HIEs: A Major Disconnect

HIEs: A Major DisconnectI recently came upon some unsettling information about the current state of HIEs (Health Information Exchanges). It was disturbing in light of the increasingly important role that interoperability plays in healthcare and because expectations are already being placed on many physicians regarding clinical data exchange. Much is written about the problems that HIEs face—the challenges most commonly being attributed to funding, business sustainability, and, in a recent post, insufficient EHR penetration. But what I discovered in conversations with a major HIE reveals an even bigger shortcoming.

A nationally known hospital system in a major metropolitan area has implemented an HIE operated by one of the biggest names in the world of health information exchange. One would expect this large company to be on the forefront of this emerging area of technology. However, this HIE vendor is incapable of accepting clinical data in the current, standard format (CCD—Continuity of Care Document), despite the fact that CCD has been recognized as the “new” standard since 2008. CCD was selected by the Healthcare Information Technology Standards Panel (HITSP), recognized by the Secretary of HHS, and named as the standard for clinical data exchange in the Meaningful Use regulations. This major HIE told us that CCD is “on their development roadmap,” and that they currently accept clinical data only in HL7 format.

The problem this creates is that, once again, physicians are left holding the bag! At this particular hospital, many of the independent physicians are members of an organization that represents their interests. They are implementing EHRs—which is a good thing—and are expected to participate in the HIE and to exchange data by the end of this year. However, their respective EHR vendors will have to maintain multiple standards to satisfy all of the various participants, and this will incur higher costs, which will ultimately be borne by the physicians.

How can we expect true sharing of data when not all parties that participate in information sharing are being held to the same standards—standards that have been established specifically for this purpose? Perhaps HIEs should be regulated to ensure compliance, just as EHRs and the physicians who implement them are.

4 thoughts on “HIEs: A Major Disconnect

  1. This is a pretty rediculous story. The CCD is an HL7 format. What HITSP adopted and sent to the Secretary was not the CCD but the C32, a sort of CCD lite. Why the journalistic silliness? It is one thing to protect your sources, it is quite another to keep the name of the subject of a story secret. That borders on gossip not news.

    [from Evan Steele:]


    Because EMR Straight Talk is read by people with technical backgrounds like you, but also by people with non-technical expertise, this post addressed the issue at a high level, without including the details related to the various HL7 formats.

    You are technically correct that CCD is an HL7 standard (part of the CDA HL7 3.x framework), however, when I referred to “HL7 formats,” I was talking specifically about the HL7 2.3 and 2.5 standards. It requires several 2.3/2.5 messages to transmit the same set of information that is encapsulated in one CCD message. This is why instead of sending this particular HIE one CCD, we are required to send them ORU, ADT, MDM and other types of HL7 2.3/2.5 messages which all have subtle differences. Because CCD is so much more comprehensive than the traditional HL7 2.x messages, the interfaces focus on the delivery of one message in one format, significantly reducing overall costs.

  2. Totally agree with your comments Evan. I’m running into the same issue with our regional HIE. They want everything transmitted via HL7 when the EMR already supports CCDs. While the vendor can do this, you are absolutely correct in your assumption that the cost of the interface will have to be borne by the physicians. Translation: I believe there is simply not enough value being delivered by the HIE to encourage adoption by independent medical practices.

  3. I am one of the non-technical people and though I understand the surface not the details of the formats. What I do understand is that everything we are doing in Healthcare right now is riddled with problems.

    I still have payors who cannot receive and electronic claim or send and electronic ERA and we are hovering over 5010 now instead of 4010.

    Gov’t is contemplating ICD10 which I am all in favor of but not until we have 100% compliance with 5010 electronic claims and payments. Those that can’t comply need to take their ball and get off the field.

    Then as things such as HIE and the sharing of data comes to fruition we are still working on getting paid timely.
    As far as HIE formats – we need it one way and beta test the __ out of it. Then bring it to market and quit changing formats every couple of years – each major change requires another 15,000 interfaces to be written. Anyone seen the medicare and medicaid rates these days – it’s not sustainable to have these ongoing electronic costs and changes. Then of course there is the purpose?

  4. The MU audits are just starting, and as of July 1, ANSI is now empowered to hear complaints from providers and others about certified systems that do not implement ONC MU criteria. Creating, communicating and reading CCRs and CCDs are mandatory parts of the certification process ( 170.304(i) ). So if this big time vendor won’t accept a CCD, sounds like you (or your client with your help) should file a complaint with ANSI and ONC. That’ll get their attention.

    In my experience, some vendors ‘danced’ through the ONC certification process with ‘prototype’ systems, it’s now time to hold their feet to the fire!

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