HIEs: Between dreaming and growing, a lot of ground to cover

Mary Stevens, Editor

For a short time last week, the ANIA/CARING annual conference in Boston became an informal HIE progress report from some of the savviest health IT users on the front lines. During a presentation that discussed the role of nursing informatics in the HITECH Act activities, nursing informaticists from across the U.S. weighed in.

What is an HIE? Presenter John Delaney, RN, director of IT outreach at University Medical Center (UMC) in Lubbock, Texas, said his hospital was ready to declare itself a health information exchange. UMC and its companion ambulatory facility were both using Cerner EMRs and share the same database.

“We fought for it because we thought, ‘what’s better than that? We don’t even have to send [health information to UMC physicians], they already have it. It’s all in one database,’ ” he said. But the UMC system is not considered an HIE because data are all generated by one healthcare system, and are not exchanged with other facilities.

The good news is, operational HIEs do exist, where ‘operational’ is defined as two or more healthcare organizations exchanging information, he said.

How do HIE organizations get to that level? Delaney defined his own stages of HIE development:

1. “Dreaming. You know you need it but you don’t have the first idea of what your’ going to about how to get it.”
2. “Thinking about it. You’ve got shared vision and goals, talking to others in community, and realizing what you need.”
3. “Talking about it. You’ve started to come together on a model, started to secure funding--people are buying into it. People are saying, ‘we can better take care of our community if we just talk to each other and share data.’ ”
4. “Initiating. That’s where you’re really testing. You’ve started your model, maybe had some text exchanges from one organization to another.”
5. “Operating. You have a fully operational HIE organization transmitting data, being used by healthcare stakeholders.
6. “Sustaining. That’s a big question about HIE. Lots of people have tried to set them up, but … who pays for it? If you charge most doctors to use it, they won’t use it.”
7. “Growing an HIE. You’re expanding services, transmitting different types of data, developing other services for customers.”

Although most of the audience reported being beyond “dreaming,” none said their exchanges had gotten past “operating.” Across the U.S., the majority of HIEs are not fully operational, fewer are sustaining and growing, Delaney said. For most HIEs, a time frame of four years or more is reasonable, he noted.

Although everyone present agreed that exchanging health information was vital to better care in the future, his audience also said money was a huge issue, along with very tight time frames and reluctant practitioners. Privacy, security and governance issues also must be dealt with before the “operating” and “growing” information exchanges outnumber those at the “dreaming” stage.

Nevertheless, nursing informaticists, as front-line technology users, will play a unique and vital role in successful exchange of healthcare information, Delaney said. His audience understands this; their CMIOs should, too.  

Mary Stevens, editor
mstevens@trimedmedia.com