In response to this tweet by Kristen Valdes during the SHIEC 2021 conference happening this week in Arizona, Brendan Keeler offered this really important look into healthcare data exchange and HIEs. Here’s his tweet storm for easy reading:
If centralizing patients’ data from thousands of local records to ~80 aggregate hubs is good and the right way to enable access, lemme tell you about a crazy idea: 1 aggregate hub
Drastically and tremendously oversimplified, there are only two perspectives for data exchange:
1. You dump all the data in one aggregate spot
2. You keep all nodes on a network decentralized but give the right tools to find and access
Other industries have had great success with the “dump in one spot” m method
MIB in life insurance
VIN for vehicle history
The credit bureaus
It’s sorta a security risk (easier target) and it’s viewed as kinda ooky (bad credit bureaus) but it’s pretty damn effective
On the other hand, decentralized can work. Nodes go down or are not functional and aggregating a complete picture is hard but the network is resilient and security posture is better
The internet is a great example, obviously
Everyone’s been hammering patient access via providers since MU2 VDT provisions. But the decentralized nature makes aggregation hard
So it’s logical to use the vehicles doing the aggregation as the backdoor to solve the problem – the HIEs (and the immunization registries, hopefully).
But it’s hard to say “oh yeah, yay, that aggregation is good” and in the same breath still argue against further consolidation and increased aggregation. If 80 nodes are better than 10000, what about 10? 5? 1?
There are some good and cool HIEs. There are also a ton of exceedingly mediocre ones. I’d love to cut the dead weight and ensure national coverage with the maximum services. States with multiple HIEs underperform states with a single.
If this consolidation and aggregation is so good, why only have a state HIE? Why not a national HIE?
Anyway, really cool stuff by @ciitizen to help improve patient access.
One other note – as care is increasingly virtual and startups increasingly aim at nationwide coverage, state boundaries matter so much less and in fact hurt care.
@nikillinit articulates this well
outofpocket.health/p/healthcare-s…
80+ HIEs don’t help this problem
Leave it to Brendan to break it down in simple terms. Of course, the idea of 1 aggregate hub is simple in concept, but not in reality. Especially when you talk about the reality of how these hubs are funded. As usual, we head back to the almighty dollar to understand why we have 80+ hubs and not one. I’m not suggesting this is the right approach, but funding is really the reason why we have so many HIEs. Some were funded by states, some were funded by federal dollars, some were funded by cities. Plus, every locale wanted their HIE implemented first. They didn’t want to wait for a massive national hub. Not to mention the major security concerns that Brendan mentions.
Of course, many HIEs realize that their shouldn’t be an HIE in every state. People often travel from one state to another. That’s why we’ve seen many states consolidate including the recent merger of the Colorado and Arizona HIEs into Contexture. I expect we’ll see more and more of this over time, but I don’t think we’ll get to the point of just one HIE.
The other thing holding back moving from 80+ HIEs to 1 HIE is that each one has taken a different approach to the value they provide their communities. We’ve seen more alignment in this regard, but every HIE has a different value proposition and therefore a different set of data and a different relationship with their community. Consolidating those different values and data sets is harder than it would appear on the surface.
Do I think we should have one HIE for healthcare? Yes
Do I think we will? No
I’d love to hear your thoughts. What’s the future of HIEs in healthcare?
If you look back I believe this was the original thought of Meaningful Use, makes interoperability easier and cheaper. Apps only have to build and support means to send data to one place, API’s only connect to one. Only have to look at how Medicare claims are handled now compared to years ago. One is safer, cheaper for all to support. Just think a patient has one portal to connect to look at all chart info in one place no matter how many clinicians you see.
Was that the original thought of meaningful use? I think there were some that thought it was the goal and some that wanted it to happen, but the regulations didn’t really push that goal. It mostly pushed the goal of adopting EHR.
Your right John the regs didnt back up what some thought the flow of data could or should be since then paths seem to go different directions.