Approaching HIE Engagement

Service Provider

Some HIE organizations (HIO) may act as a service provider. Like a telephone company, they offer various services at different prices. Your relationship is limited to picking the best contract for the best service at the best price. If you want something better or cheaper, you change providers - in other words, the service is a commodity. Like your phone company, they don't expect or even want you to seek a seat on their board.

Currently (summer 2014), this is not a common exchange service offering for public health. This is because HIE connections for health departments are not yet very standardized, and existing public health exchange services can be both limited and complicated from either a technology or a pricing perspective. However, as more exchange services become nationally standardized and integrated into certified EHR products, these relationships may become more common. Health departments investing in EHR systems may find some HIE services, like Direct messaging, currently offered through their EHR vendor, and thus may already have options to choose from.

Business Investment

More often, there will be a significant up-front business investment in the form of time, money and maybe technical modifications to implement HIE. The fiscally responsible health officer should ascertain whether the return on investment (ROI) - in money or in public health capacity - is worthwhile.

Such calculations are not always straightforward. In addition to calculating the costs and benefits of the exchange services arrangement, one must also consider the risk that the HIO in which you invest fails to produce the expected benefits, or to survive. On the other hand, your stockholding may give you influence and potential participation in the governance of the HIO.

Your value to the organization is more than financial. Because your participation may influence others' participation and funding, and because your department may bring unique information to the exchange, you might be able to negotiate when it comes to prices and services.

Strategic Relationship

Finally, you may to enter a strategic relationship with an HIO, creating an ongoing affiliation for transformative change in the community. In other words, you may conclude that the health of the entire community could benefit from HIE services, and thus your involvement is about more than just your agency's ROI. At this level, the public health department is not only an investor, but becomes a strategic leader in the exchange.

Available relationship opportunities will change depending on who offers services in your jurisdiction, which services are needed by the health department, and the health department's capabilities. There is no "one right answer." The environment for HIE will likely continue to change rapidly over the coming years, and so will the need for regular reassessments of such decisions.

The Environmental Scan

There may be more than just one organization offering, or planning, HIE services in a given jurisdiction. Identifying each of these early on is highly recommended. Information on HIE service offerings and HIOs goes out of date very rapidly, so there is no one single comprehensive source of such information available at this time. However, the following resources may be useful in assessing the options available in your area.

• Your Regional Extension Center (REC) for health IT
• The list of HHS ONC State HIE Grantees
• The list of Agency for Health Research and Quality (AHRQ) HIE Grantees
• Your EHR vendor (if you have one)
• Your state hospital association
• Your state medical association
• Local chapters of the Healthcare Information and Management Systems Society (HIMSS) or the American Health Information Management Association (AHIMA)
• State and local public health staff addressing Meaningful Use objectives (e.g., syndromic surveillance, disease registries)
• Others who frequently exchange information with clinicians (e.g., vital registration and health alert network)

DOWNLOAD: Tool 2 - Locating HIE Services

It is important to note that some public health information systems represent successful narrow-purpose HIE systems, and should be considered alongside other HIE options. For example, a communicable disease surveillance system, syndromic surveillance system, or immunization information system in your jurisdiction may be establishing successful relationships directly with healthcare providers without depending on third-party HIE organizations.

Be sure to consult your own staff leads in these program areas to assess the adequacy of current and planned public health exchange solutions. If state public health systems meet local health department needs (and those of healthcare providers), they need not be duplicated. This frees you to explore other available HIE functions that might match different health department needs.

Early Data Gathering on Each HIE Option

As you investigate HIE options, try to obtain the following information:

• What existing HIE systems serve healthcare providers in your jurisdiction?
  • These may be public or private, broad-purposed or narrowly focused, EHR-based or freestanding, etc.
• What use cases / exchange functions does each offer now, and plan to offer in the future?
• Who are the actual or committed information exchange members?
  • In other words, which providers - and which types of provider - are committed to exchanging what information?
• What are the corporate and governance structures?
  • Examples include private for-profit companies, non-profit collaboratives, institutionally sponsored organizations, etc.
  • How could the health department participate in governance?
• Membership criteria
• Fee structures
• Participation agreements (such as membership, data sharing and service level agreements)
• Business plan, if it is shared

DOWNLOAD: Tool 3 - HIE Data Gathering

The information gathered above will help you in the following sections to identify which HIE options have relevance for a particular health department, identify possible HIE projects, perform due diligence on a possible HIE partnership, and create the final business case for an HIE project.