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HIE’s – Now That the Funding is Complete, What Will the Operational Environment Look Like?

Last week the Department of Health and Human Services (HHS) announced an additional round of $162M in funding for Healthcare Information Exchanges. Combined with the state grants announced in February, this brings total funding to $547M. This means that all the states and state designated entities are on a path towards implementing the vision of the Office of the National Coordinator for Health Information Technology (ONC) laid out in their strategic plan.

The next step in the process calls for states to develop and align strategic and operational plans that cover what the ONC has termed as the five essential domains: governance, finance, technical infrastructure, business and technical operations and legal/policy. These plans are critical because strategic and operational plans must be approved by HHS before the states are free to begin to use HIE funds for implementation purposes. The plans are also critical to ensure coordination around standards and expand the use of HIE to a national level.

As one might expect this has created a great deal of activity in the healthcare IT sector as vendors position themselves for the operational phase associated with the state funding. As we enter this next phase in the evolution of HIE’s one of the major challenges to be overcome in driving HIE success is associated with ensuring security and privacy, as well as efficiently demonstrating compliance with HIPAA and HITECH requirements. With user requirements ranging from large hospitals to small physicians’ offices, answers to basic questions such as appropriate technical protection mechanisms and access controls present significant challenges. To a certain extent, forming the appropriate answers to questions of security and privacy requires definition of the compute and storage model that will be most prevalent in the environment.

In many respects, the leading model that is emerging in the HIE market is that of a cloud services based platform. In this model the cloud service provider is responsible for providing highly scalable services, authorization, access control, audit logging and data protection. Many vendors such as Axolotl, Covisint, IBM, Microsoft HealthVault/Amalga and Medicity have announced offerings in some form. These have included API’s that allow specialized applications to be developed rapidly while taking advantage of the core infrastructure services. Example applications range from clinical decision support to meaningful use reporting. An illustration of this framework is shown below.


The platform as a service model can be very powerful in the HIE environment because security and privacy services can be leveraged by the applications as well as the providers and consumers of the information. However, for rapid deployment and efficient ongoing operations it is critical that the providers of healthcare cloud services communicate security, privacy and compliance practices and procedures to customers in a transparent fashion. The hospitals, laboratories and physician practices that form the customer base of the HIE need to be able to understand this information and ensure that their security, privacy and compliance needs are met.

A further critical requirement in this model is for the API’s to support a secure ecosystem with common security controls that have been thoroughly tested. I think the emerging nature of the HIE market presents an excellent opportunity for platform vendors to coalesce around a common set of application security controls such as OWASP Enterprise Security API. Adoption of ESAPI would provide consistent application protection as well as leverage for both cloud platform providers and application developers.

As the HIE market evolves through this important phase of development it will be critical to continue to look for additional areas of leverage in the areas of privacy, security and compliance among the many stakeholders.

This Post Has 2 Comments
  1. John,

    The visionary HIE Cloud “PaaS” vendors should also look to coalesce around a common content exchange standard format for enabling the efficient reporting, viewing and sharing of all 6,000 different diagnostic test results for the first time in U.S. medicine.

    The crying need to improve the results reporting, viewing and sharing processes has existed since the mainframe computing era and must be met to yo achieve data liquidity, vendor and platform neutrality and full interoperability for this vital clinical content that is displayed by all EHR, PHR and HIE platforms.

    On March 9, 2010, Aneesh Chopra, America’s first CTO, and Dr. Blumenthal were recently made aware of the problem and the simple proposed solution on the Federal Advisory Committee (FACA) blog at:

    http://healthit.hhs.gov/blog/faca/index.php/2010/02/12/aneesh-chopra-invites-you-to-tell-us-about-opportunities-and-challenges-facing-hit-implementation/comment-page-1/#comments

    Bob Coli, MD

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