Will HIEs Become the Next Route 66 When TEFCA Arrives?
With the ONC planning on releasing the next iteration of TEFCA this year, many HIEs are likely very concerned about the potential impact of this federally-constructed interoperability initiative.
At recent conferences, we have repeatedly heard concerns about how there will be a list of winners and losers when it comes to TEFCA. What immediately comes to mind is the image of merchants on the old Route 66 being bypassed by the new and vastly larger interstate highways.
With regards to TEFCA, will a similar phenomenon happen with HIEs? Those that get to be part of the new interstate system will flourish, while the others may become like Radiator Springs, the town that time forgot in the 2006 movie Cars.
We don’t have to look too far back in history for the answer. During the HITECH Act stimulus package, there was a rising tide of HIEs, all with robust budgets from the stimulus. During this time, many HIEs invested in infrastructure, and waited for the customers to come onboard – the “if you build it, they will come” method. This strategy did not work for all HIEs, and some ultimately did not survive.
The HIEs that prospered focused on providing tangible value to their customers, whether it was hospitals, payers, individual practices or state agencies. The value of the HIE came in the form of specific use cases where customers could see clear value in sharing data. Is wasn’t a conceptual “sharing data is good for all,” but real world scenarios and applications where the data exchange was vital to operations or improvement.
With TEFCA around the corner, a value-based approach is more important than ever. While this mandate will put constraints on how HIEs exchange and access data, this will require significant effort and be viewed as a cost. TEFCA may be a requirement for some HIE constituents, but it in of itself, it will not be seen a “value.” HIEs will still have to create value by enabling constituent use cases. To go back to our analogy, just being on an interstate exit doesn’t guarantee business success – you have to have things people want to purchase.
Another challenge is that the expectations for the value-added services that HIEs provide are continuing to rise. As such, HIEs have to use their unique positions in the community to climb the value chain.
For example, larger EHRs are integrating with data sharing networks like CommonWell and Carequality. A senior interoperability director from a large Integrated Delivery Network (IDN) claimed that they don’t need an HIE because they can query and retrieve records between Epic and Cerner.
In our analogy, there’s a competition for customers at the interstate exit. If the gas station (aka EHR) starts selling soda and chips, you have to have something of more value to bring them to your shop. Custom-made sandwiches, pizzas, and slurpies – HIEs have to find out what high value services that customers can’t get elsewhere.
One fertile area for future HIE success is “orchestrating” services – use cases that require data beyond an EHR’s domain. Coordinating community-wide events, records, lab data, and population health data. It means going well beyond providing event notifications or portals with consolidated records.
To enable “orchestrated” services – you need data from many places. In this way, the number of facility connections is critical to creating HIE perceived value. The problem, as most HIEs know, is that wide area facility connections can be hard and expensive. However, the right platforms can make a big impact on enabling the efficient, seamless, and secure transportation of data and connects the full ecosystem of healthcare for HIEs.
For example, one HIE has created “federated query” orchestrations – where known clusters of communities can query multiple other communities’ data easily in a rule-based network. The HIE has extended this service by allowing healthcare facility to automatically pre-fetch patient data before visits.
These types of solutions give providers the data they want when they want it – reducing the complexities data exchange and showing real value. The onus is on HIEs to go beyond the basic use cases, and provide high value services their constituents want and will use.
In order for HIEs to avoid becoming like an abandoned store on old Route 66, they need to develop the right strategies for demonstrating true value to all of their constituents.
This means identifying the high-value use cases of the future, expanding connectivity and having an infrastructure that can support highly flexible, orchestrated services. As Lightning McQueen, the protagonists from the Cars movies states, “They’re driving right by, they don’t even know what they’re missing.”
It’s up to HIEs to make their customers notice and want them – TEFCA or not.