Setting a good example

Regional health information exchanges (HIEs) have been joining forces and the federal focus on interoperability can only help the cause. Lowering other barriers also is leading to a greater rate of information exchange.

In the 1980s, the emphasis of information exchange was on point-to-point transmissions and how “we get there has continued to evolve,” said J. Marc Overhage, MD, PhD, speaking at the Healthcare Leadership Forum. Currently CMIO of Siemens Healthcare, Overhage previously was founding CEO of the Indiana HIE. It’s been challenging at the community level because of barriers including fear and anxiety about protecting both patient’s privacy as well as providers’ economic well-being, he added.

“Direct was conceived as a simpler, easier way to get healthcare information to move and, frankly, it’s gone almost nowhere.” Today, we have almost a federated identity approach to allow users to know who the information is sent to but numerous challenges persist including how to identify patients and providers, how to engender trust and how to create business models that support information exchange.

That fact is, he said, “if data are fragmented across many providers, putting them back together is quite a daunting challenge.”

Indiana took a simple approach with its HIE, Overhage said, first dealing with matching patient identity within organizations and between organizations. Algorithmic methods for patient matching are very reliable with high specificity and high sensitivity. Once that’s been done, providers can know where their patients are.

There’s been moderate progress on this, he said, in terms of standardization of terminology and content. But, there are “a whole host of nursing interventions that are poorly normalized.” To manage that, they did a mapping process between standardized codes and local codes. “We did that once for each organization so that it didn’t have to be repeated by everybody. As we did that over and over, we created a series of silos.” Those silos are separate and segregated which was critically important, he said, “because it allowed trust and control of data to evolve.” Data were not mingled until they were used.

Indiana is getting close to true population-level coverage, he said. “That’s interesting for a lot of reasons. If you look at quality, processes and transitions of care, the whole population becomes critical to understand as a policymaker, a payer who wants to understand what the future looks like and a researcher who wants to understand disease and its progression.”

Hopefully more and more exchanges can succeed by following Indiana's lead.

Beth Walsh

Clinical Innovation + Technology editor