Thursday, August 30, 2012

"Version the Verb" is more efficient with "HIE the Noun"

What happens when you version the standards for P2P exchange?

One of the key value propositions of "HIE the noun", for example an Enterprise Service Bus (ESB) based regional patient-centric exchange, is that it abstracts between data providers and data consumers. Thus, if a new standard comes along, some can implement it and some can hold off. The HIE provides the abstraction between the two. There is no tight-coupling between trading partners. In the "we will all do the same thing peer to peer" model, doesn't it break when something new comes along? Otherwise, every P2P end-point needs to support every standard that emerges as they emerge and until everyone has it implemented, the world is frozen.
That sounds an awful lot like where HIT is with ICD10 right now. Most systems seem to have tightly coupled to the ICD9 codes rather than having an abstraction in their system between internal coding and the outward facing standard codes, now they have trouble upgrading, and nobody can move until everybody moves or the trading partners need to build the abstraction that they missed so that they can do both without losing granularity in the coding. Why repeat the ICD10 mess, build on abstraction!
Part of the argument for a P2P strategy is that current HIE is too expensive if you can even do it. I say ESB based HIE is less expensive than the support of P2P because of reuse and we do it every single day.

Essentially, I only see 3 possible ways to support electronic HIE:
  1. You build on a single standard and never change it so that P2P is inexpensive but is not adaptive to change or extensible for new solutions.
  2. You allow change but still want P2P so everyone runs an ESB and everyone supports every version of every standard and they need to tightly-couple to their trading partners by knowing what standard they support and transforming to that standard.
  3. You have a community service bus, an "HIE the noun", and thus you benefit from reuse. Everyone has one integration with the ESB rather than with each other. And you benefit from abstraction. You don't need to know how your trading partners can send or receive data, the HIE takes care of the transformation.
If option one were a reasonable model, we would all be running Version 1 of just about everything. So logically, that is not going to happen. Option two is what option one leads to once you realize standards version and get replaced. Option three is the cost saving alternative to two where you centralize the abstraction as a service. That abstraction service is called HIE and it is generally provided by RHIOs in the parts of the country that have successfully matured this service. So what is the argument for P2P being less expensive again if it results in every system having to be an ESB and everyone having to know how what their trading partners can support?

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