JAN 29, 2013 12:28pm ET

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CIO Spooner: Interoperability Standards can Cut Interface Costs, HIE Barriers

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Interface costs are one of several barriers impeding adoption of health information exchange, according to Sharp HealthCare CIO Bill Spooner. The HIT Policy and Standards Committees held a joint hearing on Jan. 29 to get public input on a range of HIE issues and Spooner’s testimony laid out eight recommendations to support continued maturation of HIE.

That includes reaching the goal of truly standard interoperability standards that could be expected to bring down interface costs, Spooner said in written testimony. But he also asked that the government consider publishing each vendor’s interface fees on a Web site. “While the EHR is not the specific topic of this hearing, it is important to note the barriers to HIE related to incomplete and unspecific interoperability standards and the cost of interfacing the EHR with the HIE,” he noted. “It is not uncommon for providers to report interface cost quotes in the $5,000-$10,000 and higher range, with some reported as high as $20,000, while vendors comment that every interface is different and requires custom development. Small practices just cannot afford such costs.”

As the industry moves toward accountable care organizations and other new care delivery and payment models, federal and private health payers must move toward standardizing data collection and reporting processes, Spooner asserted. He recommends ensuring that transaction types and outcomes indicators of federal and private ACOs are consistently defined and can reasonably be automated.

“Work with vendors and providers for agreement on the appropriate indicators and reasonable implementation timetables,” Spooner wrote. “While this recommendation more closely relates to the EHR itself, the data must be interoperable among ACO partners. Additionally, excess effort with such outcomes indicators impacts HIE as such effort diverts resources that might be otherwise employed at HIE. This is a significant problem today.”

Testimony from Spooner and others is available here.

Comments (2)
Single Standard Works! In New York State we adopted a single standard which uses IHE (PIX, PDQ, and XDS.b) for transactions and the NIST validated continuity of care document (CCD 2.5) with HITSP extensions for content as specified for meaningful use. HIXNY, the northeast region of the state, went live with this on 9/29/11 and now has several EMR vendors at interoperablity with more on the way. HIXNY has well over 1 million CCDs in the exchange, clinical data on 85% of the people in the region, hundreds of practice locations connected on the open standards, thousands of users in total on its portal and interoperable web services, and interoperablity with legacy data feeds (HL7 2.x from hospotals) by forming an on demand CCD and/or portal view that comprises both. HIXNY doesn't have to pay to develop any additional custom interfaces inside the HIE and it doesn't support any non-standard means for providing or consuming CCDs. See http://www.govhealthit.com/news/rybas-16-rules-hie for more information on how HIXNY made this happen.
Posted by Joel R | Tuesday, January 29 2013 at 4:11PM ET
I agree single standard does work and a strong focus on IHE profiles is the only way to appropriately achieve interoperability within HIE transactions. However in Northern Illinois within the Rockford Area HIE Pilot program we haven't found that the underlying EMR vendors are as ready (OR WILLING) with these standards as one would think. Unfortunately the Federal Government and the ONC has set the BAR way too low for HIE interoperability to be fully integrated within underlying EMR systems very soon. Instead we focus on something like DIRECT that although works is probably the worst insult to provider workflow that has ever been invented. Transfer of secure email through DIRECT isn't a standard its a copout and forcing a provider to go to their email or a Web Portal to look at clinical information on their patient rather than embedding it within the underlying EMR application where it can be discreatly consumed and properly managed to support provider workflow is not Interoperability. We have a long way to go and until the ONC sets the bar for EMR vendors to have to reach rather than hop over we will just be here in 2, 3, or 5 years talking about why HIE's failed rather than achieving the required cost reductions through HIE.
Posted by Phil W | Saturday, February 02 2013 at 8:12AM ET
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