Over the past couple of years, health information exchange (HIE) has come to mean two things. First, it is simply the exchange of health information (i.e., the verb). Second, it refers to the organizations whose mission is to support the exchange of health information between healthcare organizations and providers (i.e., the noun). Despite the obvious connection between HIE the noun and HIE the verb, the two are not inseparable. In fact, developments over the past several months and emerging trends likely to take place in the coming years show that the exchange of health information can occur without the use of health information networks or organizations (much to the chagrin of the latter).
So what trends can you expect to see in 2013 and beyond? John Loonsk, MD, FACMI, Chief Medical Information Officer at CGI and former Director of Interoperability and Standards in the Office of the National Coordinator for Health Information Technology (ONC), has identified several trends to look for in HIE.
1. The rise of private HIE:
According to Loonsk, the care delivery reforms driven by the Affordable Care Acts will require that healthcare organizations and providers have their own capacity to exchange health information to support forms of accountable care:
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.
2. The promotion of personally-mediated HIE
The Blue Button championed by the ONC and the Department of Veterans Affairs has given patients the ability to access their electronic health information although there is still a ways to go:
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.
3. Two models for supporting HIE
Two paths will emerge for the exchange of health information with very different approaches to governance:
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.
* Care Connectivity Consortium (CCC)
** 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:
4. The rise and fall of state-run HIEs
As Loonsk notes, the ONC has moved toward a position of “having more of a policy role than an operational role,” but the work already done by some states has demonstrated that they “have continued to advance operational roles and some of those are matured or really maturing now.”
That being said, many areas of the country will experience setbacks. “And in some states we’ll probably see stalling or diminishing efforts at state operational levels because a lot of the national policy has been to de-emphasize this and to focus more on pushing data and meaningful use relative to incentives for data exchange,” says Loonsk.
5. The tenuous role of HIEs in meaningful use
After a rather heated ONC Town Hall session at HIMSS13, it has become clear that the EHR Incentive Programs, beginning with Stage 2 Meaningful Use, do not necessarily look to HIEs to support the former’s efforts to motivate eligible prfessionals and hospitals to exchange health information:
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.
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