America's Next Top HIE Model...

Greg Freeman, for HealthLeaders Media , September 13, 2011
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“The biggest drawback with centralized data is physically managing the data of a million-plus patients in one system,” McCleese says. “Feeding that data in to the system in an efficient way, keeping the record updated and making sure you’re matching data to the right patient, is crucial to creating an effective resource. That’s a challenge when you’re handling millions of messages a month, which is typical for an HIE.”

The decentralized or federated model
  • Since the healthcare provider stores the data , there is no conflict concerning who owns the data.
  • The data is always current because the provider does not have to send updates to a central data bank.
  • The failure of a single system doesn’t cripple the whole network. 
  • The provider must ensure that only authorized third-party systems connect to the network.
  • Standards and guidelines for inter-provider access to patient data are still being defined.

“There is a trade-off. If we keep the record within our system here and our network is down for some reason, then the providers in the exchange are not going to be able to access that information,” McCleese says. “But if you have the HIE maintain all that patient data, there is a cost associated with that. Our hospital serves roughly 160,000 people in this area, but an HIE could have data on millions of people.”

Data discrepancy also can be an issue with the federated model, McCleese says. If a patient is identified differently at two facilities, it may be difficult to match up the records and get a complete EHR.

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