# HIEs: Too Many Cooks Spoil the Broth

Is the number of people working on developing Health Information Exchanges (HIEs) is greater than the total number of people who attended HIMSS in Orlando; more than 30,000?  Why are five hundred HIEs are being built?

Let us assume for a moment that there is a set of standards somewhere, a blueprint perhaps, for what a good HIE should be able to do.  Granted, if we are going to be honest, an HIE does not have to do very much; does it?  It does not change the data in a health record.  It does not add data.  And, it neither creates nor destroys health records.

In its simplest form, a health record comes in from some place, and that same record goes out to some other place.  And what is in that health record?  If we are trying to keep it simple in order to show the problem is in fact solvable, what is in the health record is a formatted collection of ones and zeroes.  And how does the HIE “move” the ones and zeroes?  The movement is caused by writing computer applications; code—ones and zeroes.

The blueprint for an HIE is nothing more than a pipe to move formatted zeroes from point A to point B.  Now in reality, we have about five hundred HIE teams working hard to build disparate HIEs.  To what end?  To move ones and zeroes from point A to point B.  So, the 500 HIE teams are writing 500 different HIE applications using ones and zeroes to move ones and zeroes.

Doing the math—500 HIE teams * 1 HIE application per team = 500 different HIE applications.  If done correctly—which is an entirely different conversation—we will have 500 HIEs, each of which are capable of doing the exact same thing; which is—moving ones and zeroes.

Let us dissect the ones and zeroes concept for a moment.  When Al Gore created ones and zeroes he did so with the premise that all ones were created equal, all zeroes are created equal, and that ones and zeroes are equal.

Now, what makes the one and zero concept particularly great with regard to HIEs and all of healthcare IT is there is never a need for a “two”.  No CIO worth his or her salt will ever sit at a steering committee meeting and state, “If I only had a 2, this whole problem would go away.”

If one looks correctly at the issue of HIEs by breaking it down to its simplest elements, it is a unique problem to solve.  Unique—as in singular.  Two HIEs do not solve the problem better than one HIE.  Once you have two, you no longer have a unique solution, and when you have 500 HIEs, you have a mess.

Here is the kicker to this argument.  What else do you have when you have a single HIE capable of reading the data from all of the various EHR platforms?  Exactly.  You have the N-HIN—the Nationwide Health Information Network.  Why?  Because when push comes to shove, the N-HIN is nothing more than a glorified HIE.

However, once you have more than one HIE, you then need an HIE for the HIEs, which is the only reason there is any discussion about building an N-HIN.

So, in addition to the fact that 500 HIEs are 499 too many, do they create any other problems?  Of course they do.  They add a very high and unnecessary degree of additional complexity to the healthcare IT systems of every healthcare provider.  Some providers offer services within many different HIE footprints.  Every provider will need to adapt their systems so that the provider’s healthcare records can be accepted by their corresponding HIE pipe.

Instead of building 500 HIEs, and forcing them to some semblance of a standard, why not just build one HIE and have that be the standard?