Micky Tripathi is the president and CEO of the Massachusetts eHealth Collaborative, a non-profit consulting firm that helps state governments across the country with EHR and HIE strategy and adoption. MAeHC contributed to a study that looked at how HIEs can avoid bankruptcy and bring more value to hospital customers. Tripathi talked with DOTmed News about how the next generation of HIEs will have to be better targeted to customer needs if they want to survive and help hospitals transition through health care reform.

DMN: What are some strategies you share with your HIE clients?
MT:One of the things that we find with a number of them is that they have a lot of stakeholders and not enough customers. That's not necessarily a bad thing. A lot of these collaborations were set up to address societal needs and not just a business need of any individual organization. As they move now to a model where they're going to have to essentially have customers paying them for services, part of the balance is figuring out who are these customers that have immediate needs that I can solve, whose needs are also aligned with the overall mission of the collaborative activity that we're trying to undertake. What's the difference between the stakeholders and the customers? And then sharpening your focus on what the immediate customer needs are.

You also want to think about where are you in the value chain. If you're a state level HIE, it's unlikely you'll be able to solve the ACO needs of a particular provider or organization. A state-level HIE might be more focused on connecting up the silos. Those silos might not be thinking, how do I connect to the next ACO, but we have a public interest in one ACO being connected to another. It's offering a kind of complementary service to those being offered by a higher-level HIE.

DMN: The report said many hospitals don't feel they're getting their money's worth from HIEs. How can HIEs offer more to hospitals?
MT:With technology, the technology isn't the driver, the business strategy should be the driver. If it wasn't set up to fit the hospital's needs, then it would only be coincidence if it did end up fitting those needs. Some HIEs have been set up with this broad multi-stakeholder set up that's solving a wide variety of needs. The hospitals are footing a large part of the bills for a number of these. I think that's why you're seeing those private HIEs emerge. Most of the private HIEs are a hospital plus a number of practices who get together and say we're going to launch an HIE. They provide most of the staff, and they end up being pretty happy with the results of that. They deploy something that's specifically focused on the needs they have.

One of those needs is to become a common platform for pushing information to their provider community, which is more efficient than the way it's done today. If you think about what a hospital does today, they're required to send out lab results for the outpatient, and then radiology reports to the provider community. Right now they do it in an inefficient, clunky way. Then you add on top of that the expectations coming from Meaningful Use.

Hospitals are also very often the drivers of these ACOs. As they look to their needs regarding ACOs, they start to need things like care management functions, population health, using medical record information to identify risk, patient engagement — all those things they're seeing as being closer and closer to the core of what they're being asked to do in affordable care, and using HIEs to accomplish that.

DMN: What do you predict for the future of HIEs?
MT:I think we're going to see private HIEs flourishing even more than they are now. We're seeing that already. We're certainly seeing it in New England, as we work, private HIEs are starting to blossom from the bottom up. The second is that the state level HIEs that don't pivot or change their business approach to recognize that reality and then figure out how to provide complementary services are not going to survive. The good news is that the ones that do that will survive and offer a nice complementary service.