Whither public HIEs?

LONDON – Some sobering news came from across the pond this past year. On September 22, England's Department of Health announced it would finally scrap the country's decade-long, problem-plagued health information technology initiative, the National Programme for IT (NPfIT).

Nearly £6.5 billion had already been spent on the planned £11 billion National Health Service (NHS) project, which sought to outfit UK hospitals and health trusts with electronic records and link them via a nationwide health information exchange system.

But the missed deadlines, cost overruns and physician resistance since the top-down program was launched in 2002 had finally gotten to be too much. Policymakers opted to eliminate huge swathes of NPfIT (while attempting to salvage certain portions that actually worked). The program was deemed unfit, according to the Department of Health, to offer "the modern IT services that the NHS needs."

The project's original sin, said many, was its government-led approach, By hand-picking vendors and following a one-size-fits-all nationwide strategy – and especially by giving short shrift to the needs and feedback of physicians – NPfIT, however well-intentioned, was bound to fail.

"Labour's IT programme let down the NHS and wasted taxpayers' money by imposing a top-down IT system on the local NHS, which didn't fit their needs," said Andrew Lansley, the UK's secretary of state for health.

Marc Willard, CEO of San Jose, Calif.-based enterprise HIE platform developer Certify Data Systems, is from England. And although he's been living and working stateside for more than 15 years, he couldn't help but be aghast at what he saw going on in his home country.

"It came down to everyone trying to create this centralized business model and just asking folks to share information," he said. "Politics got in the way, and it just failed."

A self-described "serial entrepreneur," Willard founded Certify Data Systems eight years ago. Having spent five of those years, in consultation with physicians and healthcare organizations, developing the company's HIE technology – which launched in 2009 and is now deployed at more than 70 hospitals and health systems – he isn't an impartial observer. But while he concedes that it's "very hard to compare and contrast the UK with North America," he feels sure that the U.S. will be learning similar lessons on the HIE front as England did with NPfIT.

The top-down approach to public HIEs – with their requirements that physicians and hospitals store patient information in centralized databases, with their unreliable funding models – are ill-suited to catch on with docs and stay sustainable, Willard argues.

"When you try to bring competing agendas together, you're always going to get conflicts of interest," said Willard. "My view is that, if you take a region, and say there's five health systems and 1,500 physicians, everyone is going to have a different viewpoint. When the goal is to share everything, it sounds great on paper but it doesn't work that way … you just create this political dynamic that is really hard to overcome."

Instead, "Why not just connect folks and share information when it's needed?" After all, "you go outside of healthcare and see that sort of situation working all the time: a network approach," he said.

The state-level HIE, meanwhile, is "a very tough business model to sustain year after year," said Willard. "What happens when the funding runs out?" (Indeed, as John Hoyt, executive vice president of HIMSS Analytics, told Healthcare IT News last month: "I don't know if the government wants to be in the funding business [of HIEs] forever.")

And especially in this limping economy, in this charged political environment, who wants to hinge their HIE's long-term success on the whims of Washington and the state capitals?

Willard's experience with Certify has shown him that many more health systems are opting to go it on their own, embracing the premise and the promise of an enterprise model: "healthcare is local, connect your community, make sure you connect your primary care physicians, and then, if the patient crosses boundaries from one health system to another, make sure, through standards, that you can offer the patient information to other health systems," he said. "I just don't think one size fits all."

A recent KLAS study, "HIE Perception 2011: Public or Private?" polled providers about their concerns when it comes to HIE vendors. And while the research firm found providers were equally split between public and private exchanges, it did note that, for some of them, the private model won out thanks to the promise of better control over data, more robust prospects for funding and a quicker time to go-live, despite the need for more integration and interfacing.

“What we are really finding is that there is no one-size-fits-all HIE vendor," said Mark Allphin, the report's author. "The selection depends so much on the provider’s needs and priorities.”

Such a diversity of wants and needs is exactly why NPfIT didn't work in the UK. As Sir David Nicholson, chief executive of NHS said upon the program's shuttering, an effective and successful health system depends on "information systems that are driven by what patients and clinicians want. ... Restoring local control over decision-making and enabling greater choice for NHS organizations is key as we continue to use the secure exchange of information to drive up quality and safety.”