Chuck Christian, VP of Technology & Engagement, Indiana HIE, Chapter 3

If you really want to get Chuck Christian’s goat, ask him why all banks are connected through ATMs, and yet healthcare still struggles with interoperability. The simple answer? It took quite a bit of time for banks to figure out a system. Oh, and accessing data is slightly more complex than withdrawing $10. In the latest of our Fireside Chat series, Christian talks about the progress Indiana Health Information Exchange has made in facilitating data exchange among organizations, why it’s not a lack of standards, but rather the lack of a single standard, that is hurting the industry, and what healthcare can learn from industries like banking and railroads. He also discusses the need to use data to help and not hinder clinicians, and why he strongly disagrees with reports suggesting that HIEs have maxed out.

Chapter 1

Chapter 2

Chapter 3



* Responding to Chilmark’s report: “Not all HIEs are the same.”

* Decreasing in numbers, increasing in strength

* “We’re just now starting to scratch the surface.”

* Data access & public health initiatives

* “We have more data we can use appropriately & securely.”

* Impact of food deserts

* Cyberattacks: “You have to be forever vigilant.”



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Bold Statements

The other thing that everybody should understand is not all HIEs are the same. Some persist data like we do, others do not, and so the data services we’re able to offer are different. We have to be very careful about painting all the HIEs with the same color and the same brush.

I’m going to violently disagree that HIEs have maxed out. I think that we’re just now starting to scratch the surface on what the capabilities may be.

You need to know where that patient is getting services, and if the only view you have is the data you have in your own EMR, you’re going to have a very narrow band of view.

The large majority of care from an individual standpoint is happening at the physician practices. Now that the large majority the physician practices that are automated, you have a whole lot more data that you can use appropriately and securely to do things around public health.

When you think you have all the doors bolted, somebody is going to crawl through a crack, and so you have to be forever vigilant.

Gamble:  One thing I had to bring up especially knowing you for a couple years was the recent Chilmark report that talked about HIEs and saying that they’ve reached their limits of effectiveness and I know that kind of thing makes your blood boil.

Christian:  The thing about it is, there’s a researcher at University of Michigan, Julia Adler-Milstein who published a piece which said that for Medicare patients in areas that are covered by an HIE, there is an annual savings of about a $139 a year. Well, that doesn’t seem like a whole lot of money, until you multiply that by all the Medicare lives that HIEs can cover — it’s millions, if not billions of dollars. There are competing viewpoints about health information exchanges.

The other thing that everybody should understand is not all HIEs are the same. Some persist data like we do, others do not, and so the data services we’re able to offer are different. We have to be very careful about painting all the HIEs with the same color and the same brush. Have you ever heard of the parable of the five blind priests that went to see the elephant?

Gamble:  No, but it sounds pretty good.