HIEs Must Have a 'Clear Business Case'

Even though the health information exchange (HIE) industry hasn’t come to an agreement on the subject of data ownership, one thing is clear—exchanges must be driven by clear business use cases to be productive and sustainable, said industry leaders gathered at the IHT² Health IT Summit at the Westin Times Square in New York City on Sept. 21.

At the panel “Intelligent HIE: Utilizing analytics with HIE data to provide proactive care,” the analytics and business cases of HIEs were analyzed, as well as who—patients, providers, or payers—own the data. “All across the whole spectrum of clients we have, right behind security [as a concern] is ownership of data,” said John Tempesco, chief marketing officer, ICA (Nashville, Tenn.). “What each of the participants within an HIE will tell you is that they own their own data and the most concerning thing is the comingling of data within an aggregated source.”

One of the biggest initial challenges HIEs face is whether or not there is a high or low trust model, said May Terry, eHealth solutions architect, GE Healthcare (Waukesha, Wis.). Differing patient consent models at individual organizations add to the complexity. “You could potentially model your data in a way that could perhaps have levels of trust,” Terry said. “And you can also potentially have traceability and auditing capability.”

Tempesco said that trust, which is created by physicians using the exchange, is a key factor in creating a successful HIE. To illustrate this he mentioned how trust was gradually created in a few hospital systems in Memphis, where administrators only allowed physicians to access the local HIE in the emergency department (ED). Soon other hospitalists were coming down to the ED to check patient records and ask for reports. Since then, HIE use has spread to other departments.

Having a clear business case for HIE, even if it’s a small project or scenario, is necessary for a strong foundation, said Terry. “IT is only an enabler for an outcome, [but more important] is your clinical and business use case,” she added. Terry spoke of two contentious hospitals in Central Florida, Orlando Health and Florida Hospital, that partnered on a small pilot to share information to target drug seekers who went between both EDs. The project eventually expanded to neighboring affiliated clinics, and adoption of HIE eventually became more palatable in the area.

One of the business cases for HIE at Harvard Medical School’s Center for Biomedical Informatics in Boston is integrating genomic data into medical records for clinical decision support. Dennis Wall, Ph.D., director, Computational Biology Initiative, said his organization’s initiative, Informatics for Integrating Biology and the Bedside (i2b2), uses a query engine to conduct queries across all participating hospitals in the area to identify patients with various characteristics in order to conduct further analyses or target patients for research studies and appropriate clinical trials. He said this genomic data can also be populated with the patient’s personal health record.