Rebuilding the Tower of Babel – A CEO’s Perspective on Health Information Exchanges

The United States is confronting the most significant shortage of health care professionals in our country’s history which is compounded by an increasing geriatric population. In 2005 there have been one geriatrician for every 5,000 US residents over 65 and only nine of those 145 medical colleges trained geriatricians. By 2020 the industry is anticipated to be short 200,000 doctors and over a million physicians. Never, in the history of US healthcare, has been demanded with so few personnel. Because of this deficit combined with the geriatric population increase, the medical community has to find a way to provide timely, accurate advice to people who need it in a uniform manner. Imagine if flight controllers spoke the native language of their nation rather than the present international flight language, English. This example captures the urgency and critical nature of the need for standardized communication in health care. A wholesome information exchange might help improve security, reduce length of hospital stays, cut down on medication errors, reduce redundancies in laboratory testing or procedures and make the health system faster, leaner and more effective. The aging US population and those impacted by chronic disease like diabetes, obesity, cardiovascular disease and allergies will need to see more specialists who will need to locate a means to communicate with primary care providers effectively and economically.

This efficacy can only be achieved by standardizing the way the communication takes place. Healthbridge, a Cincinnati based HIE and one of the largest community based programs, managed to lessen their possible disease outbreaks from 5 to 8 down to 48 hours using a regional health information exchange. In both cases communication can be achieved but the process is cumbersome and often ineffective.”

United States retailers transitioned over twenty years back in order to automate inventory, sales, accounting controls which all improve efficiency and effectiveness. While uncomfortable to think of individuals as stock, perhaps this has been a part of the reason behind the dearth of transition from the principal care setting to automation of patient records and data. Imagine a Mom & Pop hardware shop on almost any square in mid century America packed with inventory on shelves, ordering duplicate widgets based on lack of information regarding current inventory. Picture any Home Depot or Lowes and you get a glimpse of how automation has changed the retail sector in terms of scalability and efficiency. Possibly the”art of medicine” is a barrier to more productive, effective and smarter medicine. Standards in information exchange have been around since 1989, but recent ports have evolved more rapidly thanks to progress in standardization of state and regional health information exchanges.

The success of the early networks was linked to a integration with primary care EHR systems in place. Health Level 7 (HL7) signifies the first health language standardization system in the United States, beginning with a meeting in the University of Pennsylvania in 1987. HL7 has been successful in replacing antiquated interactions such as faxing, direct and mail provider communication, which frequently represent duplication and inefficiency. Process interoperability raises human understanding across networks health programs to incorporate and communicate. Standardization will ultimately affect how successful that communication functions in exactly the exact same manner that grammar standards foster improved communication. The United States National Health Information Network (NHIN) sets the standards that foster this delivery of communication between health networks. HL7 is currently on it’s third version that was printed in 2004. The aims of HL7 are to increase interoperability, develop standards that are coherent, educate the industry on standardization and collaborate with other sanctioning bodies such as ANSI and ISO who are also concerned with process improvement.

From the United States among the First HIE’s began in Portland Maine. HealthInfoNet is a public-private venture and is believed to be the biggest statewide HIE. The goals of the network are to improve patient safety, enhance the quality of medical care, increase efficiency, reduce service duplicationand identify public threats more quickly and enlarge patient record access.

In Tennessee Regional Health Information Organizations (RHIO’s) initiated in Memphis and the Tri Cities region. Carespark, a 501(3)c, in the Tri Cities area was considered a direct project where clinicians interact directly with each other using Carespark’s HL7 compliant system as an intermediary to interpret the information bi-directionally. Veterans Affairs (VA) practices also played a crucial role in the first phases of building this network. In the delta the midsouth eHealth Alliance is a RHIO connecting Memphis hospitals like Baptist Memorial (5 sites), Methodist Systems, Lebonheur Healthcare, Memphis Children’s Clinic, St. Francis Health System, St Jude, The Regional Medical Center and UT Medical. These regional programs make it possible for practitioners to share medical records, lab values medicines and other reports in a much more effective manner.