The Three Biggest Hurdles to Architecting a Successful State-Wide HIE
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Chad Cosper explains the three biggest hurdles to architecting a state-wide HIE
All fifty states (and 6 provinces and territories) have received a grant from the Office of the National Coordinator (ONC) to plan and build a state-wide health information exchange (HIE). The awards ranged from $600,000 (American Samoa) to $38,752,536 (California) - but this is not a post about the money. You likely already know all about that. (But you can get the details on ONC's website.)
No, this is a post about the very real challenges that states face now that the grants have been made. Designing and implementing an HIE that meets the needs of multiple participants and stakeholders is a significant challenge for states. Most point to three hurdles as the biggest barriers:
There is no “one size fits all” or federally mandated architecture model
The ONC has made demands that each state spend a certain amount of its grant money on enabling interstate and federal exchange. However, they have not mandated that any state conform to a particular model either for these exchanges or for intrastate exchange.
With no specific architecture dictated, states can design one that incorporates the strengths of their existing HIT initiatives, as well as one that addresses the particular requirements of their HIE.
However, this freedom can be daunting to those states just starting out. Should we design a federated model? Should we build a Services-Oriented Architecture? How do we know which design decisions are best to achieve the results that our stakeholders demand?
Each state has unique priorities based on demographics, resources and participants
Is your state primarily rural, or does it contain many large metropolitan areas? Does your state generally act alone on initiatives, or do you work closely with your neighbors? Perhaps the residents of your state work in another state or even get their healthcare in another state. Does your state already have an HIE infrastructure - or regional HIEs operating within your borders?
The ONC recognized that each state's readiness for HIE will vary, as will the demands and needs of participants. Accordingly, HITECH, the ARRA provision that provides for state HIE, was framed to provide states with the opportunity to organize their efforts in a manner that is most beneficial to their situation. Even this freedom, however, has implications on architecture design.
ARRA funds and federal grants support short-term funding, not long term sustainability
This shouldn't come as a surprise because the intention of ARRA was not to fund long-term projects. However, states are now left to devise long term plans to provide the projects with the income that will make them sustainable.
Some states are looking at a subscription / membership model for sustainability. Others are considering value-added services that may be purchased by participants to offset costs. However, as states plan to achieve long term sustainability, they must plan for it now and consider the implications of those goals when designing their technical architecture.
Over the next few weeks, I will address topics that dig deeper into some of these challenges on this blog and how the registry and exchange technologies will help address these challenges to deliver successful state-wide HIE.
Are there any significant hurdles or challenges I’ve missed? Add your comments below.
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I'd certainly add the fact that there are no standards and that the major EHR vendors have no incentive to make this happen.