The final point of Mickey’s article seems to be “Start with PUSH” because it is high value to physicians and low risk. It is true that PUSH is high value to physicians and that it is the primary thing they are willing to pay for. But, this alone will not make an HIE sustainable because physicians and hospitals won’t pay enough for it. On the other hand, Governments and Health Plans have been willing to make longer term investments into the data warehouse that supports PULL/Query of a patient centric record. So to some degree, HIEs have to follow the money. This isn’t such as bad thing as for example the money for New York HEAL grants was to establish a strong foundational architecture for HIE. This is critical for HIEs to provide PUSH as a service between hospitals and physicians at a faction of the cost of those organizations setting up private HIEs.If your HIE is “well-architected”, you will create value and sustainablity through reuse for push and pull and lower costs overall.

http://www.hixny.org

The pushing of documents as the first step vs. the aggregation of encoded data for end-user display: rather than a choice of first increments, how about a doling out of assignments? States seem well-poised for exchange of documentation via Direct and Privates are hungry for discrete data. Surely, these fundamentals need to coexist and each are feasible first increments. Sounds to me like the beginning of a beautiful network of friendships.

Many thanks to everyone for your kind comments! I'm glad you found it useful.

Thank you Micky for speaking out on this need for incremental interoperability. You discussed this during your recent visit to Tennessee which is causing many to rethink their strategy. I have been evangelizing the need for "baby steps" for several years now.

http://www.serendipityhealth.net

Excellent analysis of the current state of state managed HIEs! It's unfortunat the millions of dollars invested in these initiatives might not realize any meaningful return of investment.

The power of a useful step, followed by another, followed by another, cannot be understimated. It is a longstanding principle for any successful effort. Thanks for reminding us of the need for one step and then another as the way forward.

Could not agree more.

Micky,

Spot on. In my prior role as VP of HIE products at Optum/Axolotl, I saw this all the time - both in public and private HIEs. A few examples stand out. A high profile RHIO after two years in implementation/operation had 15 doctors using the system. This particular organization would apply for grant after grant for cutting edge population health research and quality measurement - a classic example of "too much ambition" - instead of focusing on immediate value delivery of exchanging information for care coordination. Another example is a high profile private HIE that expected turnkey integration with any and all EHRs including SSO between the EHR and the HIE portal.

The successful HIEs that I served around the country as a vendor got the push model right first. That generated adoption. Then they rolled out pull/query via a portal which usually got a tremendous reception/adoption by providers who were already deriving value from the push exchange.

-Anand
CTO/CPO
Health

http://www.healthfidelity.com