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a baseline of native interoperability around the continu- ity of care document (CCD). Furthermore, nearly all major healthcare IT vendors have made investments in the IHE/HITSP approach to cross-enterprise exchange (e.g. XDS and related integration profi les), which are increasingly reaching the fi eld and enabling plug-and-play interoperability,” he says. “Today, proxies/translators are an unfortunate reality, but they will give way to native interoperability.”

Earl Jones, vice president and general manager of GE Healthcare’s eHealth So- lutions, doesn’t think an HIE will require a large number of translator products. “A spoke-and-hub model based on a docu- ment registry and repository (or mul- tiple repositories) concept is the most sustainable and efficient; this results in one platform managing connectivity and translation,” he says. “Our system uses a powerful integration platform as part of our implementation to connect systems with and without standards support. It includes a growing library of adapters that can be used with products that are not yet standards-compliant, to accelerate implementation. It can also be used to rapidly develop new adapters for proprietary or custom systems as needed.”

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and knowledgeable humans will be the keys.” Nonetheless, it is a foregone conclusion that some major vendors will be reluctant to make it easy for the data stored in their systems to be shared with other systems. According to Hamid Tabatabaie, president and CEO of lifeIMAGE, “This is a self-preservation strat- egy of sorts. However, the standards are getting more mature; just as there were and are dozens of HL7 interface engine vendors today, I foresee there to be many exchange gateway providers whose sys- tems will be tuned, to various degrees, to deal with a broad range of vendor-specifi c installations.”

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Joel Vengco

Communicating between systems To a large extent, the existence of translators depends on the federal certifi cation process, says Joel Vengco,

Continued on page 12 HEALTH MANAGEMENT TECHNOLOGY July 2010 9

Translators will not proliferate, agrees Chuck Christian, director of information systems and CIO at Good Samaritan Hospital in Vincennes, Ind., agrees. “The obstacles to data sharing will be over- come (as they have been by the few suc- cessful growing HIEs),” he says. “For the foreseeable future, improved application of existing standards, interface engines

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We asked our experts the following question: What are the most important factors for an end-user to examine when considering the implementation of an HIE?

Reifenberger: “Governance. Are all the stakeholders in agreement on how data will be shared, security models, consent models, etc. Sustainability. Is there a business model, or are those deriving the most value footing the bill? Adoption. Successful HIE is dependent on widespread adoption of HIE services by the hospitals and physicians. Either a signifi cant portion of the users should be interested in HIE in the region or a solid plan to drive adoption should be in place.”

Arlotto: “Business and clinical goals for the HIE and key stakeholders; fl ow of information from a patient perspective; how decisions will be made.”

Blackmer: How they will allow physicians to participate in information sharing without requiring them to give up ownership of their data; resources for physician outreach and marketing activities; and which portions they, as the sponsoring organization, will pay for vs. those that they will ask participants to pay for.”

Menschik: “How to use the HIE to enhance their business; specifi cally, to build patient/referrer affinity, build brand/differentiate and expand geographical reach; what will maximize success, scalability and sustainability: procuring traditional software and staffi ng up the organization to operate the HIE, or moving to a Software-as-a-Service model? Interoperability. Will the solution simplify vendor-neutral exchange among diverse systems, or does it depend on proprietary connections to ‘like’ systems?”

Tabatabaie: “Much of the success of an HIE depends on getting various healthcare organizations to agree on a comprehensive set of shared policies and principles that will help govern and operate an HIE for an expanded period of time. Confl icting or misaligned interests are probably the most important factor of an HIE’s success. Will hospital A not want to share the oncology data on a patient because they may lose the patient to the newly formed oncology center of hospital B? “Are there project-based approaches that can help facilities incrementally adopt and HIE? Boiling

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