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National HIE hindered by interoperability barriers, vendor reluctance

Two radiologists who built HIEs from scratch don't see a national HIE happening soon. Vendors aren't keen to embrace HIE standards, they say, and interoperability is a struggle.

This tip examines the possibility of leveraging the work being done by private and state-run health information exchange organizations and creating a national HIE. It is the third in a series based on interviews with Michael Abiri, M.D., chairman of the department of radiology for Continuum Health Partners, and Patrick Ward, CIO of Central Illinois Radiological Associates, both of whom piloted private HIE implementations in lieu of waiting for state or national infrastructure to be in place.

Even optimists like former national HIT coordinator David Blumenthal, M.D. admit that the Office of the National Coordinator's dream of an interconnected network of health data exchange could take 10 years or more to build, if it ever gets completed.

Ward believes health information exchange potentially could remain a regional phenomenon, as hospitals build exchange functionality on an as-needed basis. This typically means connecting a network of hospitals, PCPs and specialists within a region, and it would cover most of the health care activity that spurs the business need for health data exchange.

National HIE could emerge if savings of data exchange are quantified

Even that's a tough proposition. Current data standards, at least for radiology, go far in making images interoperable, but "basically they've replaced CDs and DVDs with the Internet… [and] really have not accounted for the clinical data," Ward said.

Our series on health information exchange

Part 1: Nationwide, HIE connectivity happening slowly, surely

Part 2: For some providers, HIE implementation cannot wait

Part 3: National HIE hindered by interoperability barriers, vendor reluctance

Beyond that, normalizing clinical data once it's accessible is even harder, because simple protocols such as file-naming vary from one provider to another. That makes it impossible to verify that a radiologist is making an apples-to-apples comparison with a patient data.

Add to that software and equipment vendors' commercial, competitive perspective, and HIE "scares them to death," as Ward put it. If everything's interoperable, it's hard to differentiate one vendor from another.

Furthermore, many hospitals have radiology systems featuring hardware and software from a single vendor, end to end. Once IT leaders remove health data interoperability barriers, Ward said, hospitals will probably realize that other vendors can accomplish certain elements of their radiology workflows more cheaply -- and begin piecing out those workflows, such as archiving or viewing, to other vendors.

The other problem with vendors, Ward continued, is that they look at supporting new standards and regulations as a profit center.

"I'm aware of a large company that acquired another company's products recently. There was specific functionality that existed before the acquisition that's [since] been turned off. That would make it easier for that product to be interoperable," Ward said. "I'm just waiting for the other shoe to drop, for the [vendor] to announce a new 'interoperability initiative' and the products that they'll sell to help make the function in the HIEs."

You can go and do your banking online. Why can't you do your health information?
Michael Abiri, M.D.chairman, department of radiology, Continuum Health Partners

That being said, Ward hopes that, once HIEs are proven to reduce costs by eliminating duplicate or unneeded tests, a national HIE will be built. Concrete numbers, he thinks, could ultimately sway public opinion and policymakers' influence. It could force competing vendors and competing hospitals to drop their reservations about interoperability and sharing patient data with one another. And Ward believes the savings will be most dramatic in radiology, one of the most expensive components of U.S. health care.

If U.S. has national banks, why not a national HIE?

Abiri, having experienced how much more simple setting up radiology information exchange was compared to how complicated hospital leaders had anticipated it would be, asked why the U.S. health care system cannot build a coast-to-coast network of connected HIEs.

"What do you think we do now?" Abiri said, referring to how Beth Israel delivers radiology information to physicians out of its HIE network, such as if a New York patient is wintering in Florida and needs to take a report to his physician there.

"Before we used to print the films and give them to UPS or FedEx. Now we create a CD and send it to them. But when we do multi-center research, we connect our systems together so we can send images [electronically]," he said. "You can go and do your banking online. Why can't you do your health information?"

Let us know what you think about the story; email Don Fluckinger, Features Writer or contact @DonFluckinger on Twitter.

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