What are the opportunities for integrated solutions to address the health industry gaps discussed in prior blog postings? One of the exciting possibilities is the use of IT to make the overall health care system more efficient through a new class of intermediary – Health Information Exchanges (HIE) – that serve as integrators of the highly fragmented information silos that exist in the industry. HIE’s are, in essence, Integration Competency Centers that promise to improve health care delivery by improving efficiency and applying Lean Integration principles.
HIE’s have been around for some time. The Indiana HIE was established in 1994 and there are now over 190 HIEs across the U.S. That said, many of these are still in an early stage of implementation fueled recently by the American Recovery and Reinvestment Act of 2009 and fewer than 20% have a sustainable business model (i.e. able to operate without government subsidies). This movement is not just a U.S. phenomenon and there are Health Information Exchanges in Canada, Australia, U.K. and Europe.
The basic idea behind the HIE is to facilitate sharing of electronic health records (EHR) and other clinical information. An EHR is a systematic collection of health information about individuals in digital format. The records may include a range of data including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, and billing information.
The EHR is typically generated and maintained within an institution such as a hospital, integrated delivery network, clinic, or physician office. Its purpose is to ultimately serve as a complete patient record that enables streamlined workflow in health care settings and to increase patient safety through fact-based decision support. Many of the EHR systems however have been independently developed and are based on incompatible data models which is driving the need for integration. The main factors that are fueling health information exchange efforts according to an eHealth Initiative study are:
- Improving quality of healthcare
- Improving patient safety
- Inefficiencies by providers who need information to support patient care
- Increased attention on health information exchange at the national level
- Rising healthcare costs
- Public health surveillance needs
The HIE market is poised for rapid expansion in the coming years due to the maturity of industry standards such as HL7 and increased investments in infrastructure fueled by government stimulus. But exactly what kind of services would an HIE offer? The 2009 eHealth Initiative survey provides some useful insight in this regard. The top 10 services of interest to participants of the health care system (customers of the HIE’s) include:
- Results delivery (e.g. laboratory or diagnostic study results)
- Connectivity to electronic health records
- Clinical documentation
- Alerts to providers
- Electronic prescribing
- Enrollment or eligibility checking
- Electronic referral processing
- Clinical decision support
- Disease or chronic care management
In summary, there is a backlog of pent-up demand in the health care industry for more effective use and sharing of electronic health records. New business ventures that are able to invest in the capabilities to provide compelling services that are cost-effective and meet consumer demand (patients, health care providers, and health care payers) have the potential to thrive in this new segment.
Integration Competency Centers which use Lean Integration principles are a proven approach to solving similar information management challenges in other industries. Tune in next week when I talk about health information exchange risks and challenges and how to overcome them. In the meantime, for more information about Lean Integration, visit www.integrationfactory.com.
 eHealth Initiative website http://www.ehealthinitiative.org/directory-health-information-exchange-initiatives.html
 eHealth Initiative, Migrating Toward Meaningful Use: The State of Health Information Exchange, August 2009