How Not to Create an HIE

Sometimes, the job of an analyst can be so frustrating.

A core part of the Chilmark Research charter is to educate healthcare stakeholders on critical trends in the marketplace that will lead to better, more successful adoption of IT and subsequently improve the health of the nation (if not the world).  There are a couple of things we have learned along the way:

1) Little if anything gets adopted at scale in the healthcare sector (and for that matter virtually any other market) if it does not provide value to the end user that exceeds risk. That risk could be privacy, it could be a productivity hit, it may be liability; plenty of risk in healthcare, both perceived and real to trip up an IT initiative.

2) Provider engagement is crucial but if we really want to improve the health of the nation while concurrently lowering total healthcare spend (or at least slowing its growth) consumers/patients must also be engaged.

With those two points in mind, I was sadden and to some extent shocked at the press release announcing the formation of the New Hampshire Health Information Organization (NH-HIO). As I read this PR all I could think of was OMG, are they serious, is this their vision? If that is a vision, the NH-HIO leadership is wearing a blindfold.

So what brought on such a visceral response? Going back to those two points above:

1) Pushing summaries, referrals and orders electronically is the most basic function of any HIE and any quasi-government HIE, of which the NH-HIO is one, that has stated this as their core function has struggled to survive without some form of continual government subsidy. This isn’t a vision, this is just the same old, same old – your grandpapa’s HIE and will likely meet the same fate as that of Carespark and a host of others. Such an HIE provides very little, if any value to providers. And don’t even get us started on talking about the Fed’s Direct which frankly will do what NH-HIO envisions and doesn’t even need any overhead infrastructure, just a provider directory.

2) Nowhere in this fairly long and verbose PR is there any mention of what the citizen of New Hampshire gets out of the NH-HIO. Will they have equal access to their records? Will they be cc’d when summaries are sent so those files can get dropped into their personal, self-controlled folders, be it on their hard drive, their cloud service email account or even HealthVault? Nothing, absolutely nothing is said in this PR that relates to the consumer/patient. Talk about lack of vision. Geez, he says as he slaps his palm against his forehead.

Just to be fair, New Hampshire is not alone in lacking vision. This scenario has played out before and will likely be seen again but in this time of enormous government investments being made to facilitate the delivery of healthcare services via IT to ultimately reign in healthcare spending, examples such as this are the exact opposite as they will not lower costs and are a colossal waste of precious tax payer dollars.

Please, someone stop this madness.

John Moore is an IT Analyst at Chilmark Research, where this post was first published.

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