Commentary: Future HIE success comes from past mistakes

张琨

Learning From Mistakes
(October 01, 2007) For the past several years, thought leaders in health care have generated a great deal of buzz about the concepts of interoperability and information-sharing networks like regional health information organizations.
Unfortunately, preliminary performance has not always lived up to optimistic expectations. Early adopters encountered challenges, and detractors quickly concluded that results weren't worth the time and resources invested.

Nothing could be further from the truth. Health information exchange is an idea whose time has come and will, in fact, play an increasingly vital role in improving the quality of care and patient safety.

Consider the phenomenal growth of pay-for-performance initiatives, for instance. Currently, many practices-particularly primary care specialties-have limited opportunities to demonstrate results or reap P4P bonuses, simply because they are unable to aggregate performance and outcomes data relative to care delivered by multiple providers.

At this juncture, therefore, it is important that we learn from mistakes made during initial efforts to achieve HIE in order to realize and maximize benefits going forward.

In some cases, pioneers in this emerging field concentrated on creating entities, not functionality. In other words, they set out to build an organization like a RHIO, rather than advance the attainment of information exchange. With the focus on form, not function, it was easy for participants to get sidetracked with political agendas, competing priorities and administrative processes. They often emphasized rapid return on investment, rather than building the HIE to achieve specified long-term objectives that would ultimately produce the results desired-improved patient safety, enhanced care delivery and the reduction of health care costs.

Early efforts were often technology driven, rather than goal driven. In contrast, I practice as part of a primary care group with four offices that adopted electronic medical records seven years ago.

We made this decision not because we wanted advanced technology, but because we wanted to eliminate the frustration of needing a patient's chart filed in an office across town. From the outset, we were intent on improving internal workflow and quality of care. Technology was the tool by which we accomplished these goals, not the goal in and of itself.

Shortly thereafter, I oversaw the implementation of computerized physician order entry software at our community hospital. Now I'm involved in developing a system-wide HIE solution for the University of Pittsburgh Medical Center.

In both cases, obstacles range from stakeholders' concerns about the difficulty and cost of implementing new systems, to developing ways to ensure disparate technologies can work together. From micro to macro, however, we discovered that HIE can be successful if participants remain focused on the ends, rather than the means. In other words, projects that are dedicated to process improvement and care delivery will succeed over those that emphasize the technology.

Too many health care organizations in the recent past were satisfied with building interfaces in a piecemeal fashion to quickly achieve some level of interoperability. These solutions seldom produced the desired results, deflating hopes that technology could indeed provide reliable HIE. Efforts should instead focus on implementing platforms designed specifically to facilitate HIE and interoperability, which will ultimately support timely, consistent and secure transfer of data.

These platforms represent emerging technology that offers an organization a feasible evolution to semantic interoperability, which will allow systems to not only transfer information, but to make use of the "true meaning" of the data being shared. They enable users to do more than simply import and review lab results from disparate software, for instance. They also integrate the data for comprehensive analysis and trending, which enhances the provider's diagnostic and therapeutic decision-making. Typically, these new platforms are configured for scalability and can accommodate data sets of even greater complexity as an organization grows and its needs intensify.

Without a doubt, achieving the goal of HIE is a daunting task. But it is one that must be pursued, despite apparent early setbacks. Consider what would have happened in the early 20th century if this country had refused to develop roads and highways until the horseless carriage had been perfected. The population would have had cars, but nowhere to go. Likewise, we need to accelerate the development of infrastructure that enables HIE in order to maximize the availability of, and access to, patient information vital to improving care delivery.