Are HIEs trying to do too much too fast?

Micky Tripathi, president of the Massachusetts eHealth Collaborative and an expert on health information exchanges, warned against "over-architecting" HIEs in a recent feature posted in iHealthBeat.

In an article entitled "The Dangers of Too Much Ambition in Health Information Exchange," Tripathi pointed out that, despite the recent HIE explosion, there is a history of failed efforts to create information exchanges stretching back to the Community Health Information Networks (CHINs) of the 1990s. Just within the past year, he noted, the CareSpark HIE in Tennessee and the Minnesota HIE went under, and CaleConnect in California has run into serious problems.

Tripathi defined an over-architected HIE as "one that tries to do too much for too many with not enough money and time." Such an HIE attempts to become a "one-stop shop" for clinical and administrative data for heterogeneous customers--usually on a shoestring budget--and winds up achieving none of its goals. In short, this kind of exchange aims for the stars, but fails to achieve short-term, incremental gains in connectivity.

He contrasted that with HIEs that have more modest goals such as delivering results and reports from hospitals to physicians. They don't achieve as much as many participants would like, he notes, but they do what they do well, and the results are positive.

A recent Chilmark Research report found that the HIE market grew more than 40 percent last year. Most of that growth, Chilmark said, was in private HIEs. A June 2011 KLAS report also predicted rapid growth in HIEs, and noted that private HIEs were growing faster than public ones.

Both public and private HIEs are emphasizing over-architected HIEs for different reasons, Tripathi says. The public exchanges--including federally funded, statewide HIEs--are shooting for a big reduction in waste that will lead to big savings. The enterprises that are building private HIEs, meanwhile, want to become accountable care organizations so they can participate in the ACO programs of Medicare and private payers. But the end result will be the same, Tripathi forecast: trying to do too much too fast without a solid foundation.

CIOs should avoid this strategy, regardless of the pressure on then to achieve results, Tripathi said. "Over-architected HIE approaches hit a CIO where it hurts most," he added. "Jumping to the end doesn't speed execution, it delays gratification. Better to proceed with achievable steps that deliver incremental value along the way."

To learn more:
- read the iHealthBeat article

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