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Spotlight on HIEs and EHRs

How outsourcing fi ts in. By Jack L. Buxbaum


ealthcare IT is rapidly gaining attention thanks to the spotlight on healthcare reform, which partially revolves around the development of health information exchanges (HIEs) and leveraging electronic healthcare records (EHRs). Many healthcare organizations are challenged to fi nd a way to transform HIEs and EHRs from concept to reality. By integrating an HIE into existing technology, a healthcare organization or public health entity can have one cohesive healthcare system that delivers more value from the tech- nology investment.

HIEs: A look back

HIEs are essentially the creation, deployment and operation of technologies that support the exchange of healthcare information electronically. Thanks to health- care legislation, HIEs are receiving a lot of attention. However, they’ve been around in some form or fashion for 30 years. The fi rst semblance of an HIE capability was in the 1980s, when there was a proliferation of clearinghouses that offered a service to route claims and other fi nancial and administrative transactions between providers and pay- ers for a fee. Many healthcare organizations justified the costs in order to streamline business operations and im- prove revenue cycle man-

Jack L. Buxbaum is vice president, HIE services, ACS, a Xerox company. For more information on ACS solutions:

agement. Eventually, this process became automated and standardized across the industry, thanks to the introduction of HIPAA and the adoption of electronic data-interchange standards.

In 1987, non-profi t organization Health Level Seven (HL7) was founded to provide a comprehensive frame- work and standards for the exchange, integration, sharing and retrieval of electronic health information in support of clinical practice and the management, delivery and evaluation of health services. At the time, efforts to es- tablish information sharing between caregivers focused on a linear linkage between physicians and their affi liated

20 May 2011

hospitals. Later, community health information networks (CHINs) emerged to support a “many-to-many” relation- ship between caregivers within a community – a precursor to today’s HIEs.

Challenges While HIEs undoubtedly facilitate safer, faster, more

effi cient and effective patient-centered care, they’re not without challenges.

Since inception, there have been obstacles in standard- izing clinical data exchanges throughout the healthcare information landscape. This is in large part due to the fact that the language used in patients’ medical records is not standardized, making it diffi cult for HIE systems to interoperate and to identify patients and locate their records across numerous provider organizations. Another factor contributing to this challenge is the lack of a unique healthcare identifi er for every individual in the U.S. Additionally, a number of non-technical challenges have applied pressure on the emergence of exchanges – from the days of CHINs to present-day HIEs – including: • Governance – what entity will take ownership of oversight and operations? What governing board and constituents will participate in formulating its strate- gic direction? How will the many competing interests within a community be corralled and focused on a common interest in information sharing?

• Operating model – developing and executing a model to manage the technology, the user support, contracts, subscribers, fi nancials, etc.

• Provider outreach and adoption – engage physicians and other caregivers to join the exchange as both data source providers and as users. Assure provider adoption of the exchange. Align with other infl uencers.

• Economic sustainability – how will the exchange remain viable after exhausting start-up funding from public and private sources?

• Policy and enforcement – opt-in and opt-out policy decisions, managing privacy and perceptions, assuring uniform adherence to policies across a large region, etc.


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