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HIE Should Work Like the Electric Company

silhouette of power lines in front of a sunset

The journey to improved healthcare and health outcomes is predicated on having an infrastructure in place that enables interoperable health information exchange (HIE). As a patient, I seek care in multiple places with care providers who do not share hospital affiliations; therefore, they don’t share EHR systems. Yet, each year I have this expectation that somehow, when I have a mammogram, the results will make it to my OB/GYN, who is not part of the same health system as my PCP. I’m surprised that reality still does not exist, despite my being an educated consumer.

The fact that we still talk about HIE and interoperability means that we are still in the early stages of development. Did the banking industry have years of discussion about standards and exchange that would allow me to withdraw money from an ATM in Florence, Italy, from my US-based bank account? While some of the issues in banking are less challenging than in healthcare, I’m looking forward to a time when we spend most of our time and resources solving problems that use health information exchange and data, vs. talking about how to exchange.

I want HIE to work like the electric company. It’s a utility that’s necessary and that people are willing to pay for – because it allows us to do more impactful things.

At a recent conference on MACRA, almost every speaker and panelist said what they really needed was data. After the Affordable Care Act and HITECH, we actually have started to accumulate clinical data that can be shared and comingled with claims, administrative, patient-generated, and other data sources. We have a pile of data electrons, but we need to continue to build the wires and transformers to let them flow and power the hope and future of healthcare.

I know that many smart people are trying to solve this problem – getting the data to flow and be available to those who can harness it, identifying standards everyone can agree on, and pushing the industry to change. Unfortunately, we aren’t moving fast enough. We need the one or two killer apps or disruptive breakthroughs that will make the path forward more pressing. If care coordination between stakeholders is an imperative, can we build an application that allows shared care plans to be accessible by all of those involved, including the patient, without the care plan being tethered to any one contributor?

For example, Hillingdon Hospitals NHS Foundation Trust in the UK has connected to a personalized urgent care plan developed by Coordinate My Care (CMC), which is available to all key stakeholders. Perhaps changing to value-based care will be that necessary catalyst, pushing the entire healthcare ecosystem to sense the urgency to change. Not until the power grids and wires are in place will all those electrons freely flow.


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