Hawai'i Health Information Exchange


The Hawai‘i HIE is a non-profit organization that was established in 2006 and became the state designated entity in 2009. Hawai‘i HIE’s mission is to positively transform healthcare in the State of Hawai‘i through efficient and secure exchange of critical health care information, improving the health outcomes of Hawai‘i’s patients and reducing the cost of care for both patients and healthcare providers. Their goal is to develop a seamless, effective, and secure statewide health information exchange that is able to connect with the nationwide health network.

In this HIE Non-profit Q&AChristine Sakuda discusses her experience as Executive Director of the Hawai‘i Health Information Exchange, where the need for physicians to connect is one of the few constants in a rapidly evolving health care environment.


I joined in 2005 because I valued bringing national health IT knowledge and expertise to our small, remote state. Since then, I’ve been rewarded with authoritative, accurate, credible and timely information that HIMSS does so well.

Geographic isolation, cultural distinctions and infrastructure challenges in Hawai‘i bring to bear the ability (that HIMSS provides) in enabling us to network with other like-minded HIE organizations. The state HIE community is a small but tight-knit one; HIMSS has helped to facilitate an open, trusted dialogue – critical to our success.

Since ONC funding ended, the Hawai‘i HIE has continued to benefit the community.  Some Hawai'i HIE major milestones include:

  • 2014 – Hawai‘i HIE supports transmission of lab data to payers, reducing waiting time from six weeks to two minutes.
  • 2014-2015 – A pilot partnership between Hawai‘i HIE and U. of Hawai‘i at Hilo, College of Pharmacy, saves $ millions for Medicare
  • May 2015 – The Community Health Record goes live
  • May 2015 – The Hosted Referral Module goes live
  • Oct 2015 – 400 clinics and practices use Hawai‘i HIE
  • Nov 2015 – Hawai‘i HIE reaches 1,000,000 unique patients
  • Nov 2015 – Hawai‘i HIE reaches 20,000,000 clinical records
  • Dec 2015 – 1,000 providers use Hawai‘i HIE
  • Dec 2015 – Hawai‘i HIE reaches 25,000 Transition of Care messages sent

Change is constant. Case in point: the recent Meaningful Use incentive programs evolving into MACRA. Despite the upheaval, the need for physician EMRs to be connected just becomes more and more evident. Another example is our customers’ demands. To continue being viewed as a viable solutions provider, the Hawai‘i HIE continues to meet the ever-changing requirements of each integrated delivery network we serve.

Hawai‘i HIE has built a solid foundation of governance and trust. We survived after ONC funding dried up in 2014. The statewide Community Health Record has gone from a unicorn to a reality; physicians who once heard about it with cocked eyebrows now can touch and feel it. But we’ve also learned that working on trust and governance is never ending. Given the constant changes in health care, we must repeatedly validate and articulate the value we bring to the customer.

First, we gathered the major health care leadership in the same room, so to speak, and made sure all stakeholders agreed on what foundational technology and services would constitute the first phase of an exchange. Second, we established a core set of data contributors: hospitals, laboratories and medication suppliers. Third, we implemented key products that leveraged our common data set: 1) a web-based query on a patient’s health record across the community, 2) direct secure messaging and 3) a web-referral management system. Participation, by the way, had to include the major Neighbor Islands (Hawaiian islands other than O‘ahu). Then, we worked hard to deliver the products by focusing on the data contributors, followed by an implementation strategy to rapidly onboard physician users. And we asked each user to invite five friends, à la Facebook.

At the end of the day, customers buy solutions, not technology. You have to articulate the value of your products. The foundation of any HIE is trust and accountability. And that goes both ways; we can’t provide a viable solution unless everyone agrees to share data. Trust is more than a word; it’s an action. To elicit trust, you have to demonstrate trust.

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