Emerging Standards and the Disruption of HIE 1.0

Emerging Standards and the Disruption of HIE 1.0
Jitin Asnaani, ONC

Agenda
What is HIE?
How does HIE create value today?
What are the emerging standards for HIE?
How will these standards affect HIE business models?
What does this mean for vendors?
Perspectives – What do you think?
Acknowledgements
1

What is HIE?
Since the 1970s patient care has accelerated away from the “one provider” model  physicians live in silos
Health information exchange (HIE) services have emerged with the aim of re-connecting physicians with their patients
With adoption of HIE projected to accelerate in the near-term, new and incumbent vendors of HIE services are searching for viable business models:
How will value be created?
What will customers pay for?
What’s the best strategy to capture this value?
2

Creating Value: A Different Perspective
Traditional product management and marketing strategy focuses on “Who is the customer?”
Segmentation based on attributes
Geography, local demographics, level of urbanization, distribution of physicians, presence of academic medical centers, etc.
But successful entrepreneurs first ask the question “What is the customer trying to get done?”
This is how customers experience life – whether the customer is a patient, physician, hospital, government agency, etc.
They “hire” a product to do a “job” for them
For physicians, Health IT is about solving valuable hard jobs in patient care!*
* Physicians also have hard jobs in reimbursement – while we chose to focus on the clinical hard jobs here, the implications for HIE described in this document will similarly apply
3

Creating Value through HIE:A Jobs Point of View
Clinical Job (physicians)
“Help me provide safe and effective care”
.
.
.
“Help me ensure continuity of care”
“Help me diagnose this patient”
“Help me create an effective treatment plan”
Clinical Sub-Jobs
.
.
.
“Help me share and access clinical data with others”
“Help me store and retrieve patient clinical data”
Jobs for Health IT
Filing Cabinet
Scanned Documents
EHRs with Unstructured Data
EHRs with Structured Data
Paper Discharge Summaries
Phone / Fax
HIEs/RHIOs/HISPs
Connected EHRs
Products “hired” for this job
time
time
Performance Basis: Today
Integrated Workflows within hospital/practice:
Access across hospital units
Comprehensive set of clinical tools
Connectivity to relevant external data sources:
Raw ability to send, receive, translate
Privacy, Security, Consent mgmt.
4

ONC and others are commoditizing connectivity
Widespread interoperability is being driven by rule-making such as Meaningful Use, and the emergence of accountable care
ONC and others are establishing standards for the content and transport mechanisms for exchange
Together, this will make “connectivity” easier, cheaper, and simpler
Clinical Sub-Jobs
Jobs for Health IT
Filing Cabinet
Scanned Documents
Phone / Fax
HIEs/RHIOs/HISPs
Connected EHRs
time
time
Connectivity to relevant external data sources:
Raw ability to send, receive, translate
Privacy, Security, Consent mgmt.
5

Emerging Standards: Content
S&I Framework:
Community of 350+ participants: HIT vendors, SDOs, government agencies, IDNs, academic centers, physician practices, etc.
Transitions of Care (ToC) Initiative: focused on defining a common modular set of clinical data for exchange during a care transition
Lab Results Interfaces (LRI) Initiative:focused on standardizing lab results reporting to ambulatory primary care settings
Numerous initiatives elsewhere across the industry to standardize public health reporting, lab orders, etc.
6

Emerging Standards: Transport
v1 of Nationwide Health Information Network:
Standardizes transport, security and queries for scalable patient and document discovery across communities of care
Implemented by 8 substantial IDNs/Federal Agencies, with several more onboarding over the year
Evolving models for certification and governance
Direct Project*:
Standardizes transport and security mechanisms for secure directed messages between healthcare participants
Commitment to implement by 50+ vendors and 25+ states
S&I Framework:
New initiatives focused on Provider Directories and Certificate Interoperability
7
* To be merged into the Nationwide Health Information Network in the near future

What happens when functionality like “connectivity” gets commoditized?*
A commoditized product is in “overshoot”
Functionality provided exceeds value customers can utilize
Customers not willing to pay more for added functionality on the existing performance basis
Disruption!
Once requirements for functionality and reliability have been met, customers redefine what is not “good enough”
Customers become willing to pay premium prices for improved performance along new trajectories of innovation, such as convenience or customization
8

Disrupting HIE 1.0
HIE 1.0 required fully-integrated bespoke architectures, because “connecting” was hard
As emerging standards simplify and commoditize connectivity, the nature of firms involved in HIE changes
HIE & EHR vendors that compete on “being able to do it” will be disrupted
Commoditization will enable modular interfaces, driving down cost to deploy basic connectivity – and consequently, low price points*
HIE 2.0 will be all about seamless clinical workflows, regardless of where the data resides
Basis of competition shifts towards providing clinical value: seamless clinical workflows & quality management
Good businesses are going to couple technology and service for workflow integration and change management
9

HIE 2.0: Seamless Clinical Workflows
.
.
.
Clinical Sub-Jobs
.
.
.
Jobs for Health IT
Filing Cabinet
Scanned Documents
Phone / Fax
HIEs/RHIOs/HISPs
Connected EHRs
time
time
Performance Basis: Today
Integrated Workflows within hospital/practice
Connectivity to relevant external data sources
HIE 2.0: Seamless Clinical Workflows, regardless of where data resides
Performance Basis: Future
10

What does this mean for EHR vendors?
EHR vendors can embrace one of two strategic paradigms:
Apple Model – integrated lifestyle/computing platform
Provide high-performing, fully-integrated solution for health information exchange and clinical workflows
Attract demanding/high-end customers who are willing to pay for it
PC Model – modular components with standard interfaces
Optimize performance on key functionality, i.e., clinical workflows
Create modular interfaces to standardized or third-party plug-ins for connectivity
Appeal to broad customer base
11

What does this mean for HIE vendors?
Incumbent HIE vendors must move up-market, race to scale, or embrace disruption:
March Upmarket:
Provide high-performing connectivity solutions that high-end/demanding customers will pay for (the Apple model again)
Race to Scale:
Try to become super-regional or even nationwide providers of low-margin connectivity solutions (the Utility Company model)
Embrace Disruption – very hard:
Partnerships/M&A with the disruptors who will provide clinical value in the future (AOL/Time Warner, Cisco/Flip, etc.)
12

Your perspective
This is our hypothesis: what’s your view?
What do you think will be the impact of standardization?
Where do you see HIE business models heading in the next 3-5 years?
How will this affect hospitals, IDNs, physician practices, labs, IT vendors, and other healthcare participants?
What role and impact will payment reform have in terms of HIE capabilities and business models?
13

Acknowledgements
This discussion utilizes theories and terminology articulated by Clayton M. Christensen and Michael E. Raynorin my academic and professional engagements with each, and described in detail in their excellent book “Innovator’s Solution”
The storyline is built on the vision and real-world experiences first shared with me by Arien Malec, Coordinator of the Direct Project and the S&I Framework
Much thanks to the edits and suggestions provided by ONC colleagues and contractors Brian Ahier, Erica Galvez and Sachin Jain
14

Thank You!

http://news.avancehealth.com	257
url_unknown	11
http://paper.li	1

Emerging Standards and the Disruption of HIE 1.0

by Jitin Asnaani on May 30, 2011

Accessibility

Categories

Tags

Upload Details

Usage Rights

3 Embeds 269

Statistics

Emerging Standards and the Disruption of HIE 1.0 — Presentation Transcript