How Do You HIE?

Sunday, 10 February 2013

It's no longer if, or even when...

A recent Frost & Sullivan market analysis indicated U.S. healthcare providers will "significantly ratchet up their participation" in health information exchanges (HIE) over the coming months. Health information exchange is a key aspect to achieving outcome-driven accountable care; it is being persuasively propelled by the increasing requirements in the Meaningful Use Stage 2 guidelines and will undoubtedly have a major impact on the positive transformation of healthcare in the U.S.

Of course, one of the primary goals of health information exchange has been to provide smarter data to improve clinical and business outcomes. However, presenting an appropriate view of patient data when that data comes from multiple disparate, non-harmonized sources has gotten in the way. It’s not just about how the data will be transported, but ultimately about making the data useful for the healthcare professionals and patients using that data.

Many HIE initiatives are spending most of their initial focus on the transportation of health information, followed by the format for that content (e.g., the HL7 Continuity of Care Document). However, these alone do not produce the true interoperability required for successful health information exchange. Interoperability that enables two or more disparate systems to communicate information meaningfully requires three predefined components: Transport, Content and Presentation. Standard vocabularies and vocabulary management services provide a computable content framework along with the necessary flexibility in presentation. Building a local and standard vocabulary infrastructure early in the HIE development can offer rewards including a higher degree of interoperability and a more satisfying end user experience. As an example, using a standard vocabulary for lab results, such as LOINC, provides computable data for decision support and public health reporting. Additionally, the powerful combination of marrying LOINC with a mapping and translation service allows local test compendia to be represented on screen along with its standardized concept, ensuring that clinical information is clearly understood by all healthcare professionals across the HIE, and helping to drive positive transformation of healthcare delivery.

Every HIE initiative should have a comprehensive strategy for all the components of interoperability, and should address elements such as:

  • How can we efficiently, accurately, and affordably harmonize our data to be truly semantically interoperable for health information exchange?
  • How do we transform current and legacy data to vocabulary standards required for delivery on Meaningful Use and ACO Quality Measures?
  • With continual advances in medical knowledge, how do we maintain our information assets once we’ve created them?

While these are questions every healthcare organization should ask, they are especially critical for HIE participants. Since HIEs encompass many stakeholders who will ultimately be impacted by the success or failure of how well these questions were addressed, it underscores the need to have a vocabulary strategy early in the planning process… and that’s just what a major Health Information Exchange did.

This large HIE is a non-profit organization formed by hospitals, local and state health departments, and other healthcare and community organizations across the state. Already well-established, this HIE seeks to grow both the number of participants and the breadth of services it provides.

Legacy processes, which required an intensive and mostly manual vocabulary mapping effort against a homegrown dictionary, were deemed to be unsustainable as the organization grows. A plan to integrate industry-standard vocabularies and purpose-built vocabulary management tools was developed and put out to bid. Working with the prime systems integrator and directly with the HIE, Apelon was chosen to assist in this effort. Now, additional participants can be onboarded more quickly, runtime access to terminology standards has been streamlined, and updates to terminology standards are automated.

As HIEs continue to evolve and provide greater value in support of clinical decision support, public health reporting, business intelligence and analytics systems, it is essential to have a semantic framework that can be deployed efficiently, accurately, and affordably. Apelon’s capabilities in deploying large-scale semantic HIE environments is unparalleled, and to that end, we look forward to being a very significant driver of positive healthcare transformation.