Want sustainability? Focus on transformation not automation

Our nation today faces a singularly important juncture in the history of the U.S. healthcare industry. Unsustainable escalation in healthcare costs, inconsistent care quality, challenges with medical errors and patient safety, and the need to expand care coverage have all converged like the perfect storm. There is growing consensus that the lack of clinical information transparency – that is, clinical information either in paper form or siloed away in disconnected software systems – is a key contributor to the problems before us. To help remedy this problem, the federal government is making an unprecedented investment to modernize U.S. health systems. Under the Health Information Technology for Clinical Health Act (HITECH), providers and states are receiving billions of dollars in economic incentives and grants to modernize health IT infrastructure. Janet Marchibroda, from the Office of the National Coordinator for Health IT, crystallized this moment in time, saying “we will never have this amount of investment again for health information technology; let us not waste this moment.”

The emerging solution for Connected Care Communities is the Health Information Exchange (HIE). The investment in HIE is growing rapidly:  in fact, according to eHealth Initiative's 2009 HIE survey, the number of operational HIE's grew nearly 40% from 2008.[1] The recent $547 million in grant funding by the federal government is further driving HIE adoption.  Despite the growth and unprecedented federal investment, many questions remain regarding the long-term sustainability of health information exchanges and health information organizations. Jennifer Covich Bordenick, CEO of the eHealth Initiative, pointedly noted, "Operational does not equal sustainable".

Sustainability will necessitate coordination of all stakeholders including providers, payers, consumers, and policy makers. Keith Hepp, Chief Financial Officer and Vice President of Business Development for Healthbridge, an HIE serving the Greater Cincinnati area, commented that "in order to be successful in an HIE, it really requires all the participants to step up and do their part."

To gather insight on the benefits and long-term sustainability of HIEs, GE Healthcare hosted an HIE Sustainability Summit with leading HIE policy makers, industry analysts, and HIE executives. Addressing the pressing issue of sustainability and the value of HIEs, our summit speakers shared their experiences and vision for building viable HIE entities. Several presenters reiterated:

• Build Robust HIE Infrastructure: Bi-directional, standards-based, semantically interoperable HIE infrastructure provides the connectivity backbone for connected care communities. Automating community workflows through simple secure messaging will provide short-term quick wins, but will not support more complex use-cases and workflows.

• Pay Attention to Adoption: Without strong provider engagement HIE adoption fails. Focus on early provider involvement and change management and pay careful attention to making workflows as seamless and as simple as possible.

• Drive for Transformation: Health information exchange is a means to an end. Applications such Clinical Decision Support, Chronic Disease Management, Quality and Performance Reporting, and Proactive Patient Engagement leverage HIE infrastructure to improve care outcomes and bend the cost curve. The value created from these and other performance applications is what will ultimately drive HIE sustainability.

Sustainability will also require stakeholders to address a number of tough issues that could create obstacles.  For example, one of the critical policy areas impacting HIE adoption is privacy and security. Rachel Block, Deputy Commissioner of the Office of the Office of Health Information Technology Transformation at the New York State Department of Health, has suggested "that we really can enable that broad flow of information which is absolutely essential to getting the value proposition. If we don't remove the barriers to HIE, we won't be obtaining the value that we need."  She stressed the importance of robust privacy and security measures in facilitating connected care.  She also suggested that clinicians and patients alike must trust that the system is secure.

Digitizing clinical data through an EMR is an important and necessary first step in this journey. However, when we create connected care communities - providers, patients, payers and health services linked together with seamless and secure clinical information sharing and community-based workflows - we will truly unleash the transformative potential of healthcare IT.  Information transparency and liquidity within a healthcare community will drive better care decisions and outcomes and higher productivity, and will catalyze innovation.  Joel Vengco, Director & Chief Applications Officer at Boston Medical Center, commented on their effort to leverage information across their community beyond pure data sharing. He noted that they began "to think about how to access the data that is now standardized and liquid in an information exchange, by wrapping a set of services around it that really satisfies functional business processes."

Brandon Savage MD, Chief Medical Officer for GE Healthcare IT, stated that sustainability, often viewed as a destination, is really a departure point on the journey to clinical transformation. "Performance drives sustainability, and sustainability drives growth".  Savage further commented on the power that HIE enables.  "Change is mediated by making it easier for people do to the right thing." 

Building connected care communities, with a robust, standards-based, vendor-neutral infrastructure, will create innovation labs all across the United States, fueling health system transformation.  Transformation will drive improvements in three dimensions of health system performance, namely:

• Clinical: measurable improvements in clinical quality, patient safety, and outcomes

• Business, financial and operational: measurable improvements in revenue, margins, operating costs, and reductions in barriers to efficient and effective care-solving organizational and operational problems which render value to the participants.

• Strategic communications effectiveness: measurable outcomes relative to connecting key constituents, stakeholders and trading partners; providing actionable information, in the right setting and context and at the right time.

In the final analysis, and with the support of federal funding and a meaningful use schema that will require a connected community of care givers, health information exchange will carve its way into mainstream business practice in health care because of what it fixes and facilitates.  It is with this stewardship and focus that we will begin to transform healthcare.  

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[1] http://www.ehealthinitiative.org/sites/default/files/file/2009%20Survey%20Report%20FINAL.pdf