Whither HIE? It depends how you define it. Health information exchanges (pl. noun) have clearly gone through some fairly transformative changes these past few years. Health information exchange (verb) has too. But both, to different degrees, continue to be essential to the evolution of healthcare.

We spoke recently with Mari Greenberger, director of informatics at HIMSS, for her perspective on the current state of HIE across the industry – and her thoughts on what we can expect next.

'Network of networks' is the shape of the future
At HIMSS15 Health Information Exchange Symposium in Chicago this past spring, Greenberger said she noticed a big theme emerging: "The network of network concept was pretty prevalent," she said.

"How we're defining HIE the verb is variable," Greenberger explained. "You have eHealth Exchange, which is a hub and spoke, very much focusing on being an entity, a noun, and connecting all the various other nouns across the country using HIE the verb.

Then there are organizations such as the CommonWell Health Alliance – health systems with specific electronic health records connecting with health systems that use different EHRs – "where, again, it's a network of network type concept, but it's vendors," she says.

That's another approach that allows vendors to gain marketshare "while also sending a strong signal that they'll play well together," says Greenberger. "It's another avenue to further health information exchange, but still another concept of network of networks."

Some folks out there are doing some really innovative stuff
Greenberger points to several innovative data exchange projects she's heard about recently, such as the one at New Jersey's Hunterdon Healthcare System, which is better integrating its patient portal with its HIE capabilities.

[See also: CMIO: Patient portal a 'source of truth']

Fellmeth spoke at HIMSS15 about better leveraging HIE for consumer engagement, viewing it as critical tool for gathering patient data and supporting patient-centric tools such as social networks, gaming and more.

David Watson, CEO of California Integrated Data Exchange (Cal INDEX) was another inspiring speaker at the HIE Symposium, said Greenberger: "He brought some real advice for working with payers, and advice for getting the information moving and providing value-add to stakeholders."


Likewise, she points to Kansas Health Information Network, which "has been doing a lot to broaden their tent – as it relates to behavioral health and LTPACs."

Even if they're late to the party, LTPACS are key players
Indeed, better integration of data from long-term and post-acute care organizations is critical if all this focused on interoperability is going to lead to the outcomes we all want to see. Greenberger recently wrote a blog post on the HIMSS website titled "Shifting Interoperability Focus to Non-Eligible providers and Moving beyond Meaningful Use."

In it, she makes the case that community level health information exchange is coming to the fore as ONC expands its interoperability funding. Specifically, she points to a new one-year grant: Community Interoperability and Health Information Exchange Cooperative Agreement Program.

It has three areas of focus, according to Greenberger: 1) Identify a specific non-eligible provider population (e.g. LTPACs, behavioral health) and help this population adopt and use the specified health IT tool (e.g. portal) or HIE service; 2) extend an existing HIE service or use case (e.g. building HIE capacity, community care coordination) with the targeted non-eligible population; 3) develop a sound engagement strategy built on a strong evidence base or successful previous experiences, for use by the non-eligible care provider population.

[See also: Nursing homes get help with HIE]

"The overarching theme within this funding opportunity is focused on the community and individual care providers and helping them to become an active voice and participant in the journey towards meaningful health information exchange," she writes.

Some people say the failure to include LTPACs and other such providers in the meaningful use program was something of an original sin for interoperability preparedness.

"I think it is really unfortunate," says Greenberger. "Those are incredibly important patient populations, and incredibly important care providers."

At the same time, she concedes that some of these providers just weren't "ready from a technology and workflow standpoint" for any sort of meaningful data exchange.

"I have family who work in the behavioral health area; it really just wasn't, until recently, a part of workflow. Everything was paper-based," says Greenberger.

Thankfully, "I think over the course of the past five years there's been a lot of change, and I think some of these LTPACs have embraced the technology as much as they can considering that all of the institutions around them have done so as well."

With grants such as these, "ONC is doing a good job of trying to get those folks under the tent, and into their circle," she says. "Trying to leverage existing HIE infrastructure that's been funded over the past several years and doing what they can to connect with these providers. The time is definitely now to bring them under the tent."

As focus shifts from 'HIE the noun' to 'HIE the verb,' the 'nouns' are key to bringing those non-traditional providers on board
"The HIE nouns that are still around – and there are a lot of them – they still do have a role to play," in helping facilitate the entry of long-term, post-acute and behavioral health providers into the interoperability ecosystem, says Greenberger.

"I do think that this community needs to be a part of the fold," she says. "And it goes beyond that. It's emergency medical services, education." There's a "big opportunity to leverage the HIE infrastructure" to connect more and different types of providers.

The terminology around HIEs is evolving
"There's a lot of work going on out there," says Greenberger, and as HIEs' structure and role continues to evolve, so will what we call them. Once upon a time, "they were called CHINS, they were called RHIOs, they were called HIEs," she points out.

At HIMSS15, Mariann Yeager, CEO of Healtheway "kind of made a bold statement and said HIEs aren't going to be called HIEs anymore. They're going to be called data sharing networks."

(Indeed, not long after this article appeared in the July print edition of Healthcare IT News, Healtheway itself changed its name, to the Sequoia Project.)

Whatever they're called, this much is certain: "The exchanges that are going to remain viable are the ones that can remain as nimble and flexible as possible. Meeting the needs of the region and providing value to the area where they sit."

There are different ways that's happening, different models to keep HIEs (the noun) viable. "There have been some success stories out there."

Meanwhile, "we're all moving toward the same end result: seamless, interoperable exchange, where what you send is what you mean to send and it's being received and utilized to achieve the Triple Aim," says Greenberger. "We're getting there."