Reginald Coopwood, MD, has been intimately involved in the creation of multiple health information exchanges and, most recently, the closing of one HIE.

That would be Health Information Partnership for Tennessee (HIP TN), of which Coopwood was chairman of the board before the state decided to shutter the three-year-old exchange.

Government Health IT Editor Tom Sullivan spoke with Coopwood about what happened, lessons learned that others implementing statewide HIE would be wise to heed, and why there needs to be an appetite for health data and an iPad of HIE if health information exchange is to reach its potential.

Q: With the news that HIP TN is closing, what might be some lessons learned here?
A: Probably the most valuable lesson learned is the complexity of what our undertaking was. We decided to do this three years ago. At that time there were two HIEs across the state. Among the people at the table, our goal was to create a statewide HIE, a network of networks, therefore we were setting ourselves up to be the connector from the east part of Tennessee where there was an HIE, to the west part of Tennessee. So that was the early work of HIP TN to have activity of delivering full medical records and, ultimately, radiology images – so this wasn’t just CCDs. It was a bold vision at the time and during the course of this two other HIEs have been stood up, one folded. Now we have three HIEs, two of them are different than the originals. HIP TN was kind of slowly progressively trying to get the rules, to get the ability to exchange data, trust brokers, to make sure the technology would deliver on the requests. We didn’t fail in moving in that direction.

Q: It sounds as if HIP TN was progressing, so what happened?
A: We fell upon the criticality of time where states are being incentivized to exchange data in order for providers in the state to meet meaningful use, and what we were building delivered way more than the minimum data set and probably would not fit in the timeframe the state needed in order to be compliant with the requirements ONC was placing on them. So the decision by the state was not that HIP TN was a bad thing, it’s that we were investing in building more than is required today. As Direct became more mature, more available, and met the minimum requirements of at least Stage 2 [meaningful use] that was the direction the state felt was in their best interest in order to meet the obligations to the federal government.

Q: Would I be stretching to think that HIP TN was, perhaps, ahead of its time?
A: I think time will tell that. One of the reasons why I was involved is because I was part of the early stages when we stood up the Nashville HIE and when I moved here to Memphis it was the original HIE in the state and I’ve been intimately involved with the local HIE. Then I was involved with HIP TN since its inception and I believe that – and I’m not speaking for anyone but myself – I firmly believe that in order for HIE or data exchange to do what they’re intended to do, there need to be good and robust data that gets exchanged to help manage patient care better.

[See also: The biggest challenge for HIE is not technical.]

So we were building toward that, but I couldn’t tell you whether in five years there will be something that makes that completely obsolete and does the things that I think are more robust than Direct. I think the concept is maybe before its time but when that time hits, whether that will still be the right technology or not I couldn’t tell you. But I do feel that we are going to need to exchange more than CCDs at the end of the day.

Q: Based on your experience would you anticipate that Direct has a similar impact on other HIEs?
A: The other fundamental problem with HIE is sustainable funding. If you’re depending on significant government funds, as our HIEs have in their inception, and then some degree of support moving forward, without a sustainable model of revenue that keeps the HIE independently going, it will be difficult when the funding at all levels of government is toward a certain type. In our case, the funding was there to develop what we set out to and we were wholly dependent on that state funding, which was passed down from the federal government. So when the attention then turned to Direct at the federal level and the funding got diverted, if that HIE does not have a sustainable business plan to keep it going, then that HIE is at risk of closing, yes.

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