By Todd J. Fisher, CEO, MobileMD
I've written in the past that HIE is more than just technology, and there's no doubt that is the case. Time and again, vendors drop technology solutions off at the door only to indifferently move on as their technology sits and collects dust; the technology purchasers, on the other hand, once rapt with the blinking lights of automation, rapidly devolve, suffering buyer's remorse.
Todd Fisher
CEO, MobileMD
While technology certainly plays a role, it is just one dimension within which HIE operates. To truly work, HIE must operate in four dimensions: Technology, Service, Care, and Economic. To provide a more vivid picture, I'll analogize HIE's four dimensions with the four dimensions of space-time – width, depth, length, and time.
The Technology dimension is, as I suggested, certainly important. After all, without innovative technology, HIE would still be facilitated by fax, courier, or hundreds of unsupportable, non-standard point-to-point interfaces. Think of technology as the width dimension. A broad set of well-tested, proven capabilities and features are important to ensure relevance, usability, security, scalability, and regulatory compliance. Without sound Technology, utilization is muted or, worse yet, stability is jeopardized and liability is increased. In other words, the Technology dimension is significant to ensure a working system is in place that is built on a solid, scalable foundation and protects all stakeholders from the risks inherent in communicating patient health information – both legal and clinical.
The Service dimension is critical, as I've discussed in previous HIEWorks blog entries. To be effective, to truly operate within the Service dimension, HIE should wrap Service around the deployed technology. This requires community outreach support and strategic utilization consulting as part of core operations. Visualize Service as the depth dimension, representing the extent to which and sophistication with which HIE has permeated a community. Without such depth, the solution languishes, left unknown and unused, neither deriving nor generating benefit.
The Care dimension is a dimension often lost on those that provide technology-based solutions to healthcare. A vendor's ability to deliver the Care dimension is illustrated by a true understanding of, appreciation for, and empathy with the criticality of the ultimate mission at hand – providing quality patient care. This dimension helps meld technology with the omnipresent yet often forgotten human element to provide the dimension I equate with length. For HIE to work, it must support the Care dimension across the entire care continuum. Every patient, every piece of information, every clinician, and every episode of care is critical in its own right and must be treated with a keen sense of urgency and worth. HIE can't do this without a human element that can express understanding, appreciation, and empathy.
The Economic dimension represents the fourth dimension – time. As I've alluded to in the HIEWorks blog, an economic model and business structure that is based on the invisible hand of self-interest is important to ensure sustainability. While it is indisputable a few cooperative models have succeeded, they are, unfortunately, the exception, not the rule: those that have proven successful are usually directed by strong leadership with a passionate commitment enough to place benevolence above self-interest in a manner that provides sustainability.
Generally, however, without a competitive economic model based on self-interest, HIE falters due to inadequate funding, command, control, and incentives. While altruistic thoughts of doing the right thing for the right reason are noble and ultimately achievable, our entire economic structure is predicated on the basic notion that such altruism will be achieved through incentives based on self-interest. The good of the community is achieved and sustained when individuals (e.g., healthcare organizations) search for and achieve what is good for them. Competition, therefore, must precede cooperation. As the market matures, competition necessarily bumps into cooperation as the regional nature and reality of healthcare forces its participants to engage one another in a cooperative arrangement to ensure quality care.
There you have it; HIE in 4D. If you want to know how HIE works be sure to view HIE through lenses that see in 4D. In doing so, those dimensions missing will become apparent, and corrective action can be taken to add or adjust appropriately.
Thank you,
Todd J. Fisher
CEO, MobileMD
tfisher@mobileMD.com