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Is the SHIN-NY “Public Utility” HIE Funding a Model for Other HIE?

Posted on April 25, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I first started working with the New York eHealth Collaborative (NYeC) many years ago when they first organized the Digital Health Conference many years ago. Hopefully they’ll have me back again this year since I’ve really enjoyed our ongoing partnership. Plus, it’s a great way for me to get a deeper look into the New York Health IT landscape.

While NYeC organizes this conference, has an accelerator, and is (is this a was yet?) even a REC, the core of everything they do is around their HIE called the SHIN-NY. Unlike some states who don’t have any HIE or RHIO, New York has 10 regional health information exchanges (formerly and for some people still called RHIOs). The SHIN-NY is the platform which connects all of the state’s RHIOs into one connected health network. Plus, I know they’re working on some other more general initiatives that share and get data from organizations outside of New York as well.

While the SHIN-NY has been worked on and sending data for a number of years, the news just came out that Governor Cuomo included $55 million in state funding for the SHIN-NY HIE. This is a unique funding model and it makes me wonder how many other states will follow their lead. Plus, you have to juxtapose this funding with my own state of Nevada’s decision to stop funding the state HIE that was supported with a lot of federal government funds as well.

In my HIE experience, I’ve found that every state is unique in how they fund and grow their HIE. Much of it often has to do with the cultural norms of the state. For example, New York is use to high state taxes that support a number of government programs. Nevada on the other hand is use to no state tax and government funding largely coming from the hospital and gaming sectors. Plus, this doesn’t even take into account the local healthcare bureaucracies and idiosyncrasies that exist.

What do you think of this type of HIE funding model? Do you wish your state would do something similar? Will we see other states follow New York’s example?

I’m excited to see how NY, NYeC and the SHIN-NY do with this HIE funding. Knowing many of the leaders in that organization, I think they’re going to be a great success and have a real impact for good on healthcare in NY.

Private HIE’s Will Make Nationwide HIE Possible

Posted on June 14, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

We’ve been working for a long time on creating a nationwide HIE. I still remember when I first started blogging about EMR 7.5 years ago we were talking about implementing RHIO’s. I’m sure someone reading this blog can talk about what the exchange of health data was before RHIO’s. The irony is that we keep talking about creating this beautiful exchange of information, but it never really becomes a reality.

As I look at the landscape, there are very few HIEs that are showing a viable business model. The two leaders I think are probably the Indiana HIE and the Maine HIE. They seem to be the two making the most progress. I think there’s also something going on in Massachusetts, but it’s so complicated of a healthcare environment that I’m not sure how much is reality and hyperbole.

With those exceptions, I’m mostly seeing a lot of talk about some sort of community HIE and not very much action. However, I am seeing quite a few organizations starting to take the idea of a private HIE quite seriously. I’m not sure if this is driven by ACOs, by hospital consolidation, or some other force, but the move to implement a private HIE is happening in many health systems.

For a lot of reasons this makes sense. There is a business reason to create a private HIE and you own all the endpoints, so it’s easier to create consensus.

As I look across the landscape, I think these private HIEs could be what makes the nationwide HIE possible. Once a whole series of large private HIEs are in place, then it’s much easier to just connect the private HIEs than it is to try and connect each of the individual healthcare organizations.

Watch for the major hospital CIOs to meet at events like CHIME or HIMSS and discuss connecting their private HIEs. It will create some unlikely relationships, but it could be our greatest hope for a nationwide HIE.

HIE, RHIO, and Direct Project on Google Plus

Posted on February 9, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The past couple days, a deep and thoughtful conversation has been happening on Google Plus around the idea of HIE, RHIO and the Direct Project. As of this posting, the G+ discussion has generated 80 comments from a broad spectrum of people. If you’re interested in HIE, RHIO, Direct Project or any related healthcare data exchange you’ll want to go read the entire thread.

I’ll just bring out a comment made today by David C. Kibbe that I believe does a pretty good job summarizing a good portion of the conversation. Plus, I think he does a good job describing the various methods of healthcare data exchange. I look forward to hearing from readers about Kibbe’s comments and the other comments in the thread which stand out for others.

Without further ado….David C. Kibbe’s comments:

After re-reading many of these comments, I feel compelled to attempt a few generalizations that (I hope) are based on some observations from the real world of patients, doctors, and hospitals.

First, the majority of health care in the majority of communities in this country is highly fragmented. Sometimes that fragmentation takes the shape of two or three large systems competing with one another. More often there are dozens of small, independent practices of different kinds arrayed near one or more hospitals.

Ownership of these practices, imaging centers, outpatient centers, etc. is in fairly constant transition, with perhaps a slight trend overall towards consolidation. But, in general, most of these communities will face diversity and multiple ownership, and therefore significant fragmentation that is both physical and reflected in information technology systems.

For the patient, this reality is epitomized by having to fill out similar, redundant insurance and medical history forms for each provider visited in the community. Yes, there are exceptions where a particular health care provider is very dominant, and where the “system knows me” wherever I go as a patient. But that is still not the norm, and even those highly integrated systems have their boundaries outside of which communications devolve to paper, mail, telephone, and fax.

As a generalization, there have been two health IT strategies that have dominated the discussion of how to de-fragment community health care systems. One is some version of the community health information network, CHIN. RHIOs, HIEs, and so on. This model seeks to aggregate data from multiple provider enterprises, organize it, and make it available to members. The other is the mega-EHR, which, it is assumed by proponents, will extend its tentacles out into a critical mass of providers, usually from a hospital or group of hospitals, and therefore connect everyone.

The US is a large enough society that it can accommodate both of these “solutions” to the problems inherent in diversity and fragmentation in health care resources. Both of these models are likely to persist well in to the future.

However, what we are now seeing gain some popularity and mindshare is a third model for information and data de-fragmentation in health care, one that is based upon the standards, protocols, and specifications of the Internet, the web, and a network-of-networks architecture. Unlike the other two models, this new model does not require a controlling and centralized (and probably “rent-seeking”) intermediary on the network. This new model, like the Internet, is relatively neutral with respect to operating systems and pre-existing applications. Directed exchange, essentially secure e-mail mediated by a federated trust framework using PKI for point-to-point “push” communications between known participants, is an example of this third model reaching operational status.

To a great many technologists and others involved in health care IT, instances of the new model — let’s call it the Health Internet just to have a name — seems overly simple, even toylike or retrograde, and hardly robust by engineering or health informatics standards. “Why would you want secure e-mail?” I hear every day from health IT experts. “It seems almost stupidly limited and under-powered given the complexity of health care!”

The answer to that kind of question is “Yes, you’re right, Directed exchange, for example, is not very complicated or robust compared to an HIE or an EPIC install. But it might be incredibly low-cost to use and fast-and-easy to deploy; it doesn’t require sophisticated expertise by users, and quite the contrary looks and feels like familiar software, e.g. gmail; and for a whole lot of people who are part of fragmented health care systems it may be “good enough” and their only real alternative for secure health data exchange and connectivity.”

The Health Internet isn’t a substitute for HIEs or for enterprise EHRs. Directed exchange is a “good enough,” better-than-fax solution for the enormous volumes of health information moving across geographical boundaries, outside of EHRs or billing systems. It’s uses will be at the bottom of the health data food chain, the least sexy but still critical exchanges that move data across practices and between hospitals and doctors via fax because they can’t get there any other way cheaply and with minimal technical complexity.

At least that’s the idea….If I were Epic, or the health plans, or a leader of an HIE, I’d embrace the Health Internet for the innovation and efficiency it can offer that part of the health care market that can’t afford your more sophisticated and expensive products. And, in the process, find very large numbers of new customers. Won’t a lot of those be patients and consumers?

EHR and Encryption, Down Computers and EHR, and State Health Exchanges Might Not Be Sustainable

Posted on November 13, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Time again for our weekend EHR Twitter round up. Let the fun begin.

@ahier – Brian Ahier
#EHR’s need encryption says @HealthPrivacy to Senate panel bitly.com/rTnx6s

Is there an EHR software that doesn’t use encryption? Is there a doctor’s office that’s paying for an EHR that doesn’t use encryption? Certainly not all EHR encryption implementations are created equal. In fact, I wish that things like encrypting data were part of an EHR certification. Why? Cause that’s something you can actually certify in a meaningful manner.

@drmikesevilla – Mike Sevilla, MD
RT @SeattleMamaDoc Computers all down in the exam rooms today. One major limitation of an EMR/EHR (dependence on a computer)

Definitely is one challenge with an EMR/EHR. I wonder how many patients were seen without the chart, because it couldn’t be found quickly. There are always pros and cons to IT. It does highlight the need to have a well thought out plan for how you’re going to care for patients when your EHR is down.

@iWatch – iWatch News
State health exchanges might not be sustainable after $548M in stimulus money runs out: bit.ly/t9QfSl #HIE #EHR

Wait, so changing the name of them from RHIO to HIE didn’t solve any of the problems with these exchanges? Oh yes, I forgot to mention the extra $548 million to help solve the problems. I think this best illustrates that money isn’t the issue or at least there are more issues with HIE than just the money.

HIMSS Public Policy Forum Quick Hits

Posted on April 5, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Yes, I still have quite a bit of HIMSS content that I haven’t had a chance to post. Luckily most of the information is really timeless and so it doesn’t matter when it’s posted. One of those was some of the information I got at the public policy forum at HIMSS. Here’s some quick hits from it:

Dr. Rhonda Medows from Georgia said, “Could extend benefits to Long Term care based on capital improvement benefits.” I wonder if she’ll still do this if it’s true that there will be some money for long term care in the current healthcare reform. At least Georgia was looking at some creative ways to get some money for healthcare IT in under served areas.

State representative Rosenthall from NH-Representative said that 40-50 percent of doctors in NH have some access to EMR. She also said that 900 out of 4500 have ePrescribing (20 percent).

Probably the most interesting thing Representative Rosenthall said was in response to my question about how NH (a small state) would fund a state HIE. She quickly and frankly responded that their state must do a private partnership since the state won’t have the money in their small tax base to be able to fund the HIE. I’m guessing that many states will be in this same position.

Finally, I think it was one of the HIMSS public policy people (sorry I don’t remember which one) made an interesting comment about the government’s approach to funding the state HIE efforts. They described that the “seed funding” for HIE that’s been given to states is almost like a hope that they’ll figure out some sustainable creative revenue model and not just disappear the way RHIO have.

I remember the hype that surrounded even the term RHIO about 4 years ago and no one speaks of them anymore. It’s a really serious question to ask if HIE’s are going to find that “creative revenue model” that has alluded health information exchange in the past. I’d love to hear from people about what the most promising HIE revenue models are right now.

Real Participation in RHIO and HIE

Posted on November 28, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Everyone seems to love talking about RHIO, HIE and all of the other various initiatives happening around sharing patient health information amongst doctors. This weekend, I want to open it up to you the readers to get an idea of what type of participation you’ve had in an RHIO, HIE or other clinical data exchange.

Are you participating in one now? Do you like it? Do you hate it? In fact, what do you like and what do you hate? Do you use an EMR to interface with the exchange? What’s the interface like? How much work is it to manage the interface?

I’d also be interested in hearing about people who are working through the process now. Where are you at in the process? What’s holding you up from making this happen?

Let’s help educate each other on what’s happening with something that I think we can all universally agree is important and INCREDIBLY challenging.

HHS Connect Program For Healthcare Data Interoperability

Posted on October 11, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ll admit to not being the most expert person on HIE, RHIO, NHIN, and all of the other acronyms associated what really is just creating systems and structures for sharing healthcare data between various doctors and systems. However, I do have some knowledge in the area since I believe all of these things will be important for those using an EMR. So, I was surprised when I’d never heard of HHS’ health connect software.

Here’s a short bit from Government Health IT of the government’s connect software’s latest update:

The Health & Human Services Department (HHS) has updated the government’s Connect software to improve information security and enterprise services for organizations that want to use it to exchange health data, said its senior architect.

Connect is federally developed software that lets agencies and healthcare organizations share health data by using the protocols, agreements and core services that make up the nationwide health information network (NHIN).

HHS is trying to develop improvements in the Connect gateway quickly so it can serve as an early model of the NHIN, executives said yesterday.

“The intent of the plan is that Connect will be a reference implementation of NHIN and provide a mechanism for organizations that are building gateways to have the ability to test against it and to provide for feedback to the NHIN specification group,” said Les Westberg, Connect technical lead in the Federal Health Architecture program and an executive with Agilex.

Is there anyone that knows more about this program that can give us a review of what’s going on. I’d love to hear about how far it’s come, the challenges its overcome and the challenges it still faces.

In fact, if you are someone working on one of the acronyms listed at the top that are trying to provide the all to elusive healthcare data interoperability I’d love to learn more about what’s going on in the comments or through a guest post if you have a lot to say.

The Case for RHIO and HIE for Sharing Patient Data

Posted on January 11, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

If you’ve been reading my blog, then you know that I’ve started a pretty interesting and complicated discussion about EHR and EMR sharing of patient data. I first posted an example of sharing data with an EHR and then followed it up with some challenges associated with sharing of EHR data.

In my interoperability challenges post, Bjorn from Health Xcel posted a lengthy comment discussing some challenges of data sharing and made the case for RHIO (Regional Health Information Organizations) and HIE (Health Information Exchanges) as a means for sharing patient data between hospitals and doctors offices.

His comment was so well done that I’m copying it below for more people to see and read it. I don’t personally agree with everything that was said. I also think he didn’t address the funding challenges of RHIO and the policy problems. Maybe Bjorn will return with some comments on how those might work. Enjoy Bjorn’s take on RHIO and HIE (emphasis added):

I think Google Health and MS HealthVault will be good awareness catalysts for the quiet e-health revolution that is taking place. However, I do not think the defining change we need lies with their business model. A patient-centric model sounds good but we’d be assuming that everyone has an account with one of these systems and that they know how to use them. How will the data about a patient that is stored in a hospital be reconciled with Google Health? Which of course leads to interoperability concerns.

Web 2.0 does not lend itself to creating a reliable e-health solution either as service A is dependent on service B and if service B is down, service A won’t function and has no power to fix it by their own volition.

I think so far the industry, aka hospitals, has been trying to solve the problem by adding a patient interface to large hospital systems so patients can see their records. It’s also a step in the right direction but again it is not the golden calf we are looking for.

So what is the ideal system of the future?
A patient should be able to enter any hospital in the world, conscious or unconscious, and the hospital should have all the information they need about the patient to administer correct treatment and to notify the right people.

How do we do this?
I am a believer in the HIE / RHIO model. In the [not too distant] future, hospitals should concern themselves with healing people and not how to spend their IT budget. Hospitals, insurance agencies, smaller providers and patients will all be connected to an RHIO (Region Health Information Organization) where they will have a wealth of services; either to enter sensitive data or to discover data about one patient or the entire population. RHIOs will be connected to a larger e-health backbone consisting of HIEs that are the great data aggregators of the world. RHIOs would be responsible for conforming to regional regulations. This model is similar to how we connect to the Internet today. We don’t jack directly into one of the main Internet hubs of the world but go through an ISP that can provide us with an email address, a web page AND connect us to the rest of the world.

HIEs and RHIOs run on a software platform where health IT vendors can deploy their software applications. Some required components:

User discovery
o Any one node on the system should be able to query the other nodes to find a user and her data
Portable user
o This goes with the first bullet point in that a user should be able to log in to the system anywhere in the world and even though the user does not have an account with the RHIO she is directly interfacing with, RHIO should know how to authenticate her correctly
Interoperability / Standards / Data aggregation and discovery
o The key to any successful e-health venture. Services need to be able to talk to each other. It shouldn’t matter whether the services reside within the same application or in different parts of the world. I believe the semantic web (web 3.0) will be a key facilitator of making this possible.
Federated security
o If we take the previous examples of Google Health and MS HealthVault, they would all have to have their own security scheme and user authentication and access control. Multiply that by a dozen and suddenly a lot of money is being spent on recreating the wheel over and over. We need a unified system for this.
Updates
o All applications should reside server side and users should have thin-client access only. When the applications are being updated, it should happen across the board overnight. If something goes wrong, there should be a way to undo the upgrade without hospitals or anyone else having to do anything.
Data sharing
o The patient-centric network will definitely happen as users become more educated. But hospitals still need to be able to have access to patient data even though they have not been granted access, in case of emergency.

Ok, this suddenly got really long ;-) There is a lot of work to do for everyone in order to get true e-health solutions to work. The biggest obstacles aren’t technical but political and also the willingness to adopt a new way of interfacing with your health.

Cheers
bjorn