Rebuilding the Tower of Babel: A CEO’s Perspective on Health Information Exchanges

The United States has the greatest shortage of healthcare professionals in its history. This is compounded with an increasing number of geriatric patients. There was only one geriatrician per 5,000 Americans over 65 in 2005, and only nine out of the 145 medical school’s training programs were geared towards geriatricians. The industry will be short over 200,000 doctors and a million nurses by 2020. In the history of US healthcare, never has such a large demand been met with so little staff. This shortage, combined with an increase in the number of geriatric patients, means that the medical community must find a way for the medical community to provide accurate and timely information to all those who require it. Imagine flight controllers speaking the native language of their country, instead of English. This illustrates how critical and urgent it is to have standardised communication in healthcare. Healthy information exchange can improve safety, cut down on hospital stays, decrease medication errors, reduce redundancies in laboratory testing and procedures, and make the healthcare system more efficient, faster, and more productive. As the US population ages, so will those with chronic diseases like asthma, diabetes, heart disease, and cardiovascular disease. We will need more specialists to help us communicate effectively with our primary care providers.

Standardizing communication is key to efficiency. Healthbridge, a Cincinnati-based HIE, and one of the largest community-based networks, was able reduce potential disease outbreaks from 5-8 days to 48 hours by collaborating with a regional health info exchange. One author said that standardization is similar to language without grammar. Both can be communicated, but it is often cumbersome and ineffective.

The United States has made a twenty-year transition to automation in order for inventory, sales and accounting controls to be automated. This will improve efficiency and effectiveness. Although it is uncomfortable to consider patients inventory, this may have been a reason why primary care has not moved to automated patient records. Imagine a Mom & Pop hardware shop on any corner in mid America, stocked with inventory and ordering duplicate widgets based upon lack of inventory information. You can see how automation has transformed the retail sector in terms scalability, efficiency and scale by visualizing any Lowes or Home Depot. The “art of medicine” may be a barrier to smarter, more efficient, and more effective medicine. Although standards for information exchange exist since 1989, recent interfaces have developed more quickly due to standardization of state and regional health information exchanges.

History of Health Information Exchanges

HIE’s were first successfully implemented in major urban centres in Australia and Canada. Integration with existing EHR systems in primary care was key to the success of these early networks. The first American health language standardization system, Health Level 7, was established in 1987 at the University of Pennsylvania. HL7 has succeeded in replacing outdated interactions such as faxing and direct provider communication. These often lead to duplication and inefficiency. Interoperability improves human understanding of networks and health systems, allowing them to communicate and integrate. Standardization will eventually impact the effectiveness of communication functions, just as grammar standards foster better communication. The United States National Health Information Network, (NHIN), sets the standards for this communication among health networks. The third edition of HL7, which was published in 2004, is now in its third stage. HL7’s goals are to improve interoperability, create coherent standards, educate the sector on standardization, and collaborate with other sanctioning agencies like ISO and ANSI who are also interested in process improvement.

One of the first HIE’s in the United States was established in Portland Maine. HealthInfoNet, a public-private partnership, is the largest state-wide HIE. The network’s goals are to improve patient safety and quality, increase the efficiency of clinical care, reduce service duplication, identify more public threats faster, expand patient record access, and improve patient safety. The Maine Health Access Foundation (Maine CDC), The Maine Quality Forum (Maine Health Information Center) and Maine Health Information Center, Onpoint Health Data were the first to start their efforts in 2004.

Tennessee Regional Health Information Organizations were established in Memphis and the Tri Cities regions. Carespark, a 501(3)c in the Tri Cities area, was considered a direct project. Clinicians interact directly with one another using Carespark’s HL7 compliant software as an intermediary to transfer the data bidirectionally. The VA clinics played an important role in the initial stages of this network’s construction. The midsouth eHealth Alliance, a RHIO, connects Memphis hospitals such as Baptist Memorial (5 sites), Methodist Systems and Lebonheur Healthcare. It also includes Memphis Children’s Clinic. St. Francis Health System. St Jude, The Regional Medical Center, and UT Medical. These networks enable practitioners to share their medical records, laboratory values medicines and other reports more efficiently.