Many healthcare organizations lack a coherent strategy for transforming and integrating their healthcare IT solutions. Developing this strategy requires a solid understanding of business problems and use cases that they are trying to solve. These problems and use cases should drive the development of functional and technical requirements for an HIE. It is important for organizations to recognize that the successful integration of healthcare records does not come without significant challenges that they must consider and plan carefully. The following key challenges must be considered early in the process:
Patient Consent: Depending on the state in which they operate, U.S. healthcare organizations face varying challenges surrounding patient consent, as well as the regulatory concerns around sharing healthcare data. State laws differ concerning the shareability of data (e.g., what can be shared, how it can be shared, etc.), starting with the patient deciding whether or not they will share personal healthcare information by default and what rights the patient has to either suppress or share certain parts of their health record. For example, when one state wants to share data with another state but those states have different consent models, information sharing becomes a challenge. However, national networks such as the eHealth Exchange and CommonWell Health Alliance have examined these issues and developed some good models to determine how to work through them.
Obtaining patient consent remains the greatest challenge to creating a collaborative care network, as HIEs in the US are required to obtain patient consent to be in compliance with the Health Insurance Portability and Accountability Act (HIPAA) and individual state laws and regulations. Patient consent can be obtained using either an “Opt-In” or “Opt-Out” method. The “Opt-In” method requires the patient to take the initiative to enroll in the HIE, generally through a written document of consent. The “Opt-Out” method automatically enrolls them (which implies consent) and requires a written request to opt-out or remove their consent to be included in the network.
Business Challenges: From a technical perspective, there are numerous challenges around patient identifier data flow and data normalization – in other words, making it possible to identify a patient across a community where different patient identifiers are used at each institution. Business requirements must be well-conceived before technical requirements are developed. Many customers end up making poor IT decisions based on what they believe the business requirements are and risk implementing a solution that fails to meet their needs.
Competitive Concerns: There is a delicate balancing act to consider when it comes to competition and collaboration. In other industries, it is instinctive to protect intellectual property and data; however, in the healthcare world, the greater good must be considered. There is the challenge of sharing data for the patient’s well-being, but in ways that incentivize healthcare systems, protect intellectual property, and encourage patient retention. Providers must be motivated to overcome short-term costs associated with integrating patient data to reap the long-term rewards of improving patient care. This generally requires government sponsorship in the form of HIE networks and grants.
Businesses must carefully strategize and plan to overcome these challenges before implementing their HIE. Failing to address the factors described above will lead to more problems down the road, thereby complicating life for both the organization and its patients.
About the Author
Michael LaRocca is the CEO of the New York-based health technology firm Ready Computing, which offers innovative services that improve patient care. Michael’s expertise includes a thorough understanding of the standards, protocols, technologies, and architectures required to successfully integrate healthcare data. He is passionate about holistic patient treatment plans and is very active in consortiums, and working groups focused on healthcare data integration.