At a press conference announcing the report, Chris Muir, state HIE project manager for the Office of the National Coordinator of Health IT (ONC), laid out the extent of the challenge. Despite all the efforts and investments that have been made, including $564 million in federal funds, Muir said, "There is relatively little information exchange that's taking place across the country."
He pointed out that in many areas, the infrastructure isn't even there yet for health data exchange. Where public HIEs do exist, he noted, few providers are signing up for the available services--and even when they do sign up, many people don't use what's available. Usability, trust, and workflow issues may be to blame, he suggested.
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Accountable care organizations (ACOs) may be impeding the development of community HIEs in some regions. At the press conference, Tom Fritz, CEO of Inland Northwest Health Services, one of the successful HIEs profiled in the report, said that the formation of ACOs in his area has caused some provider organizations to create barriers around their data so that their competitors won't have access to it.
Similarly, Jason Kunzman, Beacon Community senior project manager for ONC, told attendees that concern over patient "leakage" to competing providers is one of the obstacles that HIE builders face across the country. Other barriers, he said, include legislation about patient consent, sustainable business models, interoperability, and the ability to demonstrate the value of information exchange.
But despite these challenges, some public HIEs are finding new ways to prove their worth. For example, Laura Adams, president and CEO of the Rhode Island Quality Institute (RIQI), said her exchange has been emphasizing the Direct secure messaging protocol that ONC and its private partners launched last year. By using Direct, she said, physician practices have been able to send clinical data summaries to RIQI without the HIE having to interface with lots of disparate EHRs.
According to Adams, RIQI has also used Direct to provide a "detect-and-notify" feature to its physician members. When a patient visits the ED or is admitted to a hospital in the RIQI network, for example, the HIE will alert the patient's doctor about it. The exchange uses the same approach to alert physicians to patients who are "shopping" for pain meds. The HIE can also integrate mobile apps or home monitoring devices to receive patient data and can warn doctors when there's a problem, such as a sudden weight gain by a patient with congestive heart failure.
"We can lower our members' costs for data integration and analysis and begin to develop the ability to do population health management," Adams said.
Meanwhile, Kunzman said, the 17 Beacon communities, which are federally funded groups or networks on the cutting edge of health IT, are working with a number of EHR vendors to tackle the problem of interoperability between HIEs and outpatient EHRs. The providers and vendors are developing a consistent Continuity of Care Document (CCD) that can be "automatically exported to an exchange via a predefined trigger," Kunzman explained. "We're hoping to have this in production across a number of communities within the next two months."
The NeHC report, called "The Health Information Exchange Roadmap: The Landscape and a Path Forward," describes the efforts of the public and private sectors to create and implement the building blocks required for the spread of HIEs. It also delineates a four-phase roadmap to building successful exchanges, based on the experience of HIE leaders across the country.
Among the HIEs profiled in the report are:
--The Care Connectivity Consortium, a national collaboration by the Mayo Clinic, Geisinger Health, Kaiser Permanente, Intermountain Healthcare, and Group Health Cooperative
--Indiana Health Information Exchange
--Inland Northwest Health Services, Spokane, Wash.
--North Carolina Healthcare Information and Communications Alliance
--Rhode Island Quality Institute
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