Establishing A National HIE On One Platform May Be A Good Idea

When you read this statement from HIT vendor Orion Health, it sounds oh-so-simple: why not establish an entire county’s HIE network on a single connecting platform?  Given the country’s already high EMR adoption rate — about 80 percent of GPs had one, as of March 2010 — New Zealand’s already part-way there.  Just knit offices up together and you’re ready to go.

Orion, of course has its own technology in mind, naturally. But whatever vendor you use, they may be onto something. I’ll pause here to say that the following proposal could incite a riot at a HIMSS floor full of competing vendors, but hey, ideas are harmless, aren’t they?

What if CMS decided that it would pay incentives not just to meaningfully, sensitively, insightfully install EMRs, but to connect them to an overall HIE?  And to take the thought into more controversial territory, what if it had a vendor or two of choice which doctors and hospitals had to use if they wanted the dough?

As we all know, the value of EMR installations isn’t just in automating, error checking and (hopefully) streamlining workflow in practices. The data is infinitely more valuable when it can be aggregated, shared, cross-checked and mined for best practices.

What are the odds of that, however, if you have an outbreak of regional and state projects using technology from a multitude of vendors?  You can talk standards all you want, but true interoperability isn’t going to happen anytime soon this way.  National connectivity?  Well, give me a couple of decades and let’s see how far that’s gotten.

On the other hand,  if CMS signed contracts with HIE technology vendors, and demanded that they give preferred pricing to those work with them, you’d see a rash of connectivity unrivaled since the invention of the telephone.  Before you scream that this just isn’t fair, doesn’t this kind of thing happen every day in, say, military contracting?

I know, I know, this may not be practical. But you can’t argue that It’d be interesting to see how the HIE and EMR market gelled if CMS took a strong lead.

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.


  • If we took a step back and selected what we really needed, we’d realize that we already have the answer – the VA VistA software. It has it’s own MPI.

    It’s used in over 175 hospitals across the US by , the State of VA DOH uses it, Oroville Hospital in CA installed it for a $500K investment and is getting back $3M in MU, Mexico uses it in 57 hospitals, etc.

    If vendors realized that they could stop spending R&D money reinventing the wheel and use it to develop other products that the VistA system does not have, they’d increase their profitability and we’d have a National EMR system that would cost less than all the money that is being spent on EHR/HIE’s today.

    Read this Wiki –

  • I have to agree, if it is one system, it needs to be open source, and what could be better than VA VistA? States could develop their own add-ons and plug-ins to fit specific needs.

    It’s such a good idea that it is almost guaranteed not to happen until HIEs are a failure and states have spent all of the HIE grant money.

  • So tired of vendor sales pitch/comments about their ‘platforms.’

    “New Zeal-and” has how many people – 4.5Million?

    Sure, let’s go with Orion’s platform. Bwa..ha…ha!

    Ask Orion Health how their platform worked for SharedHealth in Chattanooga TN. How many people did that support?

    Just askin’

  • The “concept” here is right on target.

    Think about this from a user’s perspective — a patient or clinician looking for information. Ideally, you don’t want to have to go multiple places (i.e., use more than one platform) to access data. Physicians have pretty much told us that their workflow must be seamless and that they are willing to multihome platforms (i.e., use 2 or more platforms).

    The UPnP Forum (Universal Plug and Play — USB standards) defines interoperability from the consumer POV as “it just works”.

    The consumer (patient or clinician) doesn’t know or care about the technology that needs to make this happen. They don’t care whether there is one technological platform in the background or multiple platforms that seem seamless because they conform to industry standards.

    So, from the standard of patient and clinician experience, the concept of having one “platform” to access data is the ultimate objective.

    Can/should it be one vendor to provide the technological infrastructure? That’s a different discussion.

  • Vince,
    “Physicians have pretty much told us that their workflow must be seamless and that they are willing to multihome platforms”

    This 2 things seem to be a bit contradictory. It’s hard to create a really seamless experience with multiple platforms. Unless they’re integrated nicely. Then, they don’t care.

  • That makes more sense. Thanks for the clarification.

    Seamless is the key word. They don’t care what goes on in the background.

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