HIE: Do too many rights make a wrong?

Much of our current work focuses on engaging state and local public health departments regarding planning for meaningful use.  In the last two weeks alone, we’ve had excellent conversations with five state health departments.  A recurring theme: What to do about the state HIE?


Long term, there is no question that the right thing is to have a single source for electronic health information.  Public health would be well-served by this one “healthcare data pipeline” that carried syndromic data, infectious disease reports, lab results, immunization reports and registry data.

That’s the vision of a functional state HIE. And it is the right one.

State HIEs are looking for ways to do the right thing.  Short term, they have milestones to demonstrate their overall value—to the government, providers, and payers.

The HIEs are also concerned about establishing a long-term sustainable revenue model.  That’s the right thing to do as well.

Eligible hospitals and eligible professionals will be seeking credit for meaningful use via syndromic surveillance data exchange—definitely the right thing to do.

For State Epidemiologists, the list of rights is much longer. They need to add hospitals and professionals to their existing syndromic surveillance system (if they have one) and support the state HIE.

Here’s where it gets complicated. Because all of those rights could easily turn into a wrong.

The relationship between the state health department and the HIE is not likely to provide the core revenue model for sustaining the HIE going forward.  At best, it is a value add to the health department and an incremental revenue stream for the HIE.

But the HIE can demonstrate benefit from public supported funds by working with public health. In return, public health can quite sensibly provide a list of milestones for the HIE to accomplish.

A demonstration project can fit the bill for both parties.  Public health can continue to meet the needs of eligible hospitals and professionals while engaging the HIE.

What would that project look like?

It would involve cooperative demonstration of the HIE ability to securely connect healthcare providers to the system and monitor for real-time data flow and quality.  This type of task is different in nature than many other data exchange requirements that lack a real-time data requirement.  Billing and charges for health information exchange can be off by days or a week.  Patient medication history may not include prescriptions written in the last 24 to 48 hours.  But for syndromic surveillance, these are key requirements for compliance.

A demonstration project would show that the health department and the HIE can work together, in a limited scope, to provision data connections while managing them effectively.

Starting with a limited demonstration project lessens the risk of impacting the overall syndromic surveillance project. And it gives the HIE an opportunity to demonstrate its capabilities without undertaking a substantial new effort.

It’s a positive scenario for both public health and the HIE. And it’s definitely the right thing to do.