In my professional career and academic research, I’ve been fascinated by the successes and (all too often) failures associated with investments in information technology. While we’ve largely debunked Robert Solow’s famous quip that “you can see the computer age everywhere but in the productivity statistics,” I’ve never met an experienced IT professional that couldn’t regale you with one or (often) more stories about project failures of Hindenburgian proportions.

In short, failure happens.

What does this have to do with health information exchange?

One year ago today, President Obama signed into law the American Recovery and Reinvestment Act (ARRA) of 2009. As you probably know (unless you’re my mother, who might be reading this blog too), this economic stimulus package included provisions known as the Health Information Technology for Economic and Clinical Health (HITECH) Act, which provided massive public funding for investments in health information technology.

From my viewpoint, the tidal wave of dollars has already altered the landscape of this industry sector. It’s introduced new terms to the lexicon, such as ‘meaningful use.’ And, it has reinvigorated hope for widespread clinical information exchange, which languished for years in the doldrums of successive rounds of CHINs, RHIOs, and HIEs.

Yet, gargantuan investment alone won’t ensure ‘success.’ Remember: most dotcoms didn’t fail because they lacked capital. No matter how much we enjoyed canine sock puppet television advertisements or the promise of grocery orders being delivered via vans, the operating models of such enterprises wasn’t sustainable.

We run that same risk today in trying to push forward health information exchange. In fact, we still lack (as a profession or society) a clear definition of HIE success beyond somewhat vague notions of ‘transforming healthcare.’ And, if we look to the wisdom of crowds, consensus seems to be that ‘meaningful use’ isn’t sufficient—in and of itself—to get the job done.

Given that, how we can we really make health information exchange meaningful? 

I have a few suggested principles:

First, we should look to what I call the ‘Return on Health Information Exchange’ (RoHIE) investments. That is to say, HIE can only be ‘successful’ if the benefit it provides exceeds the cost of its delivery over the long-term.

Second, we should maximize benefits by focusing on the most valuable ‘use cases’ first. As a starting point, we should build consensus around those that are most likely to improve patient outcomes and/or reduce healthcare delivery costs. 

Third, we should expect HIT/HIE vendors to innovate in order to drive the expenses associated with health information exchange as close to zero as possible. As the product leader at VisionShare, that’s certainly one of my objectives.   

By optimizing both sides of the cost-benefit equation, we maximize the probability of ensuring that we engage in a truly ‘meaningful’ exchange of health information.

 To that end, I intend to focus my writing on…

• Health information exchange as an action verb (rather than a static noun) to better understand and explore the need and demand for such ‘exchange,’ as well as explore the workflow implications of providers.
• Use cases (rather than underlying technologies) that can transform healthcare by improving patient outcomes and lowering care delivery costs.
• Perspectives of providers and other stakeholders, including (and especially) those representative of the ‘silent majority’ rather than repeating the messages and concerns of the ‘chattering class’ of HIT pundits.
• Return on Health Information Exchange (RoHIE) – tangible methods and approaches for maximizing, assessing, and evaluating outcomes, as well as ‘case stories’ that demonstrate successes (and failures).      

One final note: I’ll always welcome your comments and feedback (favorable or not) on my views. Dialogue is the most effective means of building consensus. Besides, this blog isn’t called a ‘Meaningful Exchange’ for nothing.