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The Reduction of State-coordinated HIE: How Should Public Health React?

A recent article in Health Affairs describes a significant decline in the number of both operational HIEs and HIEs in the planning stage from several years earlier. The authors note continuing barriers to broad-based HIE and a shift to vendor-driven exchange which diminishes the effectiveness of community-based networks. In effect, this translates to a shift away from geographic-based/dominated HIEs to product-dominated HIEs. We have already noted (see The Interoperability of Things) the lack of a national strategy on HIE, and ONC’s Nationwide Interoperability Roadmap barely mentions the concept.

So what does this mean for public health, especially when most public health data exchange happens on a jurisdiction-by-jurisdiction basis? EHR vendors already complain about the inconsistent implementation of interoperability standards across public health agencies. A move away from jurisdiction-based HIEs will make it harder for public health agencies to engage with vendors and providers on core public health reporting and data access despite requirements from state/local law or the CMS EHR Incentive Programs.

Here are a few suggestions about what public health agencies can do:

• Move wherever possible to more standardized versions of both transport and messaging standards with as little local variation as possible. For example, the American Immunization Registry Association (AIRA) has developed an Aggregate Analysis Reporting Tool (AART) to help Immunization Information System (IIS) projects assess their compliance with national interoperability standards.
• Continue to work with state-based or community HIEs where they exist, as they make good partners for interoperability and can help promote standard approaches within the jurisdiction. There are certainly some strong examples of State HIE that are thriving and well – DE, IN, MI, NY, and VT to name a few.
• Consider participating in new organizations that are working aggressively to promote health exchange but which have had very little formal public health participation to date, including vendor associations (like the Commonwell Health Alliance), large provider collaborations (like the Care Connectivity Consortium), and private, national organizations providing health information exchange services (like the Sequoia Project).
• Continue to work with public health professional organizations to promote public health’s interests in interoperability.
• Continue to advocate with CDC and other government agencies for public health funding to promote and implement standards-based solutions for interoperability.

A new collaboration between public health, large vendors, and major provider organizations – organized by the Robert Wood Johnson Foundation (RWJF), the Public Health Informatics Institute (PHII), and Deloitte Consulting – is just beginning. Though the initial focus is on electronic case reporting (eCR), with any luck its scope will expand to include other initiatives as well.