Among the Obama administration's efforts to improve healthcare in the United States, health information exchange (HIE) ranks among the least controversial. HIE lacks the political and public divisiveness of healthcare reform, the government "giveaway" accusations of the electronic health record (EHR) incentive program or the widespread Republican opposition of state health insurance exchanges.
There are two practical reasons why HIE avoids the flashy headlines. When the HITECH Act of 2009 set aside funding for each U.S. state and territory to establish an HIE entity, many private HIEs linking facilities within a large network or specific geographic area were already in place and largely successful. In addition, it's almost universally accepted that patient care improves, and healthcare costs go down, when physicians can readily access patient data at the point of care.
That said, a complex blend of technology, management and financial challenges continue to stymie the further growth of HIE. Unfortunately, solutions aren't easy to find.
Providers Using EHR, Not Necessarily Sharing Them
At the recent Healthcare Information and Management Systems Society's HIMSS13 conference, the Office of the National Coordinator for Health IT issued a request for information on how to "accelerate and advance" health information exchange and interoperability beyond what existing federal policy has accomplished so far.
In the RFI, the ONC notes that EHR use grew 80 percent between 2009 and 2012. While that is good news, data exchange is progressing more slowly. For example, as of 2011, only 25 percent of hospitals could exchange medication lists and clinical summaries with providers outside their network and only 31 percent of physicians were exchanging clinical summaries with other providers. Equally frustrating for ONC is the fact that fewer than one in five patients were given online access to their medical data.
It's no surprise, then, that HIE organizations-the vast majority of which are independent, nonprofit organizations-face numerous obstacles. A recent survey (PDF) by the eHealth Initiative found HIE organizations most concerned about developing a sustainable business model, securing funding, engaging with a wide range of stakeholders (which includes hospitals, laboratories, insurers and other care providers) and convincing those stakeholders that data exchange is secure. HIE entities also face competition from vendors, large integrated delivery networks and other HIEs, all of whom could promise healthcare providers better data exchange at a lower cost.
These challenges are further compounded by healthcare reform, which emphasize two means of delivering care-the accountable care organization (ACO) and the patient-centered medical home (PCMH)-that the eHealth Initiative says can succeed only with "a robust and interoperable HIE infrastructure that can support coordination across the care continuum, data exchange between disparate sources, and evidence-based practices and clinical guidelines for care."
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