Are We Sucking the HIE Innovation Oxygen Out of the Room

by John Kansky, BS, MS, MBA, HIMSS board member 

It’s crisp and clear in Cleveland, Ohio.  A good way to start my day at the Integrating the Healthcare Enterprise (IHE) North American Connectathon Conference.  I love the smell of hot coffee intermingled with the sound of amplified speech-stirring thoughts about health IT interoperability.

I drove in from Indianapolis last night where – standing on the shoulders of those who came before me – I have the privilege of leading the nation’s largest Health Information Exchange (HIE) in Indiana.  I’m here at the IHE Connectathon to absorb information and learn.  I’m looking for a solution to a problem.

My problem is that from an HIE perspective, Indiana is an oddball.

Thanks to the work of the Regenstrief Institute and, later, the Indiana HIE (IHIE), Indiana has had some darned good functionality on top of a growing inter-organizational clinical data repository for over 20 years.  It was/is built on standards….standards that have evolved over the years.

But “back in the day,” we were able to build whatever made sense to our participants…whatever we learned, through working with our customers, would help make healthcare better.   In recent years, state and federal governments discovered the value (and potential value) of HIE and set about the important job of creating and advancing what we now call “the meaningful use of EHRs” and exchange of data via HIE.

Looking through my experiential lens, this meant that every market, every state needed a robust HIE.   Suddenly (okay, it wasn’t sudden), we in Indiana were not operating in a creative vacuum.  Instead of using available standards to solve whatever challenge of healthcare was prime for attacking, the government had an opinion about what providers (our customers) and HIEs should be doing.  And eventually, when they recognized the lack of standards was an obstacle, “they” began having opinions about how HIEs should do things.  I can’t be upset with the government.  Their efforts and policies are (generally) rational.   They want to see good health IT things happening across the US, and they are using policies and incentives to move the ball forward.

So what’s the problem?  As a country and an industry try to synchronize around common standards and use cases and uniform data sets, we are in danger of sucking the “HIE innovation oxygen” out of the room.  While I can absolutely state with confidence that meaningful use has advanced EHR adoption and the level of HIE activity in my state, that HIE activity is increasingly scripted.  The primary driver of where to invest scarce health IT interoperability resources is no longer where there is the greatest opportunity to solve a problem.  It’s checking off a list of defined capabilities.

I’m not declaring national HIE doom.  Far from it.  My message is this….

Policy and incentives have been the accelerators for HIEs. Once those two factors have run its course, then we (the collective “we”) need to introduce “the problem to be solved” as the driver. In that scenario, innovative organizations will employ standards, EHRs, data, and other health IT stuff to solve them.  And the problems that will be chosen — in each market or organization – will be their highest priority… what they and their partners and customers place the highest value on.  It’ll be great…when we can leverage what we’ve built and agreed upon…and let opportunity and customer value tell us what to do next.

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