February 19, 2010

Should Cowpaths of Cooperation Be The First Concerns of HIEs?

As posted on XEROX Healthcare Pulse on Health IT February 17, 2010

Since the ‘80s, the exchange of clinical data has been proposed under any number of acronyms. CHIN’s in the 90s and more recently RHIOs and HIEs all suffered from scaling one summit only to find that their efforts offered a better view of the next under-anticipated problem. Through all of these formulations, the struggle to prove adequate economic benefit to cover the cost of pulling together a highly fractionated system has not been won enough times to seed a movement, let a lone a sustainable business model for all.

Cooperation as a community seems to be the trick.When payers, patients and caregivers have collaborated and shared the cost savings from technology that produces greater throughput, less waste and most appropriate care, great changes have occurred in market perceptions and profitability - the Veterans Administration, Kaiser and Group Health Cooperatives have all done so without any government grants.

Hospitals and large provider groups that are not of this model are walking a thin line financially and small physician practices are not any better off. The recently announced cooperative agreement awards authorized by HITECH will seed startup costs and help many get on the road to deeper cooperation. However, these grants fall short on helping all players coming together [e.g. specialist and ancillary care]. In this environment, all are eager for successful business models that support data exchange efforts beyond enabling legislation and grants.

What is most encouraging is the recent KLAS report that spoke to the fact that HIE returns are low at this point is the fact that there has never been so many data exchange systems planned for or up and running. Past summits of concern for privacy, security and patient consent have been scaled. Financial viability remains work in progress and many believe will remain so until greater implementation of patient focused EMRs is obtained...a cooperative endeavor and isn't that what the objective of data exchange is all about? Yet, much of the discussion centers on trying to sell an HIE like they were selling a super highway -- difficult to do when the average provider community only sees, wants or can afford a cow path. What would be a better proposal?

Image Credit:  Patrick Gossens

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