The EHR|HIE Interoperability Workgroup — Potentially Earth-Shattering

Yesterday’s announcement of  “Standard Health Data Connectivity Specifications” by the EHR|HIE Interoperability Workgroup (EHR|HIE WG) is potentially earth-shattering.

My mom would not know what I mean by “Standard Health Data Connectivity Specifications,” so I’ll try to write this in plain English.

Who Are These Guys? The EHR|HIE Interoperability Workgroup

The workgroup consists of HIEs (Health Information Exchanges) representing seven of the largest states, eight EHR vendors, and three HIE software/services vendors.

The workgroup has been lead by David Whitlinger, Executive Director of  the New York eHealth Collaborative. I worked with Dave when he was Director of Standards for the Intel Digital Health Group. He has a unique blend of people and technical skills, and I have often described him as “a logical-thinking engineer who always has a smile on his face.”

What is the EHR|HIE WG up to? From their press release of November 8:

A group of states and vendors focused on eliminating the barriers to sharing electronic health records (EHRs) today issued a set of technical specifications to standardize connections between healthcare providers, health information exchanges (HIEs) and other data-sharing partners.

The objective of the EHR/HIE Interoperability Workgroup is to define a single set of standardized, easy-to-implement connections to increase the adoption of EHRs and HIE services. The effort leveraged existing published standards for interoperability from the Office of the National Coordinator (ONC). Ultimately, the specifications aim to remove impediments that make it difficult for EHRs to connect to HIEs, including technical specification differences, wait times for interface development, and high costs.

The specifications are now publicly available at www.interopwg.org.

Why is this SUCH a Big Deal?

Critical Mass. HIEs backing the EHR|HIE WG represent over 30% of the U.S. population.  8 EHR vendors. 3 HIE software vendors.

This builds significant momentum toward creating a tipping point of market adoption of standards, not simply specification of technical standards. This is bottom-up, not top-down.

A Platform + Applications. The smartphone market has been energized by the emergence of two highly competitive platforms — Apple’s iOS and Google Android. These platforms are supported by a complex ecosystem of applications — over 500K for iOS and over 300K for Android. These two operating system platforms collectively have gone from 0% of the smartphone market in 2007 to over 64% in 2011; Microsoft, RIM, Nokia and many others are eating the dust of iOS and Android.

So if you think of the smartphone market as consisting of dominant platforms with hundreds of thousands of apps…

…conceptualize today’s health IT market as thousands of apps with no widely-adopted platforms to plug into for data exchange and workflow coordination. Health care “apps”  could include virtually any stand-alone technology or service in the market today — patient and provider portals, remote monitoring, decision support, PHRs, health coaching, and scads of others.

…and so health care providers have been stuck with building individual interfaces anytime that one app has to share data with an EHR and/or another app. These interfaces are costly, but vendors have seen the revenues from multiple interfaces as part of their business model — one they are reluctant to give up.

Until — there is a group of buyers with enough market clout that get together to bring multiple vendors to the table.

…and begin to solve the problem of today’s HIT as being a bunch of apps with no widely adopted platforms. Think of the EHR|HIE WG as beginning to build a widely adoptable platform that will accept plug-and-play applications.

Renewed Relevance and a Sustainable Business Model for HIEs? In today’s Internet world, many have wondered whether there is a need for regionally based health information exchange organizations. HIEs also have struggled with their business model — who should pay and what is the value received?

While the EHR|HIE WG doesn’t provide a complete answer to these vexing issues, it breathes new life into HIEs. HIEs will need to leverage the momentum created toward critical mass.

Infrastructure for ACOs and other AC-Like Models. Since CMS issued the final Medicare Shared Savings ACO rules, many have been pointing out the interdependence of ACOs and HIEs. HIEs can act as shared IT infrastructure for multiple ACOs — minimizing the need for capital investment in IT and facilitating data exchange within and among ACOs.

A Push Toward Openness. Many hospitals have built private, closed HIEs — ones that are are focused on exchanging data within the network of providers affiliated with the hospital. State sponsored HIEs will be much better positioned to compete with private HIEs with the more open data exchange model being developed by the EHR|HIE WG.

For further perspectives, please see my previous article on 10 Reasons Why an Open IT Platform Strategy is the Right Choice for an ACO.

Just the Beginning for Data Sharing? The EHR|HIE WG press release alludes to “other data sharing partners”. Who might this include?  Just about anyone with legitimate interests in sharing health information — patients, health plans, ancillary providers, public health agencies, and many others.

Yesterdays announcement by the EHR|HIE WG is a BIG deal; tomorrow it could be a HUGE influence on shaping the future of health IT in the U.S.

Additional References

EHR|HIE Interoperability Group website

Progress On Health Data Exchange Specs
InformationWeek; November 8, 2011

The EHR/HIE Interoperability Workgroup
Life As A Healthcare CIO (John Halamka MD); November 8, 2011

Coalition Unveils Two Standards for Health Information Exchange
iHealthBeat; November 9, 2011

Coalition defines EHR to HIE data sharing standards
Government HealthIT; November 8, 2011

16 thoughts on “The EHR|HIE Interoperability Workgroup — Potentially Earth-Shattering

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  5. I agree that this is a great movement that they have going. Coincidentally I’m going to be at the Digital Health Conference being held by the NYeC at the end of the month, so I’ll have to ask them about it.

    My biggest fear is how “on board” all of these various states and vendors are. It’s one thing to put your name on a press release. Another to actually start sharing data.

    With that said, I’m optimistic that this is a step in the right direction based on the players involved.

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  12. I read your blog as soon as I saw this announcement.In simple terms, so even I can get it, does this mean that

    1. HL7 is in and CCR is out?
    2. The system is built and is available for all to use?
    3. If not, will it be and when?
    4. Will it force the “exclusive” systems to open up?
    5. Will patients have access to their own records?
    6. Is there another question I should have asked? If so what is the answer to it?

    • John, Good questions. Here is my take:

      1. HL7 is in and CCR is out? The HL7 CCD and the ASTM CCR were both acceptable summary record standards under Stage 1 of Meaningful Use requirements. ONC is signaling that they will only accept the CCD for Stage 2; this puts the CCR in limbo — some probably will continue to use it, but it will not count toward meaningful use. The EHR|HIE WG is backing CCR, but that is most likely simply a result of reading the tea leaves.

      2. The system is built and is available for all to use? Just starting to be built. The EHR|HIE WG press announcement does not speak to when these standards will actually begin to be deployed within the regional HIEs of member organizations.

      3. If not, will it be and when? Probably will have to track individual HIEs web sites and press releases to get a handle on this.

      4.` Will force the “exclusive” systems to open up? The EHR|HIE WG is a more open model and thus puts pressure on less open systems to open up, but there are no guarantees. Opening up is much more likely to occur first in the ambulatory EHR market, where growth arguably is limited by the number of non-interoperable systems. Pressure is on vendors to deliver and clinicians to implement Stage 2 and 3 MU requirements. I believe the intent of the EHR|HIE WG is to standardize and open up EHR platforms and applications…but only time will tell how well this works.

      5. Patients will have access to their own records? There is nothing in this first announcement by the EHR|HIE WG that speaks to immediate access to records by patients. We will have to stay tuned to see where patient access is on the Workgroups timetable for use case development.

  13. It should be no surprise to me that any system does not worry about patient access. We patients are just delivery systems that bring the medical issue to the provider so they can perform some proceddures on it, send the bill, get paid, and see us again when we transport our next medical issues to them.

    sorry for the rant.

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