Many of us remember James Carvell’s famous phrase, “it’s the economy, stupid”, when creating Bill Clinton’s successful presidential campaign strategy. More and more when I hear about new health information exchange organizations (HIE’s) in the news, I want to be that blunt with people that the key to success is to focus on the data…and specifically data standardization. It is precisely that which enables successful health information exchange and enables providers to compare information as “apples-to-apples”. So to twist James Carvell’s genius for my own purpose, I believe that when it comes to HIE’s, “It’s the data, stupid!”
In the new-ish world of health information exchange organizations, there are seemingly many factors that may spell success or failure. Among those are: attracting a critical mass of participants, creating appropriate governance, creating a sustainable business model and creating trust in the HIE. However, the real key to making it work long-term is something that the entire healthcare industry hasn’t worked out: how to standardize or harmonize the healthcare data across systems in an efficient and sustainable way.
Now you may say, “…but Scott, we know how to standardize data and some are doing it today…”. While that is true, it is a highly labor-intensive job. Even though there are some good tools out there (even one grown in our own backyard, so to speak), they don’t solve the fundamental problem that data standardization isn’t a one-and-done activity….it’s an on-going, never-ending, never-gets-easier, thankless task that very skilled individuals (and there aren’t that many right now) have to do.
An article this week that is making the rounds in HIE circles is about two big insurers collaborating (to the tune of $80 million) to create a new HIE in California. By HIE, I mean the entity not the verb. Now it’s a lot of money and two big companies. So who knows, maybe it will work…but my bet is that it won’t. The reason being is that the industry still hasn’t standardized the data enough to create a truly sustainable (and profitable) HIE. Sure there may be pockets here and there (i.e., IHIE is the most advanced and sustainable… and its even right here in our own backyard), but not on a wide-spread, national basis.
One of the selling points in this new California effort is that participants won’t be charged anything to join – it’s FREE (at least not at the beginning…but at some point, going to a “modest subscription fee”). What isn’t pointed out that free isn’t really free. While there may not be a specific price to join, there is a cost: Creating a real-time interface to a new HIE and ensuring the data is comparable across all other participants. There is a lot of time and work involved in the initial set-up and standardization (aka: there IS a cost!)…and then there will be an on-going cost for all changes to the data that happen over time (e.g., new lab tests, changes in tests, new systems or new reference labs).
Another selling point is that the new California HIE will be populated with claims data. This is all well and good and is somewhat helpful; but, medical claims don’t contain some critical information needed by providers to treat patients. This may seem obvious, but when a claim is submitted to be paid for a lab test (lets say), the lab result isn’t typically included. So for a provider seeing this information later, it is a little helpful to know what labs have been ordered and performed. However, the real valuable part is the see the results. So just dumping a lot of claims data into one area won’t equal a good health information exchange.
Now maybe the California effort can sustain long enough for better standardization to occur. The Office of the National Coordinator (ONC) indicated at the HIMSS conference this year, that they will focus on interoperability. As a small step forward, ONC published a concept paper for a 10-year plan. Just last week and this week, they held “listening sessions” on this topic. This indicates, they are still educating themselves and trying to create a strategy for moving forward. The 10-year plan did include some information related to data and “vocabulary” but there was more emphasis on other aspects such as security. Now, I’m all for security but it’s “a thing” that has already been figured out. There are a number of people who know how to secure data and systems.
The data standardization (in a way that is relatively cheap and efficient) is something that hasn’t been figured out yet but there doesn’t seem to be much focus on it. Therefore, it appears that it will take many years to be cheap and easy enough to support wide-spread health information exchange. So data standardization continues to be the elephant in the room…or rather, elephant in the HIE’s data center.