8 Health Information Exchanges Lead The Way

The vast majority of clinicians support robust health information exchange, according to Washington DC-based Bipartisan Policy Center (BPC). BPC has issued a pair of new reports that include results of a clinician survey and policy recommendations.

According to the survey, which was jointly conducted by Doctors Helping Doctors Transform Healthcare and the American College of Physicians, 80% of clinicians believe that the electronic sharing of information will have a positive impact on the quality of care; 80% on care coordination; 78% on the ability to meet the demands of new care models such as accountable care organizations and medical homes; 72% on the ability to participate in third-party reporting and incentive programs; 69% on improving practice efficiency; and 57% on reducing healthcare costs.

The clinicians view the lack of interoperability between their EHRs and other systems as the greatest barrier to the electronic exchange of information. Of the respondents, 71% cited that and the lack of a health information exchange infrastructure as major obstacles, and 69% cited the cost of setting up and maintaining interfaces and exchanges. Liability issues and concerns about security and privacy were seen as minor barriers.

In an interview with Information Week Healthcare, Janet Marchibroda, chair of the BPC's health IT initiative and a former president of the eHealth Initiative, said that it was highly significant that only 22% of clinicians believe the lack of a business case is a major impediment to health information exchange. "That's a real change from previous surveys," she said.

"What's driving this is the proliferation of delivery system reforms and new payment models that require information sharing between primary and specialist, between hospital and primary care," she continued. "The other big driver is that stage 2 of Meaningful Use has much more robust requirements for information sharing [than stage 1], and that will go into effect for hospitals next October and for eligible professionals on Jan. 1, 2014."

[ Practice management software keeps the medical office running smoothly. For a closer look at KLAS' top-ranked systems, see 10 Top Medical Practice Management Software Systems. ]

Clinicians agreed that the three most important types of shared information are discharge summaries when patients are discharged from the hospital; reasons for a referral; and consultant reports to referring physicians. They also sought medication lists; relevant imaging test results; relevant lab results; a care plan from specialists; discharge instructions; a list of follow-up appointments, procedures, tests, and referrals; a medication allergy list; a problem list; and the names of other providers involved in the care of the patient.

All of these priority items have fields in the Summary of Care record that certified EHRs must include in 2014, when eligible clinicians begin to go through MU stage 2, the report points out.

More than half of the respondents said they'd prefer that only essential information be "pushed" to them electronically, but they also wanted the ability to query databases for additional information. About 20% of the clinicians said they'd like all information to be pushed to them, and 10% would just like to get an alert when the information is available so they can ask for whatever data they need. For urgent cases, a majority of physicians want access to the data immediately or within 24 hours; for non-urgent cases, within three business days.

The 2014 EHR certification criteria require support only for "push" models of data transmission, the report noted. Data-transport standards that support "query" models are still optional.

BPC makes a number of recommendations to accelerate the electronic exchange of healthcare data:

--Stakeholders should develop a long-range national strategy to support standards for interoperability, aligning public and private sector efforts.

--Physicians, hospitals, other providers, and health IT vendors should build a consensus on how to meet common information needs.

--The government should provide additional regulatory guidance on how to support query access to priority information and on the exchange of imaging test results at transitions of care.

--The government should develop a national strategy to improve patient data matching capabilities. (The Health Information Management and Systems Society [HIMSS] recently proposed something similar.)

--The government should clarify privacy and security rules as they relate to health information exchange, and state privacy laws should be harmonized with federal regulations.

--The government should work with the private sector to standardize models of patient consent.

"Clinicians agree that we need a more robust dialog among primary care, specialties, and hospitals [in the area of information sharing]," Marchibroda said. But, she added, removing the obstacles to health information exchange doesn't always require government regulations. "It's something they need to work with each other on."

InformationWeek Healthcare brought together eight top IT execs to discuss BYOD, Meaningful Use, accountable care, and other contentious issues. Also in the new, all-digital CIO Roundtable issue: Why use IT systems to help cut medical costs if physicians ignore the cost of the care they provide? (Free with registration.)