Health Information Exchange Turns a Corner

Dr. Farzad Mostashari and Claudia Williams | March 30, 2012

As reflected in the guidance released last month by the State Health Information Exchange Program (HIE), this year we expect health information exchange to take off. The stage is set. Adoption of electronic health records (EHRs) by ambulatory providers doubled between 2008 and 2011. Substantial progress was made on interoperability through Stage 1 Meaningful Use requirements.

All certified EHR systems can now record, consume or produce standardized content, including: medication lists, problems, drug allergies, smoking status, lab results, and care summaries.

We have the standards building blocks needed for transport, lab results, and patient transitions.  And, perhaps most critically, payment reforms that reward better and more efficient care and not the volume of services are driving demand for mechanisms to coordinate care, reduce readmissions, and engage patients, providing a powerful business case for exchange.

Stage 2 Meaningful Use and Health Information Exchange

Recognizing this critical juncture, the HIT Policy and Standards Committees recommended that Stage 2 of Meaningful Use require actual, ongoing, and secure exchange of patient information to support patient transitions, public health reporting, and patient engagement. These requirements are included in the proposed rules released by CMS and ONC last month.

The stage is set, and it is clear we can and must make rapid progress this year on health information exchange in anticipation of the proposed Stage 2 Meaningful Use requirements.  Nearly one in five elderly Medicare beneficiaries discharged from the hospital is readmitted within a month, often due to lack of care coordination after discharge. In 2010, according to AHA survey data, only 19 percent of hospitals were sharing patient clinical information electronically with ambulatory providers outside their system. What will it take to double that figure this year?

Investing in Health Information Exchange

Happily, many hands make a light load. Galvanized by anticipated payment changes, investments in exchange are accelerating. More than 70 percent of hospitals are planning to build exchange infrastructure Exit Disclaimer. EHR vendors are launching products to help providers manage referrals and share information with patients. National networks are offering exchange services and regional and state exchange networks are growing. Many different networks, models and approaches are emerging. There is no one size fits all approach.

One of ONC’s key goals is to reduce the cost and complexity of exchange by putting in place the building-block standards, services and policies that are needed regardless of the exchange model. Our goal is to advance exchange as a verb to support Meaningful Use and improve care coordination, not to support a particular model of exchange or organization type.

The State Health Information Exchange Program

The guidance released last month by ONC’s State Health Information Exchange Program underscores the critical role that states will have in galvanizing rapid progress in exchange this year. This document builds on prior guidance from 2010 asking Grantees to:

  • Focus their efforts on supporting providers in achieving Meaningful Use, including e-prescribing, lab exchange, and care summary exchange across unaffiliated organizations
  • Use a gap-filling approach that leverages private sector investments and other state assets
  • Avoid mandating provider participation in any one exchange network
  • Use policy and purchasing levers to encourage exchange in the state
  • Ensure consistency with national policies and standards
  • Develop privacy and security frameworks based on fair information practice principles
  • Focus sustainability efforts on persistence of information exchange, not the continuation of government-sponsored exchange entities

In most cases, rapid state progress on exchange won’t be accomplished by creating a single statewide network that all providers will use for most of their exchange services. Rather, states are mobilizing exchange by filling key infrastructure gaps, building trust and making sure all communities and providers have exchange options:

  • Offering shared services that lower the cost of exchange such as provider directories and identity services
  • Jumpstarting exchange services in underserved areas to meet providers’ Meaningful Use exchange requirements
  • Establishing common policy requirements that build provider and public trust
  • Extending a helping hand—so-called “REC for HIE” services—to providers and communities that don’t have the resources or know-how to participate in exchange
  • Building infrastructure to connect existing exchange networks
  • Making investments in emerging local and regional exchange efforts
  • Tracking and monitoring progress to identify gaps and evaluate the impact of existing efforts

State HIE Program grantees are making smart investments, building on the market, and focusing on helping providers meet Meaningful Use requirements, including e-prescribing, exchanging lab results, and sharing care summaries to support patient transitions. They are offering affordable, high-value services that fill gaps, which providers are willing to pay for and payers are willing to support, assuring long-term sustainability. States’ investments are helping providers achieve Meaningful Use and are building the foundation for care transformation and payment reform efforts at the state level.

This year we expect to make health information exchange to take off. The stage is set. The time is now. Patients cannot wait. We need your help to get there by adopting national standards and business models that support information following patients across provider systems, vendor platforms, and geography.

For more information about health information exchange and health information technology, visit HealthIT.gov.