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Economics, HIE’s, and Information Security

Do economics, HIE’s and information security seem like a strange set of words to find together? I’ve been spending a lot of time recently talking with folks at healthcare providers and healthcare IT vendors, and they have found the relationships among these words fascinating. What I have encountered is a quite different set of viewpoints, that form an interesting contrast with the stories related to ARRA funding, state HIE initiatives and breach notification penalties that have been filling the mainstream healthcare IT trade press.

My primary line of discussion with providers (mainly hospitals and integrated delivery networks or IDNs) and HIE vendors has been around the topic of what are the economic drivers associated with HIE deployment and use. It was interesting to find that while hospitals and IDNs see significant benefit in participating in state funded and operated HIE’s over the medium to long term, they are launching their own HIE programs to take advantage of economic benefits in several areas. Several organizations outlined the following elements of near term focus:

• Decrease costs through elimination of redundant tests, fewer lab orders and imaging procedures.

• Improve productivity through workflow optimization in areas such as finding patient records and overall throughput.

• Increase quality in areas such as e-prescribing and more accurate diagnosis.

Over the medium to long term, expected benefits included additional areas such as meeting meaningful use requirements, increased physician referrals and improved patient satisfaction.

Another significant development that has lowered the barriers to taking on an HIE initiative is the growing popularity of software-as-a-service (SaaS) based solutions from the HIE vendor community. These services from vendors such as Axolotl, eClinicalWorks, Initiate, Medicity and RelayHealth mean that the funding organization does not have a capital outlay.  The hospital or IDN needs to focus simply on the operating model to make the economics work.

So where does information security factor into the equation? Well for one, from the vendors and providers that I have talked with, the prospect of managing the security, compliance and privacy of all the sensitive data that an HIE program drives causes a great deal of lost sleep. But security must also be viewed as an economic enabler – if the patients, physicians and hospital staff can use the system effectively, with the assurance that sensitive data is protected and accessed properly, the benefits described earlier can generate the necessary top-line and bottom-line results. Often a common pitfall encountered in structuring security programs is a reliance on simply meeting compliance requirements. While necessary, such an approach by no means is a formula for ensuring security or reducing risk.

In working with both vendors and providers on security, privacy and compliance in the HIE space, we have found the most productive approach is to start with an assessment, break the problem down in to manageable areas, staff appropriately and manage risk on an ongoing basis. The table below outlines how we structure a security assessment for both vendors that are operating a SaaS-based HIE solution or healthcare providers that are using the system.

The information security program is fundamental to the success of an HIE initiative. Making the economic model work effectively requires a focus beyond obvious areas such as compliance and technical controls with careful attention to governance, risk management, and operational process. Draw on expert experience and the business benefits of an HIE program will yield near term and long term results.

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