In Part one of an interview published last week, Jeff Loughlin, executive director of the New Hampshire Health Information Organization (NHHIO), talked about how his health information exchange (HIE) organization has had a “survival of the fittest” mindset since its creation, largely to do with New Hampshire being one of the last states to receive federal funding to get its HIE up and running.
Loughlin said in Part one, “We are also now bumping into issues with interoperability between vendors, or vendor-driven solutions, which in many cases is right way to go. But it leaves us in a quandary of where do we fit and what is our true value proposition? And that is the question for many organizations like us—how do you maintain that value proposition?”
To this end, in Part two of the interview with Loughlin, seen below, he discusses several other issues with Healthcare Informatics, including taking a look at other challenges the HIE has, how NHHIO is providing value to its members, and the organization’s plan to stay sustainable in the future.
What are the other core challenges NHHIO is currently dealing with?
Our focus has turned back towards change management. Data blocking can mean a lot of different things, and I think it’s a grossly overused term. Vendors aren’t blocking data; we have never seen that in the community. They may be charging you a lot of money to connect the data, so some might see that as blocking. On the provider side, you have hospitals who might have gone through the REC [Regional Extension Center] program, are meeting meaningful use, have fully integrated EHR [electronic health record] systems, have Direct capabilities, but they are only using the systems to meet the bare minimums for the EHR Incentive Programs. They are not incorporating data into their workflows, so they’re not clamoring to make changes, since the data is there just enough to meet the standard. We still see faxing happening every day, and this is even as we have seen surveys that show our state is in the top 5 or 10 percent of transition of care (TOC) summaries sent between hospitals and providers. Yet for every instance in which there was a TOC summary, there was a fax more often or not that follows it because you can’t send everything via Direct, and they don’t have all the workflows to incorporate all the electronic data.
What are some ways NHHIO is providing value-added services for its member organizations?
Right now, our key value is around the aspect of interoperability, and solving, or at least patching interoperability at the local level. There is a lot of talk about fixing it at a high level, but at some point you have to get two practices on either side of the street and their vendors, and get them to the table. That’s the level we’re at now, and because of the wide variation of how folks implement standards, and how they cobble together different modules to build their HIE connectivity platform, you need to get to that level of granular detail to fix it between those two practices. It’s great to talk about it, but even in New Hampshire there are three different versions of Epic and five different of MEDITECH, so even though we say MEDITECH follows this standard, that can very even amongst New Hampshire hospitals literally miles apart. Until there is a single national standard, and it’s enforced and implemented universally in the same fashion, we are sort of interpreters right now between the vendors and practices.
How do you feel about the role of the federal government when it comes to HIE?
I think at this point, they need to step back a little bit. They had a great vision and idea, and put the standards out there. What was lacking was the implementation of those standards; there was a big book saying that these are the standards, but there wasn’t enough about implementation. We have seen two different vendors that have shown us exactly in the standards the page and paragraph they read, and there are conflicts in there.
Now we are starting to see vendors collaborate much more than ever before with initiatives like CommonWell, since they know it’s in their best interest to move data around. We won’t have, at least in the near future, a single vendor platform, so if they want to survive in the marketplace, they need to be interoperable with their peers. And we’re starting to see that. I would hate to see the feds come in and choose a single standard for something, knowing that vendors are looking at different options. They should focus on it, but shouldn’t dictate it. What they need to focus on is making sure that the proper security is in place. Safety has always been a great role for government.
You hear a lot of talk about true HIE being too difficult. Do you agree with this?
It’s possible and practical, but it’s fluid. There isn’t an end result right now. HIEs are evolving over time. We made a decision not to build a centralized repository, and in some cases that has worked, but more often than not, it hasn’t. As technology gets better, more remote and mobile, that has to change. HIEs need to be nimble and fluid.
What would you pinpoint as absolutely necessary for your HIE to be sustainable going forward?
Well we need money to keep our staff going, but there isn’t really one answer. NHHIO has some significant constraints on what we can and cannot do because of the law, so we are unique in that sense. That’s a challenge for everyone. Vendors don’t care about state lines; they are trying to build systems that support patient care. Because we’re a quasi-public organization bound by state law, we have to think about state borders. But our patients don’t think about those borders, so there are issues around consent. So I think the government can help us look at the legislative side of HIE across all states, and work to change those viewpoints and the principles that guide it. Everything should be patient-centric if you really want to do good care, not state-centric or provider-centric.
