By Frank Din, DMD, MA, Medical Informatician for HIE
You probably already know all the official bullet point reasons why a Health Information Exchange (HIE) is important; improve quality, lower costs, yadda, yadda, yadda. But I want to take a more visionary and holistic view to address the ‘why’ of HIE, and by doing this, hopefully I can reduce that burden and confusion which the typical business case analysis often imposes.
When we strip away all the noise, HIE is all about bringing people closer together. Once brought together, they will communicate, interact, and exchange. It is that simple.
If you look back on history, all the great leaps of civilization are preceded by improvements in the ability to communicate. This happens either by bringing people closer together physically –e.g., the first transcontinental railroad-- or via telecommunications such as telephone and radio.
HIE is just another stage in improving communication. In each of these, the reduction in time and distance between people leads to robust economic growth due to the businesses that arise to leverage the new capabilities. For example:
- The advent of the Interstate highway system permitted rapid vehicular connections among the major cities of the USA.
- The first order benefit was that goods and people could freely move from one location to another.
- Businesses quickly took advantage of this by moving goods (e.g., oranges from Florida to the north) and people (e.g., workers) from regions of supply to regions of demand. Everybody benefits.
- The second order benefits are the new businesses that arise to help the first order businesses: shipping companies, refueling stations, hotels, etc.
- Then the third order benefits develop to support the second order businesses.
Ultimately, and most surprisingly, a whole new set of capabilities arise that no one predicted --unintended consequences. Keeping with the Interstate Highway System example, the presence of the Interstate System was the perfect foundation for building out a nationwide cellular phone network. The first, second, and third order benefits had all been established when modern cell phones became available. That is, if I am building a nationwide cellular network, what better roadmap is there than the Interstate Highway System? Not only are the routes well defined (where to install the cell towers), but populations tend to extend around them (customers and employees), commerce transits along the highway (commercial customers), and political allies (more jobs and money in a community).
If you accept the metaphor of the Interstate Highway System, then the natural question is how do we equate the HIE with the three levels of benefits, and can we speculate on the fourth unintended consequences stage?
As with the highway system, the first order benefit of an HIE is the traffic that will pass through the HIE. This includes all the claims, clinical and administrative data. Doctors sharing with other doctors, health departments, patients, etc. This is where the vision of HIE typically ends. In part two, to be posted soon, I will lay out how I see the second, third, and beyond order benefits should play out for HIE. In the meantime, feel free to leave me a comment with your thoughts on HIEs.
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