English | 中文 | Русский | Français

2,595 Posts served

8,341 Conversations started

A Vision for Scalable High Quality Health Information Exchange

By Joshua Painter (Intel) (12 posts) on August 29, 2008 at 7:28 am

This is the first of a three-part article looking at the area of interoperability and health information exchange (HIE) in the healthcare industry. In the first part, I intend to clearly articulate the key challenges and barriers to adoption faced by those looking to engage in HIE. Part 2 will examine an architectural approach to address those challenges and discuss some technology enablers to realize a vision for high quality HIE. In the last part, I will share with you a success story from industry where this approach was put to the test.

I'd like to start by looking briefly at adoption of information technology in the healthcare market. Widespread adoption of I.T. in healthcare has been largely limited to systems that provide administrative or financial transactions. But that is changing. It is increasingly recognized that connecting the right people with right information at the right time can help reduce the cost of healthcare and enable better outcomes. Information technology tools such as Electronic Medical Records (EMR), mobile point of care(MPOC) solutions, picture archiving and communications systems (PACS), and clinical and management information systems (CIS/MIS) can contribute to lower costs and can help avoid medical errors, improving both quality of care and quality of life. Fundamental to achieving this vision is the realization of high-quality health information exchange (HIE).

There has been a rising tide of interest and government pressure to establish electronic clinical information and extend it out to the community of care. We are now seeing studies emerge that highlight the significant opportunities and myriad of benefits from healthcare interoperability in various markets around the globe. Some examples include the following: in Canada it is claimed that effective information handling would trim $6-7 billion from national health costs each year; In Australia, over $1.8B could be saved through implementing health information exchange interoperability among health care providers and other health care stakeholders. The HIE opportunity in the United States alone has been valued at $77.8 billion.

But while the benefits of HIE and their value are widely recognized, the vision for wide scale, high-quality health information exchange has not been realized. This is because even though the reward is great, the challenges faced are often greater. Paramount is the problem of how to connect the many tens to hundreds of sources of clinical data into a reliable information source which has reasonably consistent structure and shared semantics for key clinical data elements like patient IDs, chief complaints, diagnostic codes, and drug vocabulary…the list goes on! Add to this complexity the significant costs associated with the startup, scaling and maintenance of HIE, and it quickly becomes apparent why many existing approaches fail to deliver on the vision of broad base health information exchange and interoperability.

Within hospitals, systems will often not interoperate, which contributes to silos of disaggregated information. As a result, these healthcare facilities are only able to build a patchwork view of patient health, or are forced to rely on labor-intensive and error-prone searches through available hardcopy. In other instances where a hospital network may have a working integration solution, it may not be flexible enough to address changes in rules for compliance, reimbursement, or other operational needs in a timely and cost-effective way. Similar fragmentation is apparent as we look beyond the four walls of the hospital. Healthcare is largely a horizontally-organized industry, comprised of patients, payers, physicians, hospitals, pharma, and medical device companies. But although some standards exists (HL7, IHE, others) and the wiring exists (the Internet), there is limited examples of large scale HIE outside of a few large, vertically integrated healthcare organizations (like Kaiser, the VA, Health Infoways in Canada, NHS in UK) which have consolidated governance and oversight of several entities described above.

To extend health information exchange more ubiquitously across communities typically requires some sort of external stimulus. Often the development of a sustainable business model, or adoption of HIE by a large customer can catalyze adoption. We're already seeing examples of both today. But there are two other variables that can substantially disrupt the status quo and catalyze adoption of HIE: addressing the cost and complexity described above. Reducing the extremely high cost of implementation and maintenance, and simplifying the deployment and management of health information exchange can be strategically significant for the adoption of HIE on a wide scale by the industry.

In part 2, I will argue that getting the architecture right at the outset is the single most important enabler for this vision.

Categories: XML Software

Comments (0)

Trackbacks (0)

Leave a comment