HERNDON, VA. – Two state officials shared their decision-making process to take to the cloud for health information exchange (HIE) efforts during a presentation at the 2012 Healthcare IT Connect Summit on June 20. While still new to the exchange game, the officials shared the circumstances and needs that cloud computing ultimately met.
Cloud computing, especially regarding the sharing of clinical information, is certainly not without concerns, noted the presentation moderator Harsha Rao, MA, principal at Booz Allen Hamilton.
A litany of questions arise when discussing HIE cloud options: Are data protected and safe? How do I get the resources I need when I need them? What is the access and transaction time? How can I get my resources in and out of the cloud?
Rao pointed out that data protection and security controls are key cloud privacy and security considerations. However, cloud computing allows organizations to handle larger datasets and can provide scalable infrastructure.
John Lekich, project director for the State of Illinois, noted their ultimate decision to move to cloud hosting for HIE purposes stemmed from various state realities. For example, Lekich cited the state’s fiscal troubles so any procurements of capital products have proved difficult. “The pay-as-you-use approach was compelling,” said Lekich.
In February 2010, an executive order from the state’s governor sparked the creation of the state's Office of Health IT (OHIT). In July of that same year, the Illinois HIE Authority was created. OHIT is to continue working on HIE efforts on behalf of IHIE Authority through 2012 before giving the HIE keys over to IHIE Authority. As Lekich mentioned, the cloud-based approach would allow ease of transition of HIE operations when OHIT passes on the responsibility to IHIE Authority.
Today, the state is in the initial HIE participant recruiting phase, building a master patient index and providing ongoing enrollment of providers into Direct (there are currently 500 providers enrolled with more than 60 percent being active users, Lekich stated). Some specific use cases Lekich mentioned that the HIE hopes to accomplish are emergency department, specialist referrals and public health reporting.
Kim Norby, state health IT coordinator for the State of Iowa, cited that the request-for-proposal for Iowa Department of Public Health Office of Health IT’s HIE proposal never mentioned any specific language regarding cloud services. The basic requirements included that data reside in Iowa for consumer comfort and the department wanted a solution where the cost benefit increased for Iowa’s customers as adoption and use increased. Yet, no specific equipment was dictated.
While the contracting process went from September 2010 through October 2011, the ultimate decision was a hybrid cloud model with both private and community type attributes where Iowa e-Health, a collaboration of consumers, healthcare providers, payors and others, contracted the tool as a combination of both platform and infrastructure as a service environment and is provisioned for use by Iowa and surrounding partners and citizens as end consumers.
“The [HIE] environment can grow easily as demand grows,” noted Norby, adding it’s metered based on aggregate storage and processing capacity; not set up by click or individual service usage.
While the operating infrastructure is not hooked up but built out, the biggest challenge was the onboarding process for initial participants, according to Lekich. “Recruiting can be difficult without a vendor or infrastructure to present,” he said, adding he would have started the initial recruiting process earlier. Currently, Lekich noted, there is a team of “Alpha Partners,” including Northwestern Hospital and Central Illinois HIE, onboard and the master patient index is being loaded with a Medicaid database of 2.7 million patients.
For Iowa, Norby stated the main challenge was the contracting process (which spanned approximately a year) due to the number of entities involved and two specific Iowa needs:
- Protection for partner relationship changes; and
- Future governance transition requirements.
“As [the HIE] timeline moves forward, needs might change,” concluded Norby.