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SOLUTION PROVIDER Q&A Facing the Complexities of


Moving forward around HIE An important conversation with Chris Hobson, M.D., Chief Medical Officer at Orion Health


Earlier this autumn, Healthcare Innovation Editor-in-Chief Mark Hagland spoke with Chris Hobson, M.D., Chief Medical Officer at Orion Health, about some of the complexi- ties facing the health information exchange (HIE) sector in U.S. healthcare, during a recent digital healthcare innovation event sponsored by Healthcare Innovation. Dr. Hobson spent 16 years as a hospital physician in primary care in New Zealand before joining Orion as an executive nearly 20 years ago; his perspec- tive is international and global, around health data exchange and related issues. Below are a few excerpts from their recent discussion.


There are so many models for HIE. Is that helpful? Or a problem, at this point in time? As a rule, we like competition; competition is a good thing. It makes us strive to do better. As a principle, we’re very happy working in a competitive market; and the U.S. is a highly competitive market. There are actu- ally different models for what an HIE does. One is direct exchange of secure messages. We see the large and small EHR [electronic health record] vendors saying, we comply with most of the standards, so you can just put your data in here; and that model holds a lot of appeal, especially to hospitals and large enterprise. And we’ve always focused on the ability to take data in any form and store and share it. So competition is good, but does have to be managed to some extent. When you look at how HIE models are evolving right now in this landscape, what’s your 40,000-feet-up view of how well the models are evolving forward? I think things are evolving forward pretty well; it doesn’t mean the next steps will be easy; but things are going well. The pressure of COVID pushed a lot of new automation. At the start of the pandemic, we had cus- tomers saying, please, just give us the tech- nology; they were very eager. And from my clinician perspective, there are a number of studies showing that the use of clinician and general use of HIEs is steadily improving.


We’re learning that in about one-third of ED [emergency department] visits, physicians looked into the HIE. But those numbers are going up; people are happy, they’re deriving value. A couple of weeks ago, a nurse told me, “When it comes to the HIE, clinicians go their first; they trust the HIE.” So I think things are improving. We were up to about 100 HIEs across the U.S.; we’re down to about 50, which seems to be about the right number.


How do you think the 21st- Century Cures Act will drive change, and hopefully innovation in the HIE sector, and greater interoperability? As a rule, we like TEFCA [the Trusted Exchange


Chris Hobson MD, MBA Chief Medical Officer Orion Health


as standards move forward, it reduces the number of times we need to do non-standard things for our clients. The more standardized, the better for us.


Framework and Common


Agreement] and the 21st Century Cures Act and the things that it’s pushing the market to do. For one thing, there’s the emphasis on FHIR APIs; that’s a good thing. That’s an ideal mechanism for It’s the exchange of patient- centric data; it empowers patients, and allows the payer to pay for data exchange; those are really good things. The reality for us is that some systems, some vendors are just not ready technologically; they can do HL7 V2. The information-blocking rules and the requirement to exchange USCDI [the United States Core Data for Interoperability (USCDI) standardized set of health data classes and constituent data elements for nationwide, interoperable health information exchange] data—if that works that will provide a big push to the industry to move forward, and we’ll be very supportive of that. The sec- ond thing to talk about here is TEFCA, the Trusted Exchange Framework and Common Agreement. We really like it. The concept of a QHIN—where you’re going from being a health information network to being a qualified health information network—we like that. And we like the ability to move data between HIEs, using standards. I saw the other day that ONC is saying that they’ll move to that next stage with TEFCA in 2022; and we see that as a positive. And


You bring up the fact that we’ve got perhaps too many models. That’s right. Having many models, you will pick up on the strengths and weaknesses of the different models, and that’s good. But, perish the thought in the United States, yes, the government does have to play a role, in setting standards and creating some common- ality. I think that ONC and CMS are doing the right things in that regard.


As we shift more and more into value-based contracting, more and more information will be needed. How will that affect data exchange? We have payers who say, we want you, the providers, to move to value-based care. And the providers say, well, we need the data. Data is essential for doing value-based care. And the interoperability, as described in the CARES Act, is really for the benefit of the entire popu- lation. So our ACO [accountable care organi- zation] clients often start with the HIE as one of the key enabling things they need.


Sponsored Content


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NOVEMBER/DECEMBER 2021 | hcinnovationgroup.com


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