Wednesday, August 4, 2010

Commercial HIE Products

Recently at the Massachusetts Health Information Exchange (HIE) Ad Hoc Workgroup we made a list of the 7 services we intend to support in 2011 (Routing, Directories, Certificate management, Vocabularies, Population Health Aggregation, Quality Registries, and Consent) then we created a matrix of solution providers. HIE is an evolving market and I'm convinced that the next year will bring many new entrants. They key will be separating fact from fiction i.e. running software from powerpoint demonstrations. Here are a few thoughts from at the services list.

Routing - In Massachusetts we believe that machine to machine, EHR to EHR, and hub to hub routing is preferable to web-based portals since it ensures the workflow of health information exchanges happens inside the software that clinicians are using to deliver care. There are few machine to machine routing products available in the marketplace. Vendors offering general HIE products include Medicity, Axolotl, RelayHealth, Covisint, Epic, eClinicalWorks, GE, Orion, Medplus, Medseek, CareFx, Intersystems, Microsoft, dbMotion, HealthUnity and Patientkeeper. Of these I know of machine to machine solutions offered by Covisint, Epic, eClinicalWorks, General Electric, Orion, and Intersystems. Verizon is a new entrant and Ingenix is rumored to be preparing an offering. Surescripts offers medication routing and may be expanding into other areas.

Directories - an index of payers, providers, and public health entities is needed as part of routing to direct transactions to the right trading partner. I have yet to find a provider with a standards based (LDAP) or RESTful API for directory query and update. However, there are many sources of provider address data such as the Council for Affordable Quality Healthcare (CAQH).

Certificate Management - Public Key Infrastructure for organizations and providers is key to secure the endpoints in routing transactions. Providers of certificates and management tools include Verisign and Covisint, which has done work for the American Medical Association.

Vocabularies - the Federal Government is the major provider of vocabularies and code sets curated by the National Library of Medicine or licensed from Standards Development organizations.

Population Health Aggregation - There are existing public sector aggregators of data at the Federal (CDC), State (Department of Public Health) and City (local health departments) level. At the moment, I am unaware of commercial companies providing this functionality.

Quality Registries - Companies like Ingenix, and Healthcare Data Services offer aggregation of financial data. Community-wide repositories and specialty specific registries for quality reporting are an evolving marketplace largely comprised of self-built solutions.

Consent Management - Supporting patient controlled consent for health information exchange is key to building trust. There are a few emerging companies, including Private Access.

I welcome comments on other emerging companies in this space and experiences you have had with real world implementations of their products.


Busybee said...


Thanks for this helpful list. Clearly, there's a lot of noise in the space and some consolidation is likely.

Do you see larger players offering a range of these services or do you anticipate different providers for (say) Patient Consent vs. Directories vs. Certificate management, etc.

Different skills obviously, but I'm wondering how HIEs might juggle so many technologies/partnerships.

Anonymous said...

Also need to Herd some Nerds

Jitin Asnaani said...

Hi John, another emerging company of note is Axial Exchange, which has built a real-time machine-to-machine solution (Axial 360) with a machine-to-portal platform for clinical data/summaries (Axial Alerts) built on top of it - see

John@Chilmark said...

John, good to see you bring some attention to this subject and outline some of the priorities of MA and where the HIE tech is today to meet those needs.

Here at Chilmark Research, we've been doing quite a bit of research on the subject. On the M2M (or EHR 2 EHR) data exchange, many HIE vendors are doing this - Axolotl, Care Evolution, dbMotion, ICA, Medicity, etc. The bigger question is: what data sets are actually being transmitted? Today, mostly just lab orders and results, though we are starting to see patient summaries.

The HIE market is in a high state of flux and it is unlikely that any single vendor (exception may be the big players: IBM, Ingenix, MSFT) will meet all requirements, thus partnerships and the architectures to support such will be crucial. Axolotl (now Ingenix), Covisint, Medicity and MSFT are all heading down this path today.