Jay Xcelresources : 450, one on one;

6months,

BluecubeIT, Vivek, 450, one on one

6 months

Enip, Amy, Erin3546 Nada Tunnel Rd.Stanton, KY 40380You have been hired as a consultant to a non-profit organization that is considering establishing a public HIE. You need to write a 3 to 5 page brief identifying the key issues that they will face. They have the specific following questions:

1. How should they approach the issues of cooperation and competition with private HIEs?2. What would you recommend as a governance model for the HIE?3. From a high level perspective what would you recommend for a technical architecture that supports the IDN?4. What lessons can they learn from earlier HIEs?

Use the course presentations, discussion board, and readings to answer these questions. Please include references on any original research that you choose to do.

There are many types of governance models in HIE. The model can be chosen according to the need of the organization and community. The governance model can be changed with the different phases of the organization. There are commonly four types of governance types i.e; Management Team Model, Advisory Board Model, Collaborative Model, and Policy Board Model or the hybrid of these models. As a consultant for a public HIE, I would recommend the Management team model adopting some of the features of collaborative model like collaboration and consensus building for decision-making. Management Team operates the daily operations in the organization. The committees and activities are organized according to the functional areas. The organizational structure of the board and committees shows the functional structure. As the management team is responsible for the daily operations of the organization, this model is the best for an organization in formative stages. The high involvement of the board reduces the time taken for the decisions made in the organization. The selection of board member was done according to their knowledge and experience in managing organizations. As the organizations matures, the governance model can be changed as the big decisions becomes rare and daily operations doesnt need involvement of the board members (Kolkman, 2011).

Most of the HIE organizations adopt one of the three main architectural models such as Centralized Exchange Model, De-centralized or federated Exchange Model, and Hybrid Exchange Model. Among the three, Centralized or consolidated model has been adopted widely by the HIE organizations. In this model, all the data from all the providers participating in the health information exchange store data in a central repository. Although some data was requested by the organization, all the data were sent to the central repository. The agreement between the organizations was done already. This method also has some advantages and disadvantages over other models. The speed of the healthcare information is exchanged, as there is no lag time. But as the data is stored in a central repository, there is a high risk of security and privacy breaches. Though having some of the disadvantages, Centralized Exchange Model is widely used in the organizations. As the cost of the installation is lower, this model is best for the organizations in formation phases. This Model can support integrated delivery network (IDN) as all the participating organizations are within the integrated network. The organizational entity or loosely linked or collaborated organizations can be integrated with common bond. So, Central Exchange Model would be recommended for the formation of initial stages of the public HIEs. (eHealth Initiative, 2013; Health IT Certification. 2008).

The exchange of Healthcare Information has been difficult between the healthcare organizations. CHINs, RHIOs and HIEs or HIOs are the organizations to make a network of organizations for the exchange of the healthcare information. The data shared among the healthcare organizations should be user-friendly and robust. The creation and operation of HIEs has been a complex process as the competition in the quality and reliability of data has been increased between the HIEs organizations. In the past, many HIE organizations were established for the exchange of the healthcare information across the organizations but many organizations were shut down prematurely. Some of the organizations were Santa Barbara County Data Exchange (SBCDE), CalRHIO, Broward Information Network (BIN), CareSpark, Wisconsin Health Information Exchange (WHIE), Louisville Health Information Exchange (LouHIE) (HIMSS, 2013; King, 2012). There is not a specific reason for the collapse of these organizations. Some of the reasons for this are financial Issue, Technology, Support, Legal issues, and the Impact of the State Exchange Cooperative Agreement Program. The most important lessons learned from these HIEs are the financial. Despite the initial funding for the organizations, there was no planning to sustain the organization except the initial funding. A subscription fee from the organizations would have been a source of funding for the organization to run smoothly. The lack of support and trust from the stakeholder is another reason for the failure of the HIEs that resulted in the lack of funding from the organizations. Technology has been an issue for the failure of many HIEs. Many HIEs has developed or bought the infrastructure like hardware, software that took time to be used successfully implement. The investment without ROI for a longer period of time has resulted in the shortage of finance. The analysis of the technology used, time to implement the technology and the effect of the technology in a HIE is crucial before establishing HIEs. The privacy and confidentiality of the healthcare data has been a legal issue as the data were exchanged among the organizations. In some cases, it took months to get the consent for the exchange of the information (HIMSS, 2013; King, 2012). There has been some of the HIEs that was successful like HealthBridge and Middel Tennessee eHealth Connect (MTeHC). Although Healthbridge has got many grants and funds in different phases, the main source of revenue was a fee-based service. The commitment of the stakeholder was for longer period of time that provides the financial security for the organizations. The long-term contract was made with the participants. There are many lessons we can learn from these organizations and these are the flexibility in project plan and technology implemented. The momentum of the business should be met providing training and integrating systems (HIMSS, 2013; Ward, 2012).

References:eHealth Initiative. (2013). Elements to consider. http://www.ehidc.org/hie-toolkit/connecting-technically/elements-to-consider Health IT Certification. (2008). HIE Architectures. HIE Certificaton. http://www.ehcca.com/presentations/hitaudio20080327/HIE-VI.pdf King, J. (2012). HIEs: Lessons learned. ExecutiveInsight. http://healthcare-executive-insight.advanceweb.com/Archives/Article-Archives/HIEs-Lessons-learned.aspx

Kolkman, L. & Brown, B. (2011). The Health Information Exchange Formation Guide. HIMSS. Chicago. Print

Wagner, J. (2013). Lessons for the Next Evolution. HIMSS. PrintWard. (2012). Why Some HIEs Fail and others Succeed. Insights. http://www.ctg.com/industries/healthcare-providers/thought-leadership/insights-columns/october-2012-why-some-hies-fail-and-others-succeed/