The Other HIE
February 18, 2012
The acronym HIE is confusing. It stands for two very different concepts. The first, which high tech types know, is health information exchange. This exchange involves sending clinical documents such as care summaries from physician to physician using a common standard on the Internet. It sounds simple, but it has been difficult to accomplish because until recently many physicians didn’t have an EHR and even if they did many EHRs can’t exchange documents in standard templates.
The other kind of HIE is a health insurance exchange. The 2010 “Obamacare” health reform law called for each state to open its own insurance exchange where consumers can shop for policies and tap health insurance tax credits. But for states that chose not to or couldn’t get it up-and-running, the law called for the federal government to step in and handle the exchange.
The Wall Street Journal reported last week that a number of Republican-led states such as Wisconsin and Florida have rejected on political grounds setting up a state-run HIE. A number of other states have indicated they will run their own exchange but made little progress to date. As the WSJ reports
“Only 28 states and the District of Columbia have made significant progress in setting up their own insurance exchanges.”
As a result, the Obama Administration asked for $860 million in its new budget to implement the HIEs at the federal level. As the Washington Post reports
“There’s little expectation that Congress will actually appropriate the funds the White House has requested, especially when the ask is so big and would pretty much go directly toward health reform implementation. What happens to the federal exchange if Congress turns down the request? Center for Consumer Information and Insurance Oversight director Steve Larsen tells Bloomberg that the government ‘will work with existing, available funding sources.’”
For the states that have committed to operating their own exchanges, the pressure is on. The Colorado Springs Gazette recently interviewed Patty Fontneau, the CEO and executive director of what is formally called the Colorado Health Benefit Exchange.
Ms. Fontneau, an attorney, made these points:
“The exchange does make sense to do regardless of what happens with the Affordable Care Act. It’s a smart business decision. It allows a competitive marketplace. It will allow a competitive marketplace to have appropriate influence on the cost of health insurance.
“I can’t tell you how it’s going to different from the federal plan. I would be surprised if the federal plan met the unique needs of Colorado. In order to get both individuals and small employers to act to purchase insurance, to use the services available to them, we’re going to have to have a tremendous education campaigns. The really broad-based education efforts won’t be until 2013 — you really want to get people aware of this project a little bit closer to when it’s going to launch.”
HIMSS Hot Topics
February 11, 2012
What will be the hot topics at HIMSS? Having talked with a number of journalists and exhibitors in the last week, I think three will stand out:
- Stage 2 Meaningful Use rules
- Interoperability, health information exchange
- Mobile device software (iPads)
The HHS has said it will introduce the final version of the Stage 2 MU rules next week. While no one is sure exactly what will in the new requirements, they are bound to be tougher than Stage 1. Explanations of what they mean and suggestions for how to meet them are bound to be popular topics. There are already half-a-dozen educational sessions scheduled on MU, with one promising to include senior HHS officials on the panel.
Another hot topic will be interoperability and exchange of health information. To use the current buzz phrase, crossing enterprise boundaries. This need is driven by the success of MU Stage 1 in spurring the widespread adoption of EHRs. As several industry analysts have noted in recent weeks, for the first time in the 30-year history of healthcare information technology, we now have widespread and diverse collection of healthcare data by physicians and hospitals.
The challenge now is to collect, share and analyze the data. My client ChartLogic is participating in the Health Story Project, which will be giving demonstrations in the interoperability booth at HIMSS. Based upon the preview information I’ve seen, some very dramatic capabilities are going to be displayed, including the use of Apple’s Siri natural language processing program to move “hands free” between EHR applications and send specific data to remote locations.
Apple devices, along with Android tablets and phones, are very popular with physicians. One study claims 80% of physicians own a smart phone. These highly sophisticated devices can have a major impact on the collection and display of clinical information. Many vendors will be showing how their software can be used on iPhones or iPads.
I’ve been attending HIMSS for eight years and it gets bigger and crazier every year. The HIMSs organizers are predicting record attendance this year, more than 38,000. Fortunately, Las Vegas has some 200,000 hotel rooms, so there will be plenty of places to stay.
Some readers may remember the 2007 HIMSS, held in New Orleans, just five months after Hurricane Katrina. Several large hotels were closed, forcing some people to stay in motels miles from the convention center. Las Vegas won’t have that problem, but will add a note of weirdness to this annual spectacle of wealth and technology
A Fading EHR Rose
February 5, 2012
Has the bloom left the EHR rose? Has it reached its peak of attractiveness and is now destined to slowly wither into faded petals?
Several recent articles suggest that EHR sales will soon plateau and then slowly taper off.
Healthcare IT News, reporting on a conference on recent healthcare finance conference in Nashville, reports that a leading bank analyst predicts just 5 to 10 percent growth this year. Factors contributing to growth in 2012 include more meaningful use requirements and the impending conversion to ICD-10.
Separately, John Moore, founder of Chilmark Research, opined in his blog recently that “There will be plenty more EHR sales in the year to come, but over 2012 we will also see EHR sales growth begin to plateau and level off by end of Q4 ‘12.”
Other studies are more optimistic. According to a new study released last week by Millennium Research Group, the EHR market will enjoy 12 percent growth per year, and is expected to reach more than $8.3 billion by 2016. The report comes on the heels of a Frost & Sullivan report that predicts that market revenues for EHR systems will peak at $6.5 billion in 2012 for new licensing and upgrades.
In the current, heated-up environment for healthcare information technology, a “mere” 5-10% growth seems disappointing, but some other industries (e.g. airlines, utilities, retail) would rejoice in those numbers.
Venture capital firms still take a very positive view of healthcare info tech. They poured $633 million into the field last year, InformationWeek Healthcare reported. That was the highest amount since 2001, when they invested $759 million.
One unknown is the exact rate of adoption by small physician practices, where 60% of the nation’s physicians work.
Mickel Phung, a market analyst for Frost & Sullivan, said he expected higher growth, since “Early reports from 2008 and 2009 indicated 20 percent growth. That didn’t happen.”
He said many office-based physicians are still “hesitant and confused” by the number and type of EHRs available. There are currently more than 350 EHR systems being actively marketed, he said. Physicians are starting to gravitate towards “the bigger, better known vendors.”