- A survey of healthcare providers in six states highlights a multitude of technical, financial, and regulatory challenges affecting their ability to participate in health information exchange.
Incentives tied to meeting meaningful use requirements and healthcare reform are prime motivators in increasing provider interest and participation in the exchange of health information, according to the NORC at the University of Chicago report presented to the Office of the National Coordinator for Health Information Technology.
However, statewide HIE capabilities fall short of enabling provider to share health information effectively in the states surveyed.
"Currently, private and state-led entities and point-to-point connections meet the need for infrastructure and services," write the authors of report. "However, the combination of expanded meaningful use requirements for HIE in 2014 and payment reform increases the need for more sophisticated exchange that cannot be met by point-to-point exchange."
According to survey respondents, the use of point-to-connections will prove inadequate in meeting future meaningful use requirements for health data exchange. So too will they for value-based arrangement, such as accountable care organizations, that require primary care providers to coordinate care and share information with home health and long-term post-acute care settings.
"Although the EHR Incentive Programs did not provide incentive payments to home health and long-term care providers, hospitals will likely draw these providers into exchange to reduce readmissions and duplication of services under payment reform, through public, private, or a hybrid approach to exchange," the authors note.
Cost presents a lingering challenge for providers and HIE adoption. A significant cost comes from EHR vendors charging for interfaces, service fees, and upgrades:
These costs have become a key impediment to connectivity. When EHR vendors charge between $15,000 and $70,000 for provider interfaces (some estimate between $13,000 and $22,000 for smaller provider practices) organizations have to evaluate competing projects (e.g., EHR upgrades, HIE functionalities, and non-health IT priorities) to determine their capacity to allocate resources.
Respondents from critical access hospitals indicated that these costs are a barrier to participating in health data exchange at a community, let alone a state, level.
Healthcare organizations must likewise determine whether HIE is worth diverting funds from competing priorities:
Providers sometimes viewed HIE services as “nice to have.” In Wyoming, many hospitals were in the midst of upgrading their EHRs to meet Stage 2 meaningful use requirements when they needed to shift focus to ICD-10. These hospitals simply did not have the capacity (organizational or financial) to focus on HIE during ICD-10 implementation. Similarly, several providers in Iowa felt other priorities, including ICD-10, PCMHs, and the Medicaid SIM grant, temporarily overshadowed efforts of the State HIE Program.
Some providers also encounter vendor-related in other areas — either EHR and HIE vendors are not ready to enable HIE services or they prioritize meaningful use-eligible providers at the expense of their non-eligible counterparts.
The remaining HIE challenges for providers in the study were in the areas of EHR interoperability and data availability. Variation in health IT standards implementation has required providers to rely on alternative methods for exchanging health information (e.g., direct secure messaging), which are not viable solutions to true interoperability. As for clinical data availability, provider access to small data stores could have a lasting impact on their willingness to use HIE services.
"Providers across states noted HIE systems need to ensure providers are able to find patient information easily and readily when they initiate a query," the report states. "If query functionality is enabled before there is enough data available, providers may search several times without finding what they are looking for, creating a perception of limited value of HIE."
Ultimately, survey respondents put their faith in state-based HIE efforts as a means of removing these obstacles by bringing various stakeholders together to reach a consensus.