Industry Voices—Next-generation HIEs: Providing measurable value in a network of networks

Doctor computer
HIEs need to have the ability to adapt to opportunities and change while working to deliver real, measurable value to their stakeholders.  (Getty/andrei_r)

To survive and thrive in the ever-evolving health information exchange (HIE) marketplace across the nation, HIE organizations need to be entrepreneurial and have a collaborative working spirit by partnering with others.

HIEs also need to have the ability to adapt to opportunities and change, while working to deliver real, measurable value to their stakeholders. 

The proposed Trusted Exchange Framework and Common Agreement (TEFCA) certainly presents opportunities and change, and also accelerates this HIE evolution by establishing a core set of data that needs to be available for exchange, laying out a common set of privacy and security requirements, as well as ensuring that healthcare stakeholders need just a single on-ramp to participate in the exchange on a local, regional and national level.

While TEFCA establishes this baseline exchange framework with core data sets and common sharing methods, such as the HL7 Fast Healthcare Interoperability Resources (FHIR) standard, entrepreneurial HIEs can work to deliver value to their stakeholders by supporting specific use cases, enhancing value-based care initiatives and managing data on a population-level—something that many HIEs indicated was an important future priority in a 2019 Survey on HIE Technology Priorities.

On the technology front, next-generation HIEs must adapt and embrace the use of FHIR, complementing and leveraging the HL7 Version 2 and Clinical Document Architecture (CDA) standards that are currently in use by most HIEs.

RELATED: ONC unveils long-awaited second draft of Trusted Exchange Framework, funding opportunity

This is a requirement specifically called out in the ONC Proposed Rule published March 4, 2019. The usage of FHIR will allow HIEs to more efficiently share data with electronic health record (EHR) vendors and application developers to support a variety of future use cases, such as electronic clinical quality measures and eligibility determination.

With just a single on-ramp needed to participate in future exchanges, HIEs—even in markets with just one traditional option for HIE—must acknowledge that they fit in a “network of networks” and adapt accordingly.

This may mean adopting or developing HIE sustainability models that differ greatly from traditional models of the past. Healthcare organizations that spanned across states or HIEs could potentially just connect to one HIE or national networks instead of paying fees to help sustain multiple HIEs that may or may not have provided value that justified the expense.

RELATED: 4 problems industry groups have with the ONC's Trusted Exchange Framework

Innovative HIEs know this and work to deliver value to these stakeholder organizations.

HIE organizations have historically collaborated well with each other in the past. The Patient-Centered Data Home initiative by the Strategic Health Information Exchange Collaborative (SHIEC) is a great example.

However, HIEs are now being asked more and more to collaborate or partner with other organizations that may have different business interests in order to benefit the common good. In some HIE ecosystems, there may be some hospital systems or provider groups that use a specific vendor for event notification services, while another group may use a different vendor and the HIE may use a third vendor.

Realizing that there is a need to support the common good, the HIE could provide the common technical network to support all three initiatives, while minimizing the impact to participants by partnering with these other groups.

Some HIEs may choose to go a step further and apply to become a Qualified Health Information Network (QHIN) under TEFCA. This could result in partnering with other HIEs or health information network organizations in their region, demonstrating again that collaborating and partnering are essential business characteristics for HIEs.

RELATED: ONC awards The Sequoia Project coordinating responsibilities for TEFCA

The QHIN Technical Framework (QTF) describes the requirements that a health information network needs to fulfill to serve as a QUIN under the Common Agreement.

Progressive HIEs know that they are able to use the technology and services they consider core to their HIE data platform to provide essential shared services that meet the technical requirements for a QUIN. This might include an enterprise master patient index; a FHIR-enabled provider directory which could leverage regional, state and national sources; a consent registry for managing exchange opt-out/opt-in status for patients across the ecosystem, including patient-directed consent for certain sensitive data, such as 42 CFR Part II consent; and admission discharge transfer event notification forwarding throughout the network.

With changing federal regulations, as well as changes in the various healthcare ecosystems across the U.S., the HIE marketplace is evolving and will look much different in the coming years.

HIE organizations that have characteristics that include being entrepreneurial, that have the ability to collaborate and partner effectively with others, and can adapt to opportunities and changes may expand or will merge to form larger health information networks, or will apply to be a QUIN under TEFCA.

HIE organizations that lack stakeholder engagement or struggle to support use cases or value-add initiatives needed in their HIE ecosystem must hone or develop these business characteristics in order to stay relevant and thrive in this new future.

Chad Peterson is VP of Public Sector Solutions at Orion Health. He has an extensive background in healthcare consulting, software implementation, strategic planning, healthcare industry and business process improvement.

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