Mastering Data Management

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Initiate's Chad Cosper considers the architecture most suitable for your state-wide HIE

As we discussed in the last post on architecting a state-wide HIE, there is no "one size fits all" model that will serve as a solution for every state.  Each state currently needs to evaluate the options they have for creating an exchange that will cover the most residents of the state in the most cost efficient manner.

Those options will depend on how the state decides to organize itself, the initiatives that the state plans to undertake, and the current technical state of any existing infrastructure elements of which the state plans to take advantage.

While there are a myriad of options to choose from when discussing which architecture style fits best for a specific state-wide HIE, the majority of states will choose from one of three:

Peer-to-Peer Model
Participants don't require a centralized database or hub to query other systems, making this option much cheaper  and faster to implement.  However, queries can be slow if they are broadcast over a large system. Some participants will find inter-system communication difficult if not done via an established standard.

Centralized or Data Warehouse Model
Response times can be quicker and there is less dependence on other systems because the data is stored in a central database that can be accessed by the querying system.

However, this model relies heavily on participating systems to update it, which can cause delays in timely information. This puts the HIE at a high risk for data duplication and other data management issues that will require remediation.

Federated / Hybrid  Model
Because a central hub maintains only an master index of  patients or providers and not the actual records, participants maintain ownership of their data. This usually means that duplication and other inconsistencies are decreased, and privacy options are easier to implement.  While this model also relies on a central authority, response times can lag if not implemented correctly.

Before deciding on an architecture model, states must undertake a rigorous requirements gathering process with their stakeholders.  These requirements should make the decision of a model an easier task.