Unforeseen factors can throw a wrench in the best HIE plans

A study of health information exchange implementation by the New York State Department of Health zeroes in how unforeseen factors can affect a complex technology implementation.

The research, published in the Journal of the American Medical Informatics Association, uses system dynamics modeling, which the authors say are valuable tools for strategic thinking on complicated and intense processes. These models can be produced with fewer resources than a full simulation, yet still provide timely and relevant insight, the authors say.

In 2007, the state health department awarded contracts with three regional health information organizations (RHIOs) to implement a technology use case demonstrating their ability to exchange health information. That exchange included web services and operational policies at the health department to enable bi-directional exchange.

These services are executed on the web through a universal public health node (UPHN), an integral feature of the State Health Information Network in New York. Standards and policies were developed through a Statewide Collaboration Process (SCP), a private--public partnership of healthcare entities and technology vendors.   

For the study, the researchers collected qualitative data over eight months from seven experts at the state health department. From group meetings, they created preliminary models that were later refined through online group review: casual loop diagrams of Sliding Goals, Project Rework, and Maturity of Resources.

The models illustrate how external factors such as leadership change, funding disruptions, and the political environment affected the process, offering insight that may have implications for similar HIE projects.

Among the findings:

  • Expertise to implement HIE should not be assumed – Transmission of information is just one step in the process. Gaps in expertise emerged among all parties in the technical requirements necessary for data standardization, and the scope of validation required for data reuse by public health programs.
  • Rework is a hallmark of HIE – There will be significant undiscovered work, often stemming from assumptions made during the design phase. Planners must account for both the staff expertise and the budget to address rework.
  • Leadership, consistent champions and communication are vital -- A project of this magnitude needs consistent champions to propel it forward, to put policies and procedures in place, to negotiate consistent funding, adequate staff and resources, and a reasonable timeframe. Effective communication can address the uncertainty that undermines collaboration.

Interoperability issues and a lack of sustainable funding continue to bedevil HIE efforts, such as one in Chicago where major health care systems say the cost to join is too high, as FierceEMR reported. 

While early efforts have been done largely through trial and error, the Office of the National Coordinator for Health IT is offering voluntary guidance on HIE governance.

To learn more:
- read the abstract


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