Skip to main content

"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?

Comments

Post a Comment

Popular posts from this blog

Game Changing Healthcare Information Exchange

Evolving HIE Beyond just replacing the fax machine   HIE can be more of a game changer for healthcare than just being a replacement for the fax machine. The route to being a game changer is to be an enabler of care management. That care management can come from a health plan (managed care organization), an Accountable Care Organization (ACO) like a Patient Centered Medical Home or Medicaid Health Home, or from the patient/consumer as care manager for themselves or as the caretaker of another.   To do this, I think the HIE needs to serve the following customers and their use cases. These are the healthcare providers for care coordination, the care manager in the role of managing care, the care management at a program management or quality improvement level, and the care management at a financial management level.     HIE must Support Provider-Patient Coordination Use Cases   Send patient data between providers This is the primary purpose of the HIE PUSH functionality
3 comments
Read more

eRegister and Get Rid of the Clipboard

The Real Use Case for Personal Health Records (PHR) I have been at this, HIE game, for a few years or so now. And when I go out and meet new people, I get the typical, "so, what do you do" question. Once I tell them and give a little explanation of what it means, about half of them have a follow-up question. There is only ever one follow-up question and it is always the same question "so, are you going to get rid of that clipboard of paperwork that I have to do over and over again every time I go to see a doctor". The fact that I only get one question from general consumers and it is always the same question tells me one thing. This is what matters to them. This is how they see their information making it from them to their provider today. This is what they want to eliminate by using HIE or a PHR. In essence, I see the HIE and PHR as one in the same. The HIE, in a fixed repository model, is a collection of "views" of the patient. We have a primary
7 comments
Read more

Exchanging Care Plans, Discharge Summaries, and other Unstructured Narrative Content

In an ongoing debate about the readiness of HIE for Medicaid Health Homes and other ACOs, one of the issues has been the need to exchange care plans. Unfortunately, I think people are hung-up on the concept of structured XML documents and structured data. Just because the document is structured and contains many areas of coded, structured data; should not be interpreted as though there cannot be sections of data that are unstructured narratives with limited structured elements describing the content such as date/time, author, and type of report. Recently, we have gone so far as to add narrative data in several areas of the CCD where it can be supported. These include pathology reports, image studies, discharge summaries, and care plans. Part of the problem with exchanging this type of data is that the default stylesheet (XSLT) from HL7 for viewing a CDA R2 document, such as a CCD/C32, as an HTML document, does not display narrative data properly. Basically, it just needs to respect
2 comments
Read more