Delivering early HIE value

By Raymond Scott

Today, healthcare information is fragmented among disparate healthcare systems and providers. Professionals recognize that this leads to ineffective, costly care; medical errors; and unnecessary repetition of diagnostic tests. Professionals also recognize that health information exchange (HIE) holds the promise of a cure for those who participate. The major barrier to successful implementation of an HIE is the lack of EMR adoption by physicians, particularly those in the smaller practices.

“An EMR lite is an easy to use, easy to deploy EMR that provides physicians who are not already electronic with the ability to receive, view, manage and act on clinical data.”
-Raymond Scott

A recent study by AC Group found that only about 10 percent of physicians in small practices (one to 10 physicians) have installed EMRs to date. These small practices represent 50 percent of all ambulatory practices in the nation - so this lack of EMR adoption can seriously impact the ability of any HIE to deliver on its promise, delaying the benefits to the patients, the community, the stakeholders and to the physicians themselves.

Unfortunately, increasing physician adoption is not merely a matter of reducing the cost. Other key barriers are inherent in the independent and entrepreneurial nature of the private healthcare sector, affecting private practices, hospitals and other providers.

With HIEs, we are moving into an era where individual and institutional providers will be sharing data. While participants value the data they capture and the relationships they have developed, the basis for competition will be the service they offer, not the data  themselves. The undeniable reality is that clinical data now need to be shared at the point of care - the key to quickly improving the quality and significantly lowering the cost of care. To achieve it, all participants must have the ability to electronically review and manage data from multiple sources. Yet, there remains a need to avoid permanent comingling of data from competing entities.

In summary, there are three interrelated requirements that must be addressed for early HIE success: the network effect - the more providers connected to an HIE, the more valuable the HIE; the automation effect - all connected physicians must be able to review and manage data electronically or institutional providers will not get benefit; the separation effect - institutional providers must be able to keep their data separate so they can exercise control over broader HIE participation and access.

The cost of EMR adoption to physicians has been partially addressed by the availability of federal ARRA stimulus incentives. Many of the remaining barriers to physician adoption, particularly those involving ease of use and changes in practice workflow, can be addressed by well-designed EMRs. The remaining dilemma, then, is how to reconcile the equally vital requirements of sharing patient data and preserving data ownership. The debate on this issue has been polarizing in both the private and public healthcare sectors. Fortunately, the power to resolve it exists in the fundamental technology of today's HIEs, the two principal components being an 'EMR lite' and hybrid-federated repositories.

An EMR lite is an easy to use, easy to deploy (browser-based) EMR that provides physicians who are not already electronic with the ability to receive, view, manage and act on clinical data. It immediately connects a small practice to an HIE without the need to purchase new equipment or undergo major workflow changes.

Hybrid-federated repositories are a database solution that allows hospitals and labs to keep their data separate and secure while allowing for appropriate searching and selective sharing at the point of care. A hybrid-federated approach works with existing information systems and provides complete data-sharing flexibility.

Any hospital, RHIO or statewide system developing its HIE plans should insist on a hybrid-federated solution and give serious consideration to an EMR lite option. Each can be a significant factor in achieving early 'critical mass', the result necessary for a successful and sustainable HIE that delivers real value to all its stakeholders.

Biography

Raymond W. Scott co-founded Axolotl Corp. in 1995 to provide collaborative electronic workflow solutions for communities of healthcare providers. He was instrumental in creating the concepts around Clinical Messaging, turning electronic medical record communication into a reality, and establishing it as a necessary requirement for successful health information exchanges and Regional Health Information Organizations.

With a strong supporting management team, Scott has established Axolotl as a market leader in electronic connectivity and collaboration, today providing the technology and services to power most of the full functioning HIEs across the US.