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Emerging Standards and the Disruption of HIE 1.0<br />Jitin Asnaani, ONC<br />
Agenda<br />What is HIE?  <br />How does HIE create value today? <br />What are the emerging standards for HIE?<br />How w...
What is HIE?<br />Since the 1970s patient care has accelerated away from the “one provider” model  physicians live in sil...
Creating Value: A Different Perspective<br />Traditional product management and marketing strategy focuses on “Who is the ...
Creating Value through HIE:A Jobs Point of View<br />Clinical  Job (physicians) <br />“Help me provide safe and effective ...
Scanned Documents
EHRs with Unstructured Data
EHRs with Structured Data
Paper Discharge Summaries
Phone / Fax
HIEs/RHIOs/HISPs
Connected EHRs</li></ul>Products “hired” for this job<br />time<br />time<br />Performance Basis: Today<br />Integrated Wo...
Comprehensive set of clinical tools</li></ul>Connectivity to relevant external data sources:<br /><ul><li>Raw ability to s...
Privacy, Security, Consent mgmt.</li></ul>4<br />
ONC and others are commoditizing connectivity <br />Clinical  Job (physicians) <br />“Help me provide safe and effective c...
ONC and others are establishing standards for the content and transport mechanisms for exchange
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Emerging Standards and the Disruption of HIE 1.0

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Emerging standards in health information exchange, driven by the ONC and others, are going to change what health IT customers (hospitals, physicians, labs, etc) are going to pay for. This is an overview of those new standards, and my perspective on the implications for health technology companies, particularly EHR and HIE vendors.

Published in: Health & Medicine, Business
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Emerging Standards and the Disruption of HIE 1.0

  1. 1. Emerging Standards and the Disruption of HIE 1.0<br />Jitin Asnaani, ONC<br />
  2. 2. Agenda<br />What is HIE? <br />How does HIE create value today? <br />What are the emerging standards for HIE?<br />How will these standards affect HIE business models?<br />What does this mean for vendors?<br />Perspectives – What do you think?<br />Acknowledgements<br />1<br />
  3. 3. What is HIE?<br />Since the 1970s patient care has accelerated away from the “one provider” model  physicians live in silos<br />Health information exchange (HIE) services have emerged with the aim of re-connecting physicians with their patients<br />With adoption of HIE projected to accelerate in the near-term, new and incumbent vendors of HIE services are searching for viable business models: <br />How will value be created? <br />What will customers pay for?<br />What’s the best strategy to capture this value? <br />2<br />
  4. 4. Creating Value: A Different Perspective<br />Traditional product management and marketing strategy focuses on “Who is the customer?”<br />Segmentation based on attributes<br />Geography, local demographics, level of urbanization, distribution of physicians, presence of academic medical centers, etc.<br />But successful entrepreneurs first ask the question “What is the customer trying to get done?”<br />This is how customers experience life – whether the customer is a patient, physician, hospital, government agency, etc.<br />They “hire” a product to do a “job” for them<br />For physicians, Health IT is about solving valuable hard jobs in patient care!*<br />* 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<br />3<br />
  5. 5. Creating Value through HIE:A Jobs Point of View<br />Clinical Job (physicians) <br />“Help me provide safe and effective care”<br />.<br />.<br />.<br />“Help me ensure continuity of care”<br />“Help me diagnose this patient”<br />“Help me create an effective treatment plan”<br />Clinical Sub-Jobs<br />.<br />.<br />.<br />“Help me share and access clinical data with others”<br />“Help me store and retrieve patient clinical data”<br />Jobs for Health IT<br /><ul><li>Filing Cabinet
  6. 6. Scanned Documents
  7. 7. EHRs with Unstructured Data
  8. 8. EHRs with Structured Data
  9. 9. Paper Discharge Summaries
  10. 10. Phone / Fax
  11. 11. HIEs/RHIOs/HISPs
  12. 12. Connected EHRs</li></ul>Products “hired” for this job<br />time<br />time<br />Performance Basis: Today<br />Integrated Workflows within hospital/practice:<br /><ul><li>Access across hospital units
  13. 13. Comprehensive set of clinical tools</li></ul>Connectivity to relevant external data sources:<br /><ul><li>Raw ability to send, receive, translate
  14. 14. Privacy, Security, Consent mgmt.</li></ul>4<br />
  15. 15. ONC and others are commoditizing connectivity <br />Clinical Job (physicians) <br />“Help me provide safe and effective care”<br /><ul><li>Widespread interoperability is being driven by rule-making such as Meaningful Use, and the emergence of accountable care
  16. 16. ONC and others are establishing standards for the content and transport mechanisms for exchange
  17. 17. Together, this will make “connectivity” easier, cheaper, and simpler</li></ul>“Help me ensure continuity of care”<br />“Help me diagnose this patient”<br />“Help me create an effective treatment plan”<br />Clinical Sub-Jobs<br />“Help me store and retrieve patient clinical data”<br />Jobs for Health IT<br />“Help me share and access clinical data with others”<br /><ul><li>Filing Cabinet
  18. 18. Scanned Documents
  19. 19. EHRs with Unstructured Data
  20. 20. EHRs with Structured Data
  21. 21. Paper Discharge Summaries
  22. 22. Phone / Fax
  23. 23. HIEs/RHIOs/HISPs
  24. 24. Connected EHRs</li></ul>Products “hired” for this job<br />time<br />time<br />Connectivity to relevant external data sources:<br /><ul><li>Raw ability to send, receive, translate
  25. 25. Privacy, Security, Consent mgmt.</li></ul>5<br />
  26. 26. Emerging Standards: Content<br />S&I Framework:<br />Community of 350+ participants: HIT vendors, SDOs, government agencies, IDNs, academic centers, physician practices, etc. <br />Transitions of Care (ToC) Initiative: focused on defining a common modular set of clinical data for exchange during a care transition<br />Lab Results Interfaces (LRI) Initiative:focused on standardizing lab results reporting to ambulatory primary care settings<br />Numerous initiatives elsewhere across the industry to standardize public health reporting, lab orders, etc.<br />6<br />
  27. 27. Emerging Standards: Transport<br />v1 of Nationwide Health Information Network: <br />Standardizes transport, security and queries for scalable patient and document discovery across communities of care<br />Implemented by 8 substantial IDNs/Federal Agencies, with several more onboarding over the year<br />Evolving models for certification and governance<br />Direct Project*: <br />Standardizes transport and security mechanisms for secure directed messages between healthcare participants<br />Commitment to implement by 50+ vendors and 25+ states<br />S&I Framework: <br />New initiatives focused on Provider Directories and Certificate Interoperability<br />7<br />* To be merged into the Nationwide Health Information Network in the near future<br />
  28. 28. What happens when functionality like “connectivity” gets commoditized?*<br />A commoditized product is in “overshoot”<br />Functionality provided exceeds value customers can utilize<br />Customers not willing to pay more for added functionality on the existing performance basis<br />Disruption! <br />Once requirements for functionality and reliability have been met, customers redefine what is not “good enough”<br />Customers become willing to pay premium prices for improved performance along new trajectories of innovation, such as convenience or customization<br />8<br />
  29. 29. Disrupting HIE 1.0<br />HIE 1.0 required fully-integrated bespoke architectures, because “connecting” was hard<br />As emerging standards simplify and commoditize connectivity, the nature of firms involved in HIE changes <br />HIE & EHR vendors that compete on “being able to do it” will be disrupted<br />Commoditization will enable modular interfaces, driving down cost to deploy basic connectivity – and consequently, low price points*<br />HIE 2.0 will be all about seamless clinical workflows, regardless of where the data resides<br />Basis of competition shifts towards providing clinical value: seamless clinical workflows & quality management<br />Good businesses are going to couple technology and service for workflow integration and change management<br />9<br />
  30. 30. HIE 2.0: Seamless Clinical Workflows<br />Clinical Job (physicians) <br />“Help me provide safe and effective care”<br />.<br />.<br />.<br />“Help me ensure continuity of care”<br />“Help me diagnose this patient”<br />“Help me create an effective treatment plan”<br />Clinical Sub-Jobs<br />.<br />.<br />.<br />“Help me share and access clinical data with others”<br />“Help me store and retrieve patient clinical data”<br />Jobs for Health IT<br /><ul><li>Filing Cabinet
  31. 31. Scanned Documents
  32. 32. EHRs with Unstructured Data
  33. 33. EHRs with Structured Data
  34. 34. Paper Discharge Summaries
  35. 35. Phone / Fax
  36. 36. HIEs/RHIOs/HISPs
  37. 37. Connected EHRs</li></ul>Products “hired” for this job<br />time<br />time<br />Performance Basis: Today<br />Integrated Workflows within hospital/practice<br />Connectivity to relevant external data sources<br />HIE 2.0: Seamless Clinical Workflows, regardless of where data resides<br />Performance Basis: Future<br />10<br />
  38. 38. What does this mean for EHR vendors?<br />EHR vendors can embrace one of two strategic paradigms:<br />Apple Model – integrated lifestyle/computing platform<br />Provide high-performing, fully-integrated solution for health information exchange and clinical workflows<br />Attract demanding/high-end customers who are willing to pay for it<br />PC Model – modular components with standard interfaces<br />Optimize performance on key functionality, i.e., clinical workflows<br />Create modular interfaces to standardized or third-party plug-ins for connectivity<br />Appeal to broad customer base<br />11<br />
  39. 39. What does this mean for HIE vendors?<br />Incumbent HIE vendors must move up-market, race to scale, or embrace disruption:<br />March Upmarket:<br />Provide high-performing connectivity solutions that high-end/demanding customers will pay for (the Apple model again)<br />Race to Scale:<br />Try to become super-regional or even nationwide providers of low-margin connectivity solutions (the Utility Company model)<br />Embrace Disruption – very hard:<br />Partnerships/M&A with the disruptors who will provide clinical value in the future (AOL/Time Warner, Cisco/Flip, etc.)<br />12<br />
  40. 40. Your perspective<br />This is our hypothesis: what’s your view? <br />What do you think will be the impact of standardization?<br />Where do you see HIE business models heading in the next 3-5 years? <br />How will this affect hospitals, IDNs, physician practices, labs, IT vendors, and other healthcare participants? <br />What role and impact will payment reform have in terms of HIE capabilities and business models?<br />13<br />
  41. 41. Acknowledgements<br />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”<br />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<br />Much thanks to the edits and suggestions provided by ONC colleagues and contractors Brian Ahier, Erica Galvez and Sachin Jain<br />14<br />
  42. 42. Thank You!<br />

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