Health Information Exchange Q&A with John Traeger, Enterprise Solutions Consultant

I had the pleasure of meeting John Traeger in October at Corepoint Connect 13. John works with a number of hospitals and health systems in the Northwest to set up private HIEs and to connect to various forms of external HIE organizations. His keynote presentation on private HIEs had some interesting information I thought readers of this blog would appreciate. Feel free to leave any HIE questions for John in the comments.

How has the demand for HIE interfaces impacted IT departments at hospitals?

John Traeger, OTB Solutions

John Traeger, OTB Solutions

The context in which we provide interfaces outside of hospital organizations is changing rapidly. There are many new regulatory and business requirements. The government and market pressures to form ACOs and HIEs have generated a high number of new participants and connections. These factors and others are creating a tsunami of interface work that is coming in at a rapid pace.

Where is most of the work focused now: Private or Public?

While there has been a considerable amount of work done on public, state and local HIEs, the private HIEs still outnumber them. Private HIEs are experiencing a considerable growth in demand for interfaces being driven by Integrated Healthcare Delivery organizations that want to capture physician “mindshare” and the patients that go along with the new care coordination model.

The integration of formerly independent organizations also frequently involves sharing new HIS system builds to make extending patient information and physician teamwork easier. These system conversions drive a considerable amount of interface work.

What are some lessons you have learned so far from implementing HIE solutions?

Frequently, the nature of the business relationships force the provider organizations to share only the minimum amount of patient data. Centralized data repositories have turned off some provider organizations from participating for this reason. HIEs that utilize this model are also experiencing high costs to manage an ever-growing data store and often have to charge high fees that put their business model at risk.

Private HIE data connections tend to be more comprehensive than public ones, with tighter integration between systems than just sharing CCD documents on a query/response model. This often involves standing up the “traditional” set of ADT, clinical results, lab and rad interfaces, depending on the nature of the relationship and entities involved (for example, specialty clinics vs. ambulatory care vs. rural hospitals, etc.).

Also, technology matters. One private HIE implementation I worked with had this long chain of handoffs making troubleshooting particularly difficult, especially when three of the components in the data flow are opaque to the participating organizations.

What would be your key take-away based on your experience so far?

ACOs, public and private HIEs, and regulatory or market requirements are driving a massive growth in demand for community data sharing. Selecting the right strategy to keep pace with the demand and being agile enough to handle the evolving requirements is critical. A key technology strategy for success is to select a robust interface solution that makes interfaces quicker to deploy, easier to support, has less skilled resource risk, and delivers community connectivity quicker and more cost effectively. (See John’s white paper “13 Steps to Select the Right HL7 Interface Engine“)


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Chad Johnson is managing editor of and senior marketing manager at Corepoint Health. He has worked in healthcare-related fields for more than 15 years, including working directly with physicians, nurses, radiologic technologists and health IT professionals.


  • John

    Very informative. Thanks John.

    1) I have read that due to high costs sustainability of HIE’s over time is an issue. What is the reason for the high costs? Any solutions to offer ?

    2) Did any of your clients derive analytics from databases that were developed in-house. Does unstructured data pose a challenge ?

  • John Traeger

    All models of HIE experience costs associated with meeting new requirements from existing or new members. However, there are some substantial differences between the two prevailing models.

    The high costs of sustaining HIEs that are based on the Consolidated Model are generally driven by two factors:
    1. Managing the always expanding database of patient medical history is a very expensive proposition given the revenue model for most HIE
    2. Ongoing changes to data requirements and regulations require sophisticated developer resources to update existing database structure and access

    The somewhat lower costs of sustaining HIEs that are based on the Federated Model are generally due to two factors:
    1. Database size is generally limited to supporting routing and credentials data from the agreements between members to support query/response between entities (as opposed to querying the massive database in the consolidated model).
    2. Ongoing changes to data requirements and regulations require only changes to document or HL7 data format supported as opposed to database structure and access.

    In my experience with private HIEs, development of HIE data analytics have been in progress through various approaches, the nature of which depends on the which HIE model is used and the relationship with the member entities. Regardless of which approach is used for analytics, unstructured data is a challenge. A considerable amount of quality of care information is embedded in unstructured data formats and most large HCO are looking for a way to extract it. There have been some recent developments in natural language processing software that may address this challenge.