HIMSS: IHE implementation challenging, but doable and valuable
ORLANDO, Fla.—Two experts who shared their experiences on implementing Integrating the Healthcare Enterprise (IHE) profiles for health information exchanges (HIEs) confirmed the utility and value of IHE profiles during the “Experiences Implementing IHE Profiles in the Real World” educational session held Feb. 23 at the 2011 annual meeting of the Healthcare Information & Management Systems Society (HIMSS).
John DeStefano, MBA, chief integration officer at Hartford Hospital in Conn., drew on the hospital’s experiences with internal and external HIEs during the last three years, as he identified key challenges for information exchange, challenges addressed and introduced by IHE profiles and reflected on the "build versus buy" and "acquire through open source" debate.
DeStefano admitted that governance, not technology, is one of the largest challenges and accounted for the lengthy planning period. Another key challenge came on the staffing front as his staff of three was stretched “far too thin” during the dual HIE implementation period.
DeStefano and colleagues realized the potential advantages of utilizing IHE profiles from the start of the process, including:
By early 2010, Hartford Hospital completed an alpha pilot with two hospitals and a physician group with the hospital pushing information to a central document registry.
“The documents don’t go anywhere, but information about the document flows into the registry. A physician can sign in to a portal and look up a patient and documents to be pulled back for viewing,” explained DeStefano.
The pilot was successful but not without challenges. According to DeStefano, “support for IHE is growing but not ubiquitous; the 2010 Connect-a-thon featured 150 different systems and 100 separate organizations.” In addition, moving data from their native format to an IHE-compatible format can be prone to artifacts. And finally, DeStefano reiterated that: “Governance issues took the most amount of time.” Key governance wrinkles included establishing partner communication and trust and agreeing on joint responsibilities.
The advantages of the model, however, outweighed the challenges, said DeStefano. The primarily open-source approach offered low start-up and total costs and flexibility and set the stage for a vendor-neutral implementation.
The speaker acknowledged common concerns about open source: a lengthy learning curve, lack of support and licensing and indemnification issues. “We use open source a lot and these are meaningless,” he confirmed, “The rewards are [manageable] costs, flexibility, no vendor lock-in and quality [because the organization can review and control source code].”
DeStefano summed, “Open source worked very well for our purposes.”
Inside the Nationwide Health Information Network experience
Jamie Ferguson, vice president of health information strategy and policy at Kaiser Permanente, shared “a very, very successful” production pilot using the Nationwide Health Information Network (NW-HIN). The pilot consisted of an opt-in model for obtaining patient information with the Veterans Administration. The Kaiser Permanente/ Veterans Administration Virtual Lifetime Electronic Record (VLER) initiative aimed to share healthcare data by common use of standards.
“The approach was mature and proven and much easier to implement than we anticipated,” confirmed Ferguson.
Two years after the first system go-live in September 2009 and operational go-live in December 2009, Ferguson shared key lessons, noting that:
Ferguson offered key success factors. Alignment of incentives is critical, he said, stressing that quality and safety are the drivers for production exchange. “We see this as a cost of doing business,” he stated.
In fact, both Ferguson and DeStefano indicated that financial sustainability was not a consideration in their implementation. Ferguson emphasized the importance of a Data Use and Reciprocal Support Agreement (DURSA) to establish governance and a minimum framework to support privacy. Another critical ingredient in use of structured information is HL7 data standards, he continued.
Echoing DeStefano, Ferguson emphasized the success of the project. “We think that NW-HIN exchange technology supports widest variety of use cases.”
John DeStefano, MBA, chief integration officer at Hartford Hospital in Conn., drew on the hospital’s experiences with internal and external HIEs during the last three years, as he identified key challenges for information exchange, challenges addressed and introduced by IHE profiles and reflected on the "build versus buy" and "acquire through open source" debate.
DeStefano admitted that governance, not technology, is one of the largest challenges and accounted for the lengthy planning period. Another key challenge came on the staffing front as his staff of three was stretched “far too thin” during the dual HIE implementation period.
DeStefano and colleagues realized the potential advantages of utilizing IHE profiles from the start of the process, including:
- Based on open standards;
- No vendor lock-in;
- Open source alternatives available;
- Many vendors have client side profile integrations;
- Growing number of vendor supported end to ends integration of IHE; and
- Profiles are specific and take a lot of guesswork out of the implementation.
By early 2010, Hartford Hospital completed an alpha pilot with two hospitals and a physician group with the hospital pushing information to a central document registry.
“The documents don’t go anywhere, but information about the document flows into the registry. A physician can sign in to a portal and look up a patient and documents to be pulled back for viewing,” explained DeStefano.
The pilot was successful but not without challenges. According to DeStefano, “support for IHE is growing but not ubiquitous; the 2010 Connect-a-thon featured 150 different systems and 100 separate organizations.” In addition, moving data from their native format to an IHE-compatible format can be prone to artifacts. And finally, DeStefano reiterated that: “Governance issues took the most amount of time.” Key governance wrinkles included establishing partner communication and trust and agreeing on joint responsibilities.
The advantages of the model, however, outweighed the challenges, said DeStefano. The primarily open-source approach offered low start-up and total costs and flexibility and set the stage for a vendor-neutral implementation.
The speaker acknowledged common concerns about open source: a lengthy learning curve, lack of support and licensing and indemnification issues. “We use open source a lot and these are meaningless,” he confirmed, “The rewards are [manageable] costs, flexibility, no vendor lock-in and quality [because the organization can review and control source code].”
DeStefano summed, “Open source worked very well for our purposes.”
Inside the Nationwide Health Information Network experience
Jamie Ferguson, vice president of health information strategy and policy at Kaiser Permanente, shared “a very, very successful” production pilot using the Nationwide Health Information Network (NW-HIN). The pilot consisted of an opt-in model for obtaining patient information with the Veterans Administration. The Kaiser Permanente/ Veterans Administration Virtual Lifetime Electronic Record (VLER) initiative aimed to share healthcare data by common use of standards.
“The approach was mature and proven and much easier to implement than we anticipated,” confirmed Ferguson.
Two years after the first system go-live in September 2009 and operational go-live in December 2009, Ferguson shared key lessons, noting that:
- HL7 CDA and CCD specifications were easier to implement than expected;
- Standard content specifications and data integrity are critical to patient safety;
- Patient identification matching is currently the biggest unsolved issue; and
- Operational processes for patient opt-in need to be streamlined (the system used paper-based direct mail to eligible veterans).
Ferguson offered key success factors. Alignment of incentives is critical, he said, stressing that quality and safety are the drivers for production exchange. “We see this as a cost of doing business,” he stated.
In fact, both Ferguson and DeStefano indicated that financial sustainability was not a consideration in their implementation. Ferguson emphasized the importance of a Data Use and Reciprocal Support Agreement (DURSA) to establish governance and a minimum framework to support privacy. Another critical ingredient in use of structured information is HL7 data standards, he continued.
Echoing DeStefano, Ferguson emphasized the success of the project. “We think that NW-HIN exchange technology supports widest variety of use cases.”