The health care industry is currently on two parallel tracks: Maintaining the legacy of fee-for-service while embracing the emergence of value-based programs. This environment has created many obstacles to interoperability and health information exchange (HIE). Organizations deeply entrenched in a fee-for-service business model may still be maintaining a “data hoarding” mindset. Providers may also be struggling to maintain unique processes, systems and workflow to support these two models. As a result, they are hesitant to fully embrace new technical, operational and clinical practices.

While the technology needed to enable true interoperability already exists, the legacy mindset can create major pitfalls for organizations entering this value-based care arena. Those that can avoid many common missteps will be well-positioned to improve population health and better manage costs through sustainable HIE.

Examining the essential domains
In order to identify potential missteps, it helps to first examine some of the industry standards and best practices that have emerged in the public sector. The Office of the National Coordinator (ONC) identified five specific domains that are essential to health information exchange:

1. Data governance,
2. Finance (sustainability)
3. Technical infrastructure
4. Business
5. Technical operations and legal/policy

These areas are tightly intertwined, so it is best to examine them through a big picture lens. For example, your organization may need to identify the hardware, software and network configurations needed to support a technical infrastructure. Of course, this dimension will also have a direct impact on your finances and sustainability.

If your organization overlooks the importance of these key areas, the mistake can lead to a lack of long-term value, increased costs and low provider adoption. For instance, sustainability requires that you think through the long-term community value for an HIE asset. Without advance planning, you may realize years down the road that your organization has not put the right infrastructure in place to manage new care models.

Governance is another area that can have a major impact on success. Common pitfalls include a lack of planning around the establishment of data ownership and control. As previously mentioned, many health systems and hospitals are still in competition for market share. Data sharing can often feel counterintuitive to this concept. Strategies that take these issues into account, by carefully establishing clear data provenance and control, will build trust and confidence among all stakeholders.

The legal and policy domain requires a willingness to constantly adapt and think through future changes. It is difficult to predict what new policies might be put in place by federal and state entities; however, you must consider these factors as you plan to develop and implement any HIE initiative. This will ensure that your efforts are aligned with the current industry environment as well as flexible to adapt to any future policies or mandates.

Applying real-world lessons
Learning from real-world experience is also critical to avoiding potential pitfalls for a number of reasons. While there is plenty of academic research around interoperability and effective HIE, many recommendations have never been put into practice. The reason? They are much too conceptual and overlook the complexities that exist within any community of care. These include providers’ distinct workflow and EHRs, a health system’s existing technology investments, etc. There is no “plug and play” HIE capability that exists today for these reasons. Most of the knowledge that has been gained in our industry has been through trial and error and the perseverance of early innovators.

A few specific pitfalls that have been identified and overcome (or avoided) by these entities, which may apply to your own efforts, include:

Not having the right people in place to support the effort. It is critical to have both strong physician and administrative leadership within an implementation strategy team. That’s because an initiative of this size and scope needs executive sponsorship and support of influencers. These individuals can sell your vision, connect with stakeholders and ensure your efforts are aligned. Otherwise, stakeholders will view your initiative as just another IT project. Instead, leaders should be communicating that this is a mission-critical clinical, technical and operational effort that happens to be supported by IT.

Lacking a true understanding of end-users. While gaining physician buy-in is a common best practice, many organizations tend to overlook the largest group of actual HIE users — support staff. These could include a physician’s office staff, an ACO’s care managers or transition care nurses. Your organization’s HIE efforts can quickly struggle if you do not define and understand the diverse needs of all end users.

Trying to “boil the ocean”. Another common pitfall is the tendency for organizations to focus on the most complex and unproven areas or to try and perfect every element of their approach before delivering value. You will commonly see the result of this decision in an 18-month (or longer) implementation. Extended wait times are not ideal for providers looking to experience value. Instead, consider a multi-stage implementation approach. This will allow your organization to focus on delivering value in one or two “quick wins” at a time.

Industry-wide effort
These common pitfalls just scratch the surface of the many lessons learned and best practices in interoperability that have recently emerged.

Interoperability is going to take input from your own staff members, community partners, and technology vendors that have had real-world experience in these areas. It is only through this level of collaboration — which is also central to the nature of HIE — that our industry will achieve successful interoperability across all communities of care.