With many states deep in the throes of developing their statewide health information exchanges (HIEs), it was interesting to see the KLAS report, Health Information Exchanges: Rapid Growth in an Evolving Market, released in July 2011, which highlighted the mushrooming growth of live private HIEs over the slower growth of live public HIEs.
Marc Willard is a strong proponent of the private or enterprise HIE model. The CEO studied the UK health system prior to founding Certify Data Systems in 2004, and came away with an important lesson: "It taught me that politics and change management issues can destroy good ideas," he said. "The UK health system is one huge centralized model. Even today, 95 percent of discharge summaries are still faxed."
Whereas the U.S. has tried to create interconnected systems with community health information networks - CHINs - Willard thought that there had to be another way of getting all the constituents to come together. The federally subsidized statewide HIEs are not the answer, however, according to Willard. "The single biggest problem with the statewide HIEs [is that] everyone has different motivations, whether it's political or not. Anytime you get a whole bunch of people in the room with big ideas, you struggle."
Willard believes that, instead of creating big data repositories or granting a group of individuals control over the data, health systems need to be empowered to connect all their physicians via a networked HIE, which is much more private and allows for data sharing only when the data is needed. "It's all about the network, connecting endpoints," he said. He's a big proponent of getting community physicians involved, especially the primary care physicians, to get true clinical exchange of data. "We all know that clinical experiences usually begin in primary care and not in a hospital or ED," he said. The problem has been finding a way to get physicians involved and doing so in a nonpolitical way, which is also self-sustaining to health systems.
The top-down UK model didn't allow general practitioners to have a voice, according to Willard, which was more of a disincentive than a motivating force. "We all have five different opinions on how things should be done, and when you force one opinion on the masses, it just invariably won't work," he said.
Willard believes in the adage that all healthcare is local. "You have to remember this when you try to create these ecosystems: 99 percent of all my clinical data is within 20 miles from me," he emphasized. "Think locally. Driving cost out in the local community is what makes sense." What doesn't make sense is spending millions of dollars trying to jumpstart, for example, California's statewide HIE, which has had a bumpy beginning. Willard points out that large California health systems such as Sharp, Scripps, Adventist West and Kaiser Permanente can share data across the barriers, "moving one medical record in a million that has to move from one health system to another." By connecting these large health systems with one pipe, "you've suddenly got this network," Willard points out. "Then you just need one reporting line-up directly to the state."
Having another parallel technology initiative running alongside private HIEs creates confusion in the market and competing objectives, he argued. Large health systems that build out their own HIEs may be driven by their accountable care organization initiatives or a desire to provide better services to their referring physicians or provide information and deliver results for patients in the emergency department environment. "The statewide HIE has no reference to an ACO, really, and no reference to an ER environment," he said. "Let's not duplicate."
At the end of the day, statewide HIEs still take a top-down approach, he said. Instead, Willard urges policymakers to query PCPs and ask them about their EMRs and their impact of the quality of their practices, their patients and their reimbursement system. With patients' PCPs in their own community, Willard believes it’s better to work with local health system versus health systems far away.
More importantly, private HIEs are where sustainability lies, according to Willard. "There is an awful lot of growth in enterprise HIE; everyone understands that’s the model," he said. Even the UK health system has rebooted and is deploying its health IT initiative by county and within each county by town. Solving the bigger problem of connectivity across the country is important, but for right now, private HIEs are improving the quality of care and driving down the cost of care in their own backyards.
