CMIO Summit: LIPIX's Stein busts HIE myths
 |
HIE mainly has clinical drivers but “technology is key. The technology is a disruptive force and I believe an HIE will only survive through strengths of technology,” Stein added.
LIPIX, incorporated in 2007 as an independent nonprofit, houses clinical information on 2.5 million unique patient records in Long Island and downstate New York, including patients in Manhattan, Nassau, Queens and Staten Island from 77 participating provider entities. With more than 2,081 clinicians enrolled, the goals of the HIE are to improve access to data at the point of care, improve safety and quality of care and reduce the costs of healthcare, Stein stated.
Using a classic distributed HIE model, clinical data flows from systems into a regional health information organization (RHIO) hub which transmits clinical patient data to those who have access to the data.
Beginning with significant funding from the state's HEAL (Healthcare Efficiency Affordability Law) grant program—LIPIX is looking to expand its HIE service to parts of Florida to accommodate patients who often vacation there. “We see Florida as another borough,” Stein quipped.
LIPIX offers core services to members for a baseline membership fee and currently uses grant funding to support the services integration and implementation. Currently, hospitals pay $90 per inpatient bed per year as a baseline that covers the majority of the membership fee. “Ongoing sustainability will come from membership fees,” said Stein. In addition to a provider clinical portal, core services from LIPIX include a practitioner directory, edge repository for demographic and clinical data, user interface integration, patient consent management and duplicate medical record number reconciliation.
“We focused on a modular approach that integrates to the system …and allows us to support the RHIO and provide services on top of the infrastructure,” Stein said.
“Core services is the right thing to do…but that only gets you so far,” Stein remarked. LIPIX is looking to expand services and beginning to build a patient gateway service, even though there’s “no evidence of connecting the patients themselves [to the exchange is beneficial], but there is more and more interest from providers to do so.”
Stein then took aim at busting seven HIE myths:
Get broad-based stakeholder involvement and buy-in before beginning down the HIE path. “You can’t get all stakeholders involved and engaged with all their needs,” said Stein, adding that Google didn’t get everyone’s input when developing its search website and its design. Stein advocated for a “If you build it, they will come” approach.
Start with clearly defined requirements based upon detailed analysis of current and future workflows. In HIE, things are too new. “You can’t define the requirements.” Attempting to do so could out the HIE at risk of running out of money, resources, time and focus, Stein stated.
Engage consultant “experts” to facilitate the project. According to Stein, it doesn't make sense to pay the high consultancy price in such a new space that is still itself developing.
Utilize standards to enable low-cost, high-quality integration. “The challenge is that standards are emerging…so don’t rely too heavily on standards being the holy grail at this point,” he said.
Let the government lead the way. “In New York, the government has been good and we’ve been fortunate," said Stein, but from an innovative perspective, it may not be good to rely upon the government.
Find a killer app. "I don’t believe it’s out there yet,” Stein said. HIEs should instead follow a suite of apps, leverage data, infrastructure, staff and policies from many different services that will lead to success.
Remember that competitors will never cooperate. Through his experience at LIPIX, Stein said, he has found that bitter rivals that normally would not be in the same room have found common ground to work together for patient care. “We think cooperation can exist.”