Alongside the meaningful use of certified EHR technology in the EHR Incentive Programs, the Office of the National Coordinator for Health Information Technology (ONC) has also pushed the need for the adoption and sustained use of health information exchange (HIE). Beginning Stage 2 Meaningful Use, eligible hospitals and professionals are expected to exceed certain thresholds for HIE around transitions of care (ToC). On the surface, it would appear that meaningful use is a complement to HIE and in many ways a driver.
In actuality, the EHR Incentive Programs could very well be hindering the increased exchange of health information as well as the capacity for analyzing large stores of patient data. “Meaningful use: Fantastic, good drivers; but what a way to stop HIEs,” Paul de Bazin, Portfolio Manager for Orion Health, told EHRintelligence.com in a sit-down during HIMSS13.
It’s not that meaningful use runs counter to HIE. The crux of the problem is that the push to achieve Stage 1 and Stage 2 Meaningful Use has tied up many providers’ resources. Relating a story from one of his colleagues at Orion Health, de Bazin reveals scenarios in which healthcare organizations have signed on as participants for an HIE but haven’t followed through with the activities necessary to facilitate a real connection to a health information network (HIN). “They’re all focused on Stage 2 Meaningful Use. That’s a pretty typical story we’re seeing,” claims de Bazin.
What stands in the way of meaningful HIE is the right mixture of politics and resources. “We’ve seen that some organizations are really organized — Inland Empire’s a good story because they already had the political will within the organization to get it done,” explains de Bazin of the California HIE which launched its pilot in January 2012 and continues to grow its network. “In the end, it’s not the technical challenges that are the barriers, the hurdles. It’s all about the politics and these days more than the politics, it’s about the resources.”
The resources in question are not financial (albeit directly) or technological. What is lacking is a labor force with the right amount of expertise and time to focus on the project of connected a health system to a local or regional HIE:
It’s people. Healthcare IT is fairly specialized. You’ve only got a certain number of people in the organization who can deal with it. Even just brining in contractors or things like that, you need someone who knows the local run of the mill or lay of the land.
Until these connections are finally made, healthcare organizations and providers won’t be able to realize and appreciate the true benefits of exchanging health information with other providers. “Once we get over that hurdle of getting people connected, we found that you need to get beyond your organization’s boundaries — beyond your four walls — and then you’ll get the real value,” adds de Bazin.
HIE and the organizations responsible for facilitating this exchange are experiencing the growing pains of an emergent technology. The problematic is that without sufficient buy-in from providers, HIE won’t be able to produce meaningful information on a scale that can improve care coordination and patient outcomes.