Academic journal article Frontiers of Health Services Management

A Customer View of CHINs

Academic journal article Frontiers of Health Services Management

A Customer View of CHINs

Article excerpt

Karen Duncan provides an interesting and informative overview of CHINs. She describes key features, likely participants, and important obstacles and opportunities. Duncan is to be particularly commended for her discussion of how a CHIN will change the administration and delivery of health services. Too often, CHINs are evaluated only in the context of their impact on current practices. Although a CHIN can improve existing clinical and business operations, Duncan correctly identifies the most important rationale for the CHIN--changing the way business is done and care is managed.

In an understandable effort to synthesize a broad subject, her article presents a more homogenous definition of CHINs than exists in today's marketplace. Duncan acknowledges some differences among CHINs, but she also makes some generic assumptions: for example, that a CHIN will serve all stakeholders, or that the ultimate motivation for a CHIN is to improve the health of the community. Not all CHINs will serve all stakeholders; they will serve more than a single stakeholder, but participation will vary. Also, the motivation of many CHIN participants may be considerably less altruistic than improving the health of the community. Meeting business needs is a more likely driver for CHIN development.

It is not surprising that definitional questions surround CHINs. As Duncan correctly notes, most of the CHIN activity in the country is talk, not transactions. The phenomenon is fairly new, the undertaking is quite complex, and most CHIN efforts are still in the planning, development, or even vision stages. Answering the question, What is a CHIN? is complicated by marketing tactics. As CHIN becomes a "hot" topic, everyone is suddenly selling, buying, or building a CHIN--at least as they define it. Yet, what passes for a CHIN in one community would not pass the definitional muster in other locations. As the industry struggles to define and describe a CHIN, it is useful to consider the evolving four-part description of CHINs-in-Progress (CHIPs) developed by the Community Medical Networking Society (COMNET) (1995) and referenced by Duncan.

An enterprise network is a health information network that links users within a single organization and its owned affiliates. An integrated delivery network is a health information network that links the owned, affiliated, and contracted entities of an integrated delivery system. A CHIN-ready network extends beyond a single organizational structure and business objective linking other designated stakeholders within a region or community of care. A CHIN ideal represents the full promise of community networks and includes the following:

* The ability to transmit clinical, administrative and financial data with seamless connectivity in a standardized format.

* The open, nonexclusive participation of providers, payers, purchasers, physicians, and other stakeholders within a community of care.

* The ability to securely house data for controlled public access.

* A separate business organization for governance/ management that includes a viable implementation/financial plan. (COMNET 1995)

The Community Health Management Information System (CHMIS) movement, the precursor and originator of the CHIN concept, defines itself in this manner (Foundation for Health Care Quality 1994): "To meet the shared health care information needs of the community by...

* Aggregating health care information in a community repository

* Delivering health care management information at the point-of-service

* Implementing standards for common electronic health care administrative transactions

* Linking the participants in the health care system through electronic networks

* Creating a partnership to govern the system(s) and apply information."

Ultimately, the acronyms and their definitions are not what matter. It is how the CHIN does or does not meet the needs of its many customers that counts. …

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