HIEs, Business Models, and Interfacing

Healthcare Information Exchange Types

There are three basic types of healthcare information exchanges (HIEs): some cover a geographic region (for instance, NCHIE in North Carolina), others a community; and yet others that cover a single hospital system (which in turn may be spread out geographically – for instance, Catholic Health Initiatives).

HIE Business Models: Grants vs. Revenue Generation

While some regional and community HIEs got their start via government grants, many of those grants are coming to their end. Even though they might remain as non-profits, HIEs are increasingly moving to revenue-generating business models in order to sustain their operations.

That means HIEs need to be focused on driving down costs for the services they are mandated to provide. Given that many have already invested in infrastructure, their on-going capital budgets have likely stabilized or decreased. Instead they must focus on containing operating expenses. So the key drivers for them are going to be cost-effective delivery, lean production, and efficient maintenance. On the revenue side, they’ve got to ensure their benefits provide sufficient ROI to partner organizations such as hospital systems and physician practices.

The Heart of the Matter at HIEs: Interfacing

A big part of what HIEs do is interfacing – HL7 pure and simple. They need to manage information flow with these systems and more:

  • Commercial labs, hospital labs
  • Immunization registries
  • Cancer registries
  • Other public health reporting and disease registries at both state and federal levels

HIEs also support continuity of care between acute care providers (hospitals) and physicians. With Meaningful Use, CCD is the method of choice. Again, with CCD, many of the issues we run into with conventional HL7 v2 interfacing apply.

In a nutshell, a big part of HIE operations is interfacing. Move the needle with interfacing, and you move the needle on the expense/cost side of their business models and on-going fiscal viability.

The best way to move the needle is to reduce cycle time on the most time consuming part of the interface lifecycle: testing tasks.

HIEs Can Move the Needle

Just how do you get started? Three ways.

1. Get the right requirements up front.

Ensure you have vendor specs, and specs for each site/practice/system. If these stakeholders don’t have specs (or what we call profiles), get sample messages and get analysts to create the specs themselves. Then do the gap analysis between systems, so capture requirements up front. This lets interface developers create a more accurate interface upfront. With high-quality requirements, come high-quality interfaces – and fewer fixes during testing.

2. Automate your testing.

Once you have the interface configured in the test instance of your engine, start testing.  And automate the testing so changes can be implemented faster. With one organization we worked with, before they automated their testing, they spent 2 weeks to test a 15-minute change in the engine. After automation, they spent less than 1 hour. Clear the testing bottleneck.

3. Keep your artifacts for the next go round.

Document it all. You’ll need it as you maintain the interface, and when the source or destination systems are upgraded.

Further Resources

Check out this presentation we gave at the Interconnected Health conference in 2012. It’ll explain why getting the requirements right up front cascades through and drives more cost-effective interfacing.


Check out Caristix Workgroup for a full interface lifecycle management suite (16-minute on-demand demo available).