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Nursing Leadership Informing Community Health Information Exchange Strategy

You are in the chief nursing officer role and have been asked by your healthcare system to represent the hospital on the board of a new not-for-profit entity established by your community to build and manage the HIE within your region. Your region has been awarded a federal grant of $250,000 to build the HIE to serve the community. At the first board meeting of diverse stakeholders, including payers, providers, hospitals, public health, and healthcare consumers, the group must advise the chief executive on what type of exchange the group believes is needed. The chief executive indicates that a basic exchange using the Direct Project protocols for the size of the community is likely to exceed the federal grant dollars, and as such, the group needs to align on a value proposition of what the community needs. This is hoped to result in the community being willing to pay for the additional costs.

The community has a population of more than 250,000, with a significant indigent population that tends to use the ED as an access to care for routine healthcare needs. Hospital staff also suspect that they have drug seekers going from one ED to the next seeking additional medications, yet do not have the information to confirm this suspicion or to track patients from one institution to another.

The community has two major healthcare systems that are heatedly competitive and unlikely to be willing to share data in a central data repository. Providers in the community compromise one large-practice consortium and multiple independent providers. The large group of providers is demanding that some sort of exchange be established to support their referral base. As a result, there is heated debate as to whether the community aligns with a business and infrastructure strategy.

Based on information within Chapter 11, consider the following questions:

1. Based on the needs of the community noted in the case study, what is your recommendation as to the best infrastructure and technical exchange model that the community should promote?

2. What are some of the barriers consistent with other communities’ failures that might be issues for your community and how do you overcome those issues?

Sample Answer

As the Chief Nursing Officer (CNO) representing our hospital, my primary goal is to advocate for a system that improves patient safety and nursing efficiency while navigating the political and financial realities of our region.

Here is the strategic recommendation for our new HIE board:

1. Recommended Infrastructure and Technical Exchange Model

Given the "heated competition" between our two major health systems and their refusal to use a central data repository, I recommend a Federated (Decentralized) Model using Query

The Federated Infrastructure: In this model, data remains at the source (each hospital or practice) behind its own firewalls. The HIE acts as a "pointer" or a record locator service. When a patient arrives at the ED, the system sends out a query to see where other records exist and retrieves them in real-time.

Why it works for us: It directly addresses the "competitive" barrier. Since there is no central "pot" of data, each health system maintains control and ownership of its proprietary information, which is usually the primary concern in "heatedly competitive" markets.