Health Information Exchange (HIE). A recipe that just might work.

If there is anything that plagues the health industry and severely damages the value proposition for information technology in healthcare, it is the dismal failure to achieve system interoperability and perhaps more importantly, health information exchange. No matter how elegant an individual clinic's or hospitals' or health system's electronic health record solution might be, the value of the patient data these systems capture is significantly diminished if it cannot be reliably shared with those who need to see it and use it. That would include not only other hospitals, clinics and health systems where a patient might go, but also a much wider universe of healthcare providers, agencies, and services that nearly all people will encounter over the course of a lifetime.

Health Information Exchange or HIE has been a frequent topic here on HealthBlog. I don't discount the considerable advances that have been made in the use of information technology in healthcare over the last decade or so. Electronic health records are becoming commonplace in developed and even some developing countries. At last count, about 83 percent of American physicians are now using an electronic solution to capture patient information. I see a promising future in which eventually all health information will reside in electronic format. I see a time when clinicians and institutions will be able to apply advanced analytics, predictive analytics, and even machine learning to patient data to improve care quality and outcomes. I anticipate tremendous growth in the application of universal communications tech to advance the use of telemedicine, tele-health, and remote patient monitoring. I see today's amazing array of new, powerful, cloud-connected mobile devices being widely deployed in healthcare so doctors, nurses and others in the industry can do their work more efficiently and stay connected while patients too have better access to the information, experts and devices they need to manage their health. However, despite these advances and their potential to improve healthcare, the horizon for broadly achieving HIE still appears distant at best.

In my travels, and over the years, I've seen many countries attempt and largely fail at developing system interoperability and seamless information exchange for health data. In some cases, literally tens of billions of dollars have been spent before HIE projects have collapsed under their own complexity. I used to hold out a few success stories from relativity small countries like the Netherlands or Singapore as examples of those getting close to achieving the goal, but lately my colleagues living in these places have been telling me that even on such smaller scales, the projects have become mired with political challenges or technological failures. So, what to do now?

I'm not an expert in health data exchange science or technology. However, I'll offer once again what I believe is a recipe, and perhaps the only hope for HIE success. It's a recipe that not only leads to HIE success on a national level, but a truly global one. It starts with a decision to aggregate all patient data around each person in a secure, cloud-based account of the patient's own choice. Here's the recipe:

At the federal/national level, legislation is written to mandate that a copy of all patient data held in electronic systems, or at least a subset of the important data, is aggregated in a cloud-based account on behalf of the patient.

Also at the federal/national level, it is mandated that all EMR/HIS systems must be able to transmit a copy of the information, or subset of the information, to each patient's account.

Patients should have choice in whom they trust to hold information on their behalf. These cloud-based accounts could be offered by government, private global tech companies, financial institutions, or other agencies. All information residing in such an account must be private and secure, and under the control of the patient.

Should the patient wish to change his or her account to another cloud-account provider, it must be further mandated that he or she is free to do so and that all cloud-based account providers can easily exchange all of the patients data from one cloud provider to another.

As the patient travels from one clinic, hospital, health system or agency to another, he or she grants access to the cloud-based account holding his or her records and allows the new entity to transmit or aggregate newly generated health data back into the account.

Citizens can always access their account to see the information it contains about them, and a method is provided to appropriately update or correct bad information.

Initially, and to avoid too much complexity, the data type requirements for each account might be limited to pertinent demographic information, payor information, medical problem list, medication list, and allergies. Lab, medical imaging and other data could follow as technology evolves.

I know that even doing what I am recommending above on a national/citizen level is considerably complicated, expensive, and politically charged. However, I truly believe it is the only model that stands a chance of taking us where we need to go to actually achieve something that works as a national or global solution for health information exchange. It puts the patient at the center, where he or she ought to be. It makes information available from anywhere to anywhere it is needed so long as there is a connection with the internet. It doesn't require perfected, bidirectional connectivity between and among the thousands of different electronic systems in healthcare, but rather asks only for a single, standardized connection between any of those systems and the patient's account in the cloud.

Only time will tell if I'm close to being right on this one, and I certainly wouldn't object to being wrong if some government, tech company, or individual finds another way. I just haven't seen it yet no matter how much time and money has been spent trying to achieve the goal.


Bill Crounse, MD          Senior Director, Worldwide Health             Microsoft 




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