Recommendation as to the Best Infrastructure

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?

recommendation as to the best infrastructure

Please note the grading rubric. The submission should be maximum 2 pages not counting the cover page and references.

Nursing Leadership Informing Community Health Information Exchange Strategy

Recommendation for Infrastructure and Technical Exchange Model

Given the community’s diverse needs and the constraints of the federal grant, my recommendation is to implement a hybrid HIE model utilizing a federated architecture with Direct Project protocols. This approach balances cost-effectiveness with the ability to meet community needs. The federated model enables data sharing without necessitating a central data repository, which is critical given the competitive nature of the two major healthcare systems.

The federated model allows each institution to maintain control over their data, addressing concerns of data ownership and competitive interests. The Direct Project protocols facilitate secure email-based exchange of health information, which is a cost-effective solution that aligns with the limited budget while ensuring essential data sharing capabilities.

Key features of the proposed hybrid HIE model include:

  1. Federated Architecture: Decentralized data management allowing individual healthcare entities to retain control over their data.
  2. Direct Project Protocols: Secure email-based exchange enabling providers to send and receive patient information efficiently.
  3. Incremental Implementation: Start with essential data exchanges (e.g., discharge summaries, referrals) and expand as additional funding becomes available.

This model supports the community’s significant indigent population by ensuring continuity of care and reducing ED misuse. It also helps track and manage drug-seeking behaviors by allowing providers to share critical patient information securely and efficiently.

Addressing Barriers and Overcoming Issues

Implementing an HIE in this community faces several barriers, consistent with challenges experienced in other regions. Key barriers include:

  1. Data Sharing Reluctance: The competitive nature of the two major healthcare systems may hinder willingness to share data. Overcoming this requires:
    • Building Trust: Establish a governance framework ensuring data security and equitable benefits.
    • Stakeholder Engagement: Regular meetings to address concerns and demonstrate mutual benefits.
  2. Financial Constraints: The federal grant of $250,000 is insufficient for a comprehensive HIE. To manage this:
    • Phased Approach: Implement the HIE in phases, prioritizing essential functionalities.
    • Additional Funding: Seek additional grants, public-private partnerships, and community investments.
  3. Technical Challenges: Integrating disparate systems can be technically complex. Mitigation strategies include:
    • Standardization: Adopt widely accepted standards (e.g., HL7, FHIR) for interoperability.
    • Technical Support: Provide training and technical assistance to ensure smooth adoption and use.
  4. Provider Resistance: Independent providers and large-practice consortiums may have differing needs and resistance to change. Address this by:
    • Customization: Tailor solutions to meet specific provider needs.
    • Demonstrating Value: Use pilot projects to show improved patient outcomes and efficiencies.

By addressing these barriers with targeted strategies, the community can effectively implement a sustainable and valuable HIE. The recommended hybrid model not only aligns with budget constraints but also fosters collaboration, improves patient care, and enhances overall healthcare delivery in the community.


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