To Achieve HIE Success, Collaborative Approach Is Needed

Many stakeholders from across the health care industry believe that establishing a national health information exchange (HIE) – through which physicians, hospitals and payers could share administrative, clinical and financial information – would improve the quality and delivery of care. Efforts to establish HIE are moving forward, but facing cultural, financial and technology gaps, according to Barry Riegelhaupt, Ph.D., vice president, Ingenix Consulting.

“HIE development has been very disjointed, with the federal government moving in one direction and the states and regional communities moving forward on a regional basis,” Riegelhaupt said. Part of the problem, he explained, is that the entities involved often have competing goals. “What’s good for the payer may be in direct opposition to what’s in the best interest of the provider,” he said. “Interested parties must be willing to be flexible if they want to put the right information into the right hands when it’s needed, and through an optimized channel.”

To make progress toward that objective, Riegelhaupt believes that health care entities will need to work “horizontally,” understanding their counterparts’ positions and developing HIE strategy in partnership with multiple constituents. “I think that the stakeholders now recognize that it will take collaborative support, advanced technology tools and a long-term investment to achieve successful HIE with a sustainable business model,” he said.

HIE progress is steady, but slow

Currently, more than 160 HIEs in the United States are either operational or under construction. Roughly 90 percent of all states have HIE in some stage of development, and the federal government has announced plans to establish a national network to share health data with all relevant parties by 2014.

For years, HIE has been viewed as the future of health care because it has the potential to reduce inefficiencies, redundancies and costs, and to improve the quality of care, according to Riegelhaupt. He defines HIE as an interoperable electronic infrastructure characterized by common networks, applications, interfaces, data formats and processes with the potential to transform clinical, financial and administrative workflows. The new architecture would facilitate the exchange of health information among all health care stakeholders.

Although this vision is based on electronic transactions, very few physicians – roughly 10 percent – currently utilize electronic records. “Physicians are still not there,” Riegelhaupt remarked, “and even though some hospitals have facility-based electronic networks, they are limited. Paper still predominates.”

However, health care stakeholders are beginning to realize that working on HIE independently, without soliciting input from all of their trading partners or striking compromises, has not been an effective approach. “After years of small gains in pushing HIE forward, we recognize that the key barriers are not those related to technology, but are rooted in competing business models, corporate cultures and lack of trust,” he said. “Getting hospitals, physicians and payers at the same table to hammer out differences is of the utmost importance,” he said. “This is starting to happen more and more, which is distinct progress.”

Challenges of moving forward can be overcome

Riegelhaupt acknowledged the variety of barriers facing HIE development. The most commonly recognized challenge, technology, is grounded on trust and privacy concerns, as well as a need for enhanced standards. “I believe that personal health information management programs controlled by consent, which could be overridden in medical emergencies, will help to preserve patient privacy. Also, role-based access control and seamless integration with local LDAPs (Lightweight Directory Access Protocols) can facilitate authentication,” Riegelhaupt indicated.

In addition, Riegelhaupt called for national standards to give disparate parties a common language with which to communicate through technology. “There currently are some standards in place, but I think HIE requires more universal nomenclature so information can provide value,” he said. These issues are significant, but Riegelhaupt noted that “we are moving from ‘translation’ as the HIE core service to a model of connectivity and interoperability.”

Beyond technology, the financial barrier – securing funding for the construction of HIE and support for long-term viability – will be difficult but not impossible to overcome, according to Riegelhaupt. He observed that a number of HIEs are beginning to demonstrate success, although grant funding is limited and some HIEs have folded.

“It takes a long time to reach the tipping point of realizing benefits, so it feels like you are just adding work and incurring costs,” he said. “But the industry must recognize that with any significant technology upgrade, you don’t reap rewards right out of the gate. What we recommend now are smaller, but coordinated and meaningful initiatives. You implement these, add value, and then move to the next step and add more value.”

Overcoming the cultural barriers – the natural friction that exists among health care entities, and the mindset that dictates that a win on one side entails a loss on the other – may be the biggest challenge HIE stakeholders will tackle. “Cultural issues are at the center of the delay,” Riegelhaupt said. “There are genuine business issues and workflow considerations keeping providers and payers apart, for example. But to actually change the core functionality of health care for the greater good and for mutual benefit, both sides will have to give in a little bit.”

Working with a partner like Ingenix can help develop a cross-industry perspective and horizontal strategy for taking steps that will advance HIE, he noted. “Ingenix has the breadth of vision and leadership, and offers solutions that play well together across all of the health care segments.”

RHIOs paving the way to HIE

With many states and communities independently working toward HIE, regional health information organizations (RHIOs) are stepping forward and providing the clinical data physicians need through one network that connects all stakeholders. “RHIOs are organizing entities, such as nonprofit groups that have governing boards and can accept funding, that are helping to make health information exchanges happen,” Riegelhaupt explained. “They have served as a critical process enabler in developing models, bringing parties together and driving consensus.” Indeed, in 2008 the Department of Health & Human Services (HHS) designated certain community-based exchanges as “chartered value exchanges” (CVEs), which are collaboratives deemed to play a vital role in improving care and making quality and price information widely available.¹

A primary example is the Wisconsin Health Information Organization (WHIO), which recently announced that it is creating a statewide repository of health claims data, with plans to report on the quality of care delivered in the state measured against evidence-based guidelines and other benchmarks. Ingenix is collaborating with WHIO to help meet these goals using decision support technology and advanced analytics. Pilot reports from the database are scheduled to launch in the first quarter of 2009.²

“Ingenix can aggregate data and measure physician quality while working across constituencies,” Riegelhaupt said. “We understand the pain points of providers and payers and can help to smooth out issues.” He emphasized the importance of working with trading partners and broad-perspective advisors such as Ingenix Consulting to plan strategically and collaboratively and address the full scope of needs, based on the desired end result.

Bridging gaps and moving forward

In the current economic climate, when many HIE constituents may feel heightened pressure to make only the smartest capital investments related to technology, it is important to note that planning properly for the early phases of adoption may help fund the subsequent phases.³ By assisting clients in identifying the right goals and prioritizing investments from start to finish, Riegelhaupt said, Ingenix Consulting strives to deliver both short-term results and long-term structure that will enable clients to build a successful HIE strategy.

“HIE proponents and Ingenix share the same mission,” Riegelhaupt observed. “We are determined to leverage the power of information to improve the affordability, quality, usability and accessibility of health care for everyone. It’s essential to unite parties and perspectives, and design intelligent plans that lay the groundwork for where individual organizations and the industry as a whole need to be in three to five years.”

In addition to Ingenix Consulting services, Ingenix offers technology tools that support vital components of HIE. For example, Ingenix Electronic Data Interchange (EDI) Solutions and CareTracker Electronic Medical Records (EMR) enable connectivity and exchange of data, and the Symmetry and Impact Suites facilitate the analysis of data for care improvement and the financial management of health care claims. “We don’t make the exchanges, but we do make them better. Because in the end, it’s not just about moving data, it’s about what you do with the data,” Riegelhaupt asserted.

“In the end, the vision is not so much about building HIE, but more about utilizing high-quality health information to achieve important health care goals, such as better care and cost savings,” Riegelhaupt said. “More and more entities want to take part in solving problems and overcoming the challenges in this space. I remain optimistic.”

¹“HHS Designated 11 Communities Working To Improve Quality and Value in Health Care as Chartered Value Exchanges,” HHS News Release (Sept. 3, 2008).
²“Wisconsin Health Information Organization Partners With Ingenix To Create Statewide Health Care Data Resource,” Ingenix News Release (June 18, 2008).
³Oscislawski, Helen, Esq., “Business Value of RHIOs,” ADVANCE for Health Information Executives (Vol. 12, Issue 6).

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