Stepping up to be a Health Information Exchange (HIE) Entrepreneur?

Healthcare has a history of being a lucrative business and recent projections estimate that the health IT business overall could show a dollar value of $31 billion over the next few years. Health Information Exchange is of course a key tenet of any healthcare transformation initiative outside the four walls of a hospital or physician clinic, however Health Information Exchanges (HIEs) have had a colored history in demonstrating value to stakeholders and how they will support their long term sustainability as viable business entities.

As with all big business markets, HIE entrepreneurs are emerging with demonstrated value and sustainability models. What are the key tenets for success? Where do they begin? What services and tools should the HIE provide? What kind of business plan is most effective? How should the HIE plan develop over time?

During the 2013 State Healthcare IT Connect Summit  (download speaking proprosal for 2014 Summit here ) Mark McKinney, CEO for Healthcare Information Xchange of New York (HIXNY) and Dominick Bizzarro, Managing Director for HealthShare at InterSystems discussed these questions and more with the audience. Both have experience as CEOs at HIXNY nonprofit organization, and have been involved in building numerous health IT businesses. They’ve known each other for about 18 years and share a lot in common. They’ve worked together in different companies and are now working in a provider client relationship. During their presentations, they shared what they think is the core of any successful business in health IT and answered many questions any Health Information Exchange (HIE) entrepreneur may have.

But first, let me provide a snapshot of their respective employer organizations:

Privately held 34 year old Tech Company

Operational in 30 countries
Customers in 100+ countries
Still run by the founder, Phillip “Terry” Ragon
80-85% of business is in healthcare

HIXNY:
2+ million patients
25+ Terabytes of data
Over 5,000 users and 400 participating healthcare organizations
8 interoperable EMR and HIS vendors

Half a billion of processed clinical messagesWe can all agree that both are pretty impressive, but the real question is how did they get there? The organizations are leaders today, but in 1999, Hixny was very wet behind the ears and pioneering new territory and InterSystems is constantly expanding to new territories. So what guidance do they have to  share?

During Bizzarro’s presentation, he emphasized the importance of business planning and determining the organization’s purpose and strategy. He says, “Strategy is not something that can be done over a weekend. It tends to sharpen its focus over time.” He believes a written plan adds important structure to your thinking. He says it is the only way to critically think about it, and simultaneously you have sharable content for supporters and have something to look back on and measure after a years time.

When Bizzarro first entered the Not-for-Profit HIE world two statements of wisdom were at first very illogical to him, but then stuck with him throughout the years. 1st: “Your product strategy is whatever your vendor says it is.” and 2nd “Your community, our HIE.”

Bizzarro describes a not-for-profit organization just like a small businesses and says technology is there to enable it. At the end of the day, not-for-profit businesses are businesses and the same rules of business apply to them. From Bizarro’s point of view, the top 10 key Tenets for Not for Profit HIEs are:

-No money, no mission –bring in revenue no matter the source.-Encourage altruism but rely on value. Although you may hold the moral hammer, that will not sustain the trade.-Solve the right problems and adoption will follow.

-Revere the early adopters – they are your best friends.
-Partner with government.
-Partner with the private sector.
-Share leadership.
-Convert stakeholders into thought-leading evangelists.
-Welcome interoperability – “a rising tide lifts all boats.”
-Plan, execute, analyze, revise — adapt.

Mark McKinney emphasized during his presentation the importance of weighing business options, then focusing on reaching important goals. From a serious business perspective, one must ask, “What do you want to do next?”, but first:

-Allow value to be cyclical –Find out what is available and what you already have and start where you can and focus even if it is small. This will give you the proof your business needs to build.
-Satisfy your mission and vision – If you want to lower costs, lower them even if your starting point is not where you thought it would be.
-Increment to get there – Test, find out what’s useful and what’s not in order to arrive to the solution. Push forward, learn from your mistakes and don’t focus on trying to get it right as you go. “Strike while the iron is hot”, he said.

Once the infrastructure is there, McKinney spoke strongly of the importance of community involvement in order to apply the right pressure to share knowledge and data. Community involvement is acquired by giving a voice to your stakeholders, members and partners by opening the governance. When this involvement is strong, then it is easier to bring more people, organizations and associations on board.

Building a business and being and entrepreneur takes time and patience, but with the right guidance, motivation and fiery spirit that both Bizarro and McKinney displayed at the Summit, success can be achieved.