Ken Willett

Healthcare IT, integration, and making patient care better

Monthly Archives: January 2013

HIEs as Open Systems

Several years ago the promise of patient access and control of their own health data was being promoted by organizations such as Google and Microsoft, as well as smaller players, where any person could have immediate access to information about their health. This view was patterned on the success of online banking, which is now ubiquitous, sophisticated, and (usually) free. But Google Health is now gone, Microsoft HealthVault provides only very limited capabilities, and progress in fulfilling this promise has largely stalled.

There are newer players who are attempting to continue moving this vision forward: Dossia and Avado are examples. But currently, access to health data by patients is essentially limited to “tethered” PHR’s or Patient Portals, which can access data from a single EHR and present it to the user via a single application.

Contrast this limited view with the “ecosystem” model of web applications and now, increasingly, mobile applications. Interesting combinations of these apps can be assembled that share data and present it in novel ways. Developers are free to create new tools and plug them into existing data, and users have a wide range of choice in selecting these apps.

The missing ingredient for doing this in the healthcare domain is a data platform that provides simple, secure access to health data about the user/patient, gathered from a number of sources: primary care providers, hospitals, labs, outpatient service providers, pharmacies, etc. An HIE could conceivably provide a significant portion of this data. But are HIEs really equipped to do this?

The current generation of HIE technology is generally tethered to a large EHR system, or perhaps a few such systems, and doesn’t have the ability to gather data from a wide variety of sources. And while there are standards that allow for transmission of data into an HIE from a variety of other systems, the ability to access this data in a multitude of ways from a variety of applications is very limited. HIEs are not currently designed with an Open Systems philosophy.

There are technical and business reasons for this. Technically, standards for HIEs data access have not kept up with the current world of online applications. HIE standards are still based on a messaging paradigm between large software systems, and address only a limited number of use cases. On the business side, HIEs are very expensive to deploy and their sponsors generally have a “pay to play” data access model to fund HIE operations. This makes them unattractive to the small app developer, who wishes to provide a healthcare application at little or no cost.

So, it seems that for now we are stuck. Valuable health information is locked in EHR and HIE systems where it’s not available to patients or to their other providers. App developers are ready to create novel applications, and users are ready to use them, but these applications are hampered by inability to access the patient’s health data. And the business model around a truly open health data system is not at all clear; the government-sponsored HIE initiatives really haven’t moved things forward in this respect.

There is at least a glimmer of hope in the SMART application model (see: The data access is simple and this technology could allow common apps to connect to different healthcare data repositories. The ONC has gotten behind this approach but it isn’t clear yet whether it will get the required commercial traction. However, this appears to be a promising direction to enable much more widespread use of this data.