Health Record Banking vs. Community Health Information Exchange*
The video summarizes the benefits of a HRB (Health Record Bank) approach to health interoperability vs. the traditional HIE model ( Health Information Exchange – federated, central, or hybrid) approach.
HRBA believes that Health Record Banks demonstrate the following advantages.
Simpler... Less Expensive...Secure...For Life
The video and these notes were developed to provide information for decision makers, particularly state and regional HIE coordinators and federal staff, who are responsible for policy and strategy regarding health information exchange. The comparison looks primarily at a Community HIE, however, enterprise (or private) HIEs have many of the same characteristics as a Community HIE.
An HIE’s success relies on cooperation, usually voluntary cooperation, of the stakeholders. Voluntary cooperation makes the process of negotiating and maintaining legal data sharing agreements more difficult. Adding to the complexity are competitive and sometimes distrustful relationships among the stakeholders. An HIE is “about” the patient but is responsible to the stakeholders. With an HRB, no provider-to-provider sharing agreements are necessary. The patient controls the information and requests/directs providers to send information to the HRB. Each patient determines who is appropriate to view their information in support of their care and health. A HRB is “for” the patient and owned by the patient.
Analyzing regions with a population of 4 million, the results show that a 5-year TCO (Total Cost of Ownership) is approximately $60 million for an HIE and approximately $5 million for an HRB -- a 12 fold difference! Both the greater San Diego region and greater Phoenix region were analyzed. Even if the $5 million figure is off by 100%, $10 million is far less than $60 million. Using San Diego as an example, there are 7-8 major IDNs (Integrated Delivery Networks) and a Beacon organization, which includes a Community HIE for base infrastructure. Each of these groups will spend between $6-10 million over five years to achieve health interoperability with a total regional outlay of approximately $60 million. An HRB could be run for 5 years for $5 million or less with comparable functionality. This translates to about $1.25 per person over 5 years. This is a comparison of costs only and does not take into account benefits and off-setting revenue streams of either model.
Reviewing the literature, cost estimates in the CITL (Center for Information Technology Leadership) report “The Value of Healthcare Information and Interoperability” (Pan et al, 2004) and subsequent CITL cost estimates on interoperable PHRs (Personal Health Records) as reported by Eric Pan at the Arizona Health-e Connection 2009 Western States Summit, are consistent with the above analysis. They actually show that the above HRBA analysis is conservative. In the first CITL report, the cost for the country for health interoperability using HIEs calculates to approximately $1000 per person. In the second report, the cost for interoperable PHRs calculates to approximately $0.25 per person. In addition, calculations made using the State of California cost estimates for a state-wide HIE, result in a cost between $27 and $54 per person (“California Health Information Exchange Operational Plan”, State of California, Draft as of March 8, 2010). There were no estimates of an HRB model in the California Plan.
If the HIE uses a central architectural model like a HRB, then both models provide high security. If the HIE uses a federated/scattered model, the HRB is more secure. When data are federated, there are more vulnerabilities than when the data are centralized.
In the HIE model, the long-term record retention is optional and often dependent on the providers participating. Legally, an organization usually needs to retain adult records for 7-10 years past the last patient encounter (depending on state laws). The organization or HIE is then free to delete records. In an HRB, record retention is controlled by the patient.
*A Community HIE connects disparate organizations while an Enterprise (private) HIE usually connects data sources within the control of a single organization.