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How would you slice up the HIT pie?

While healthcare organizations determine how to meet an undefined component of meaningful use, I’ve been approaching this complex challenge by thinking about a health information exchange pie with four slices – labeled local, regional, state and national.

The Local Enterprise

The local slice is defined by the need for single healthcare enterprises to effectively compete for local physicians. This group is focused on providing a competitive advantage by creating physician affinity via orders and results sharing through an EMR, fax machine or clinical portal.

This might be considered a proprietary or private share of the market, as the size of the local slice is driven by the competitiveness of the market, the volume of private practice physicians in the region and existing brand loyalty.

This local or community slice addresses coordinated care priorities, such as sharing referrals, orders and lab and imaging results. A single enterprise means minimal conflict around the governance of information sharing. The return on investment is probably far more tangible than other options.

But the local slice gains complexity as additional facilities, medical groups and Integrated Delivery Networks (IDNs) want to participate.

In many parts of the country, this group is receiving a majority of resources. After all, healthcare is largely local and remains competitive at that level.

Regional More Complex

The regional slice of the pie will be significantly more complex because stakeholders will likely come from various competitive organizations.

Finding a foundation that allows competitors to work toward a common goal of improved health and more cost effective care is crucial. Data governance, consent management and data sharing are basic ingredients. The size of this slice may also change significantly as the federal government releases additional grants for state-oriented HIE.

States By The Slice

The state slice, whether constructed by a private, public-private, or state entity, adds ingredients to the pie.

This piece of the HIE pie might initially have a healthcare focus due to HIT stimulus grant requirements. Here, however, there is potential for greater rewards as public health, social services and other state services are included.

If states expand the scope of the health information enterprise, then a Master Citizen Index may come into play, with broader goals of saving money, reducing fraud and coordinating care across agencies.

This piece may also grow via federal funds in support of state HIE and future requirements for Medicaid information systems evolve.

National Community

Data sharing between private and government entities is largely in pilot stages. Generally the private sector is sending information to the government sector.

Given recent concerns about the need for HIE tools such as the Federal Connect Gateway to meet government security requirements, the timeline for this slice is unclear.

It appears that the Office of the National Coordinator will begin to explore the national slice in 2010. But while the national slice is currently pretty small, the potential for data sharing across the private sector and federal and state agencies holds great promise

Personally, I’m going to cut my 2009 holiday pie (pumpkin with whipped cream and extra cinnamon!) with a large piece going to the local, community-oriented projects.

With evolving rules on meaningful use and other HIT guidelines, you can’t go wrong putting increased emphasis on local healthcare communities. Serving hospitals, physicians and their local constituents is positive and productive, serving as a solid foundation for regional, state and national efforts.

So while my 2010 pie may be sliced a bit differently, as final regulations that govern meaningful use and federal incentive payments gain traction, I’m confident it will cohere in one HIE pie.

How would you dish it up?

This is a condensed version of an article that originally appeared in Government Health IT.