sector.

There's one key question about health information exchange: Will the centralized, federated or hybrid model become the standard?

If health information exchange is compared to music, a centralized HIE model resembles music downloads from the iTunes Store or, where members log into a central repository and take away files. A federated HIE model is like a peer-to-peer site, such as Kazaa used to be -- and BitTorrent still is, where the collective stores the data and shares it through an edge server that catalogs it.

What's going to be really critical in the future will be analytics and business intelligence. You can't run reports in a federated model [of health information exchange]. It won't happen.

John Moore, founder and managing partner, Chilmark Research

The hybrid HIE model stores some data in a central server -- for finite periods -- for compiling reports. In some cases, hybrid HIEs collect data for creating snapshot reports, hold it for a time, then discard it after the reporting is complete, Moore said.

The centralized HIE model dominated at first, but it seems to be fading, due to logistical issues, security liabilities and significant up-front expenses, Moore said. Only organizations that can afford data warehouses will hang onto them for health information exchange.

In its pure form, the federated model also is problematic because it's hard to fulfill quality-reporting mandates when health data is spread out over many computers. In the end, Moore thinks, the hybrid model will win out -- that is, until the industry figures out how to make the Platform as a Service (PaaS) model work to host HIE in the cloud. (In the PaaS model, the HIE vendor hosts the service but offers health care providers and their local partners the ability to customize it.)

"Federated is fairly popular because it's easy to deploy -- you can get it out there, you can get it up and running fairly quickly," Moore said. "The hybrid models, you're going to see more of. What's [going to be] really critical in the future will be analytics and [business intelligence]. You can't run reports in a federated model. It won't happen. You have to have a place where the health data sits for a period to do your quality reports."

Moore suggested three other questions that HIMSS 2011 attendees should investigate about HIE vendors:

  • Which vendors are hardwiring business intelligence and clinical data analytics features into their applications? "We're very early into this," Moore said. "Most do not have very strong capabilities, but everybody's building something."
  • Which vendors have the most flexible, customizable application programming interfaces and software development kits? These vendors are likely to win out when it comes to the PaaS model of health information exchange, Moore said.
  • Which vendors are reaching out to ambulatory practices, which have the most innovative ideas and which can best manage patient consent management? These HIE vendors also should succeed, Moore said.

Let us know what you think about the story; email Don Fluckinger, Features Writer.

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