“In my view this really has to be driven by patients. If the consumers demand [HIE] of more doctors, more hospitals, more specialists it will become necessary for them to do it,” Manjunath said. “We want the public to speak up because it’s also in their best interest to have the most updated information for treatment. And the more specialists that use our information the better for our patients. We want more people to join.”

The more patients and providers that align with the HIE, the more data HIXNY can access. That opens opportunities to consider for the future, McKinney said, including potentially hooking into the New York State Universal Public Health Node; the initial use case is feeding patient information into the immunization registry. Future ones might include newborn screening and syndromic surveillance.

Willamette River Valley

Whereas Direct secure messaging and patient look-up gained purchase in HIE 1.0, this new breed of use cases is also under consideration elsewhere.

Across the contiguous United States in Salem, Oregon — coincidentally 25 miles due north of Albany, Ore and situated in another river valley, the Willamette — Carol Robinson is contemplating similar use cases for the future of HIE in the Beaver State at the Oregon Health Authority (OHA).

The State coordinator for Health IT and director of health information technology policy design when Government Health IT spoke with her in mid-December, Robinson (pictured at right) has since left to found her own consulting firm, Robinson and Associates. During the interview, Robinson said that among the use cases OHA might consider for the future are a pilot program under which hospitals can report into syndromic surveillance programs through Direct, as well as ensuring providers and hospitals can access their records, and patients can download them, and making that functionality available for other health reporting moving forward. Another one under consideration is Blue Button implementation.

“The Direct secure messaging tool, as simple as it is, providers that have not been able to exchange information with others outside of a fax or a phone, their eyes light up when we show them if they get their medical trading partners in, this is more secure and it will fit nicely into your workflow,” Robinson said. “Their eyes just light up at the simplicity. So when EHRs start certifying for Stage 2 and it gets embedded into the electronic health records, I anticipate that will be really significant in helping the interoperability that has been so challenging.”

[See also: To date, no one HIE model fits all.]

Profound impacts