Lingering interoperability problems and subsequent alterations to the federal Meaningful Use program create an ever-changing landscape for public health information exchanges (HIEs), which by some reports are feeling the brunt of the industry's frustration.
To that end, New Hampshire Health Information Organization Executive Director Jeff Loughlin believes that more encouragement and less mandates are needed from the federal government.
"ONC needs to move into the role of encouraging and facilitating, and leave standards in the hands of the vendors," Loughlin says. "Let the vendors hash out what these standards should be. Vendor products are going to have to be interoperable; that's just the direction the marketplace is going."
In an interview with FierceHealthIT, Loughlin, who also serves as a project director for the Massachusetts eHealth Collaborative, spoke about what he sees on the horizon for his organization.
FierceHealthIT: What's going on with the New Hampshire Health Information Organization right now?
Jeff Loughlin: We're kind of at an interesting point in our lifecycle moving forward. New Hampshire was one of the last states to get the national funding, the HIE grant, and we got one of the smaller grants, so we only received about $5 million to start .
Because of this, New Hampshire made a very purposeful decision not to try to build a centralized repository. That's a very expensive and resource-intensive program to maintain.
Since we don't have a central repository of data, we're really a transport vehicle only for health information between providers. That model has been road blocked in some ways by the Office of the National Coordinator for Health IT's certification for EHRs. The way that certification process was rolled out, some vendors forced their clients to use certain health information service provider vendors for their point of connectivity and interoperability, and others did not force them into a particular model.
For a smaller subset of organizations in New Hampshire, we are the actual direct technology HISP that allows that transport of protected health information for general care coordination with the goal of complying with the Meaningful Use requirements for those EHR incentive programs.
We serve as more of a facilitating and consulting organization across the state. We're involved in an advising capacity to a lot of initiatives across the state. We were a huge part of the State Innovation Models grant, and now we're tied to the 1115 Medicaid waiver for experimental, pilot, or demonstration projects.
FierceHealthIT: What is this interesting point in the lifecycle and what's ahead?
Loughlin: NHHIO is viewed as a go-to resource for assistance for health information technology solutions across the state, but is hindered by legislative constraints on what we can provide. We're looking to support our participants within these constraints with a variety of additional vendor platforms, but struggle with a "one-size-fits-all" approach, coupled with barriers in interoperability.
The vendor marketplace and vendor-driven solutions such as CommonWell are moving toward solving many of our challenges, and NHHIO is looking to see where we can complement, augment or support such initiatives to ensure our own value and sustainability.
With the initiatives at the state level such as the Medicaid 1115 waiver, we are working to understand our role in the project, and given our technical limitations, how NHHIO can best support the creation of the integrated delivery networks (IDN) to better advance care coordination and integrated care.
Since NHHIO is self-funded with no additional state support, we need to find the correct balance between cost and value as we closely monitor the implementation and adoption of new technical standards such as FHIR (Fast Health Care Interoperability Resources), and the requirements for MACRA (the Medicare Access and CHIP Reauthorization Act) and other payment-reform activities that will require the use of HIE, and ensure NHHIO is prepared to support our participants in these endeavors.
FierceHealthIT: What effect is MACRA likely to have on HIEs?
Loughlin: It doesn't really change much. I hate to be pessimistic, but it's basically just a new label. HIEs will still have a vital role. There's always been a drive for better coordination and better clinical care. Now there's a drive to drive down costs, too. But the HIE role remains the same.
FierceHealthIT: What do you see going forward for public HIEs overall?
Loughlin: There are probably no two HIEs alike. Every state HIE has some unique aspect. It's hard to generalize where public HIEs are going.
FierceHealthIT: In what ways is technology helping HIEs to improve care? How is that not happening?
Loughlin: NHHIO works to be more progressive by connecting with many different innovative technologies. Within NHHIO, there is a move toward sharing data elements. We recently signed with a partner to provide a secure texting platform.
ONC, early on, issued great standards on EHR certification, but didn't go all the way in implementing those. There's wild variation in the way vendors interpreted those. The ball has been dropped on implementation. There can be two different vendors who both implemented the standards correctly but still can't communicate. There's a huge role going forward in making that happen.
Editor's Note: This interview has been edited for clarity and length.