Report: Obstacle-ridden course ahead for statewide HIEs
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Large-scale, societal efforts such as the one to develop a national network of HIEs are referred to as “megachanges” in a Feb. 8 report authored by the Washington, D.C.-based think tank’s Darrell M. West, PhD, and Allan Friedman, PhD. Megachanges require consensus, cooperation, financial and operational resources and stable external environments, but megachanges often fail under the weight of these challenges.
“These organizational innovations are an interesting example of policy change in a big and complex area,” the authors wrote, citing healthcare’s overall share of the economy, its rising costs, its multiple stakeholders and the difficulty its stakeholders have had forging agreements. An additional challenge for healthcare is its unique difficulty sharing sensitive data. “Data sharing is hard. Managing access in clinical care, and determining how much data to share without compromising privacy, is a major challenge.”
Despite federal investments in HIE, the report identified financing as a challenge for statewide HIEs, pointing to the absence of a sustainable business plan and a partisan political environment as the causes of this particular challenge. The report also identified a lag in full compliance as a challenge for HIEs, noting that only 10.1 percent of HIEs, whether statewide, regional or community, reported full capabilities in 2010.
Looking at HIE implementation efforts in Indiana, Massachusetts, New York, Tennessee and California, researchers determined that challenges can differ from state to state depending on geography, state size and political environments and structures. The different approaches taken by states to address unique challenges resulted in a range of outcomes in terms of governance, collaboration and degree of consensus, according to the report.
According to the researchers’ grading scale, Indiana scored highly in seven of eight areas, Massachusetts in four, New York in one and Tennessee and California in zero. Based on the case studies of these states, researchers determined that there was a need for varied approaches, clear performance metrics and an understanding of organizational dynamics.
Current assessment guidelines rely on adoption and utilization rates, according to the report, and “future assessments should monitor performance against these benchmarks and see the extent to which HIEs meet their performance targets.”
“On a subject such as healthcare, the political polarization and budgetary limitations have had a substantial impact on the ability of states to implement HIEs,” they concluded. “The outcome for HIEs depends not just on having the right decision-making and consultation processes, but on political agreement regarding the proper policy path forward and financial resources to fund implementation.”
Read the report in its entirety here.