One trend that is ongoing is the development of private health information exchange inside of health systems and certainly that would now include accountable care organizations, and the Affordable Care Act really puts added momentum behind the development of private health information exchange. As a trend, that’s increasing into 2013 and will continue to advance.
One other trend is the effort to promote personally-mediated health information exchange, for example, via the Blue Button initiative. And it’s not only what Blue Button is about. It certainly is part of the conceptualization for some that that’s what it could be about. That is the third broad area of health information exchange. I’m not terrible optimistic about PHRs for personally-mediated exchange really taking off in the coming. The efforts for encouraging downloads have gotten some traction, but the efforts to make the consumer the conduit for their exchange for health information exchange have really not.
The final trend (and this is perhaps one of the more interesting ones) is what I would articulate as the two different approaches that are in play right now. One is the internet model for policy and participation in health information exchange where there’s no real overarching governance aside from HIPAA and state law and regulation versus the network-effect models and that’s what we’re seeing coalescing in Healtheway, CCC,* and the state HIE-EHR working group where they have a binding policy agreement in the DURSA** that adds to the connection amongst them and they represent a certain kind of co-participant group that can work with each other together.
** Data Use and Reciprocal Support Agreement (DURSA)
Although Loonsk did not identify them specifically as trends, the following two observations provide insight into how HIE will play out at the federal and state level:
Overall, meaningful use as it’s been organized has not required HIE organizations. For many years, we’ve been seeking the right alignment of incentives to make health information exchange happen, and there’s a little of that in meaningful use but not a lot. I’m not sure that meaningful use is driving health information exchange organization use, and in some circumstances it’s going to be a patchwork. And there will be sometimes where formal HIE organizations are operative and assist in meaningful use accomplishment and many circumstances where they won’t.