Vince Kuraitis
Posted 11/09/11 on the eCareManagement Blog
Yesterday’s announcement of “Standard Health Data Connectivity Specifications” by the EHR|HIE Interoperability Workgroup (EHR|HIE WG) is potentially earth-shattering.
My mom would not know what I mean by “Standard Health Data Connectivity Specifications,” so I’ll try to write this in plain English.
Who Are These Guys? The EHR|HIE Interoperability Workgroup
The workgroup consists of HIEs (Health Information Exchanges) representing seven of the largest states, eight EHR vendors, and three HIE software/services vendors.
The workgroup has been lead by David Whitlinger, Executive Director of the New York eHealth Collaborative. I worked with Dave when he was Director of Standards for the Intel Digital Health Group. He has a unique blend of people and technical skills, and I have often described him as “a logical-thinking engineer who always has a smile on his face.”
What is the EHR|HIE WG up to? From their press release of November 8:
A group of states and vendors focused on eliminating the barriers to sharing electronic health records (EHRs) today issued a set of technical specifications to standardize connections between healthcare providers, health information exchanges (HIEs) and other data-sharing partners.
The objective of the EHR/HIE Interoperability Workgroup is to define a single set of standardized, easy-to-implement connections to increase the adoption of EHRs and HIE services. The effort leveraged existing published standards for interoperability from the Office of the National Coordinator (ONC). Ultimately, the specifications aim to remove impediments that make it difficult for EHRs to connect to HIEs, including technical specification differences, wait times for interface development, and high costs.
The specifications are now publicly available at www.interopwg.org.
Why is this SUCH a Big Deal?
Critical Mass. HIEs backing the EHR|HIE WG represent over 30% of the U.S. population. 8 EHR vendors. 3 HIE software vendors.
This builds significant momentum toward creating a tipping point of market adoption of standards, not simply specification of technical standards. This is bottom-up, not top-down.
A Platform + Applications. The smartphone market has been energized by the emergence of two highly competitive platforms — Apple’s iOS and Google Android. These platforms are supported by a complex ecosystem of applications — over 500K for iOS and over 300K for Android. These two operating system platforms collectively have gone from 0% of the smartphone market in 2007 to over 64% in 2011; Microsoft, RIM, Nokia and many others are eating the dust of iOS and Android.
So if you think of the smartphone market as consisting of dominant platforms with hundreds of thousands of apps…
…conceptualize today’s health IT market as thousands of apps with no widely-adopted platforms to plug into for data exchange and workflow coordination. Health care “apps” could include virtually any stand-alone technology or service in the market today — patient and provider portals, remote monitoring, decision support, PHRs, health coaching, and scads of others.
…and so health care providers have been stuck with building individual interfaces anytime that one app has to share data with an EHR and/or another app. These interfaces are costly, but vendors have seen the revenues from multiple interfaces as part of their business model — one they are reluctant to give up.
Until — there is a group of buyers with enough market clout that get together to bring multiple vendors to the table.
…and begin to solve the problem of today’s HIT as being a bunch of apps with no widely adopted platforms. Think of the EHR|HIE WG as beginning to build a widely adoptable platform that will accept plug-and-play applications.
Renewed Relevance and a Sustainable Business Model for HIEs? In today’s Internet world, many have wondered whether there is a need for regionally based health information exchange organizations. HIEs also have struggled with their business model — who should pay and what is the value received?
While the EHR|HIE WG doesn’t provide a complete answer to these vexing issues, it breathes new life into HIEs. HIEs will need to leverage the momentum created toward critical mass.
Infrastructure for ACOs and other AC-Like Models. Since CMS issued the final Medicare Shared Savings ACO rules, many have been pointing out the interdependence of ACOs and HIEs. HIEs can act as shared IT infrastructure for multiple ACOs — minimizing the need for capital investment in IT and facilitating data exchange within and among ACOs.
A Push Toward Openness. Many hospitals have built private, closed HIEs — ones that are are focused on exchanging data within the network of providers affiliated with the hospital. State sponsored HIEs will be much better positioned to compete with private HIEs with the more open data exchange model being developed by the EHR|HIE WG.
For further perspectives, please see my previous article on 10 Reasons Why an Open IT Platform Strategy is the Right Choice for an ACO.
Just the Beginning for Data Sharing? The EHR|HIE WG press release alludes to “other data sharing partners”. Who might this include? Just about anyone with legitimate interests in sharing health information — patients, health plans, ancillary providers, public health agencies, and many others.
Yesterdays announcement by the EHR|HIE WG is a BIG deal; tomorrow it could be a HUGE influence on shaping the future of health IT in the U.S.
Additional References
EHR|HIE Interoperability Group website
Progress On Health Data Exchange Specs
InformationWeek; November 8, 2011
The EHR/HIE Interoperability Workgroup
Life As A Healthcare CIO (John Halamka MD); November 8, 2011
Coalition Unveils Two Standards for Health Information Exchange
iHealthBeat; November 9, 2011
Coalition defines EHR to HIE data sharing standards
Government HealthIT; November 8, 2011
Care And Cost 
Great article and insight into the current and potential future EHR/HIE state. Hospitals have long had closed HIE’s and struggled with implementation and adoption. Standardizing HIE data would be beneficial on many levels. It will be interesting to see how this plays out.