The $2 billion allotted for health information exchange under ARRA is a “once-in-a-generation” opportunity to help overcome a lot of barriers associated with HIEs.

The major challenge is investing intelligently on the right stuff according to logical plans that are well executed by leaders who understand the pitfalls and can overcome local competition, policies and idiosyncrasies.

That’s the advice John Kansky provided in his opening keynote, “ARRA HITECH and the Health Information Exchange: Opportunities and Pitfalls.” Kansky is vice president of business development for the Indiana Health Information Exchange (IHIE), a mature health information organization.

While $2 billion is not enough to close the gap in the HIE infrastructure, it’s a start, he said. Kansky believes there will be additional government investment “to make HIE a reality.”

Indiana has five operational interstate HIEs. Kansky pointed out that IHIE was created without government involvement and took more than a decade and more than $50 million. Still, IHIE can provide best practices and lessons learned because, like most states, it has overlapping healthcare markets and interstate exchange of data and has faced a lot of issues related to data use, hospital competition and hospital tension with payers, he said.

Sustainability is one of the major problems all HIEs face. A business case can be made if HIEs find services that stakeholders will pay for, Kansky said. Such services could be clinical messaging, medication lists and clinical quality service for pay-for-performance initiatives.

At the end of the day, meaning use is an artificial beacon to guide the direction of HIE services, Kansky said. HIEs need to think beyond meaningful use and the incentive dollars. “Business decisions that make sense in the context of the HITECH incentives must still make sense in 2016,” he said.

Developing HIEs should choose the most valuable functions for its local markets. “Don’t try to boil the ocean,” he said.

Kansky advised developing HIEs not to hurry. “Study successful models and consult with someone who has done this before,” he said.