The Health Information Exchange is a key enabling technology in healthcare reform in the United States, and conceptually a seminal step in B2B partner integration. Its intent, to standardize and unify the management of private clinical data, is not only progressive but essential in the emerging architecture of healthcare systems that must be efficient, highly responsive, and pervasive across the industry and its ancillaries.
But the evolution of HIE standards is outpacing the speed with which healthcare partners can adapt, creating bottlenecks in the growth of industry adoption of improved methodologies, necessary for support of the provisions of the Affordable Care Act.
The need for innovation was stressed at this year’s Health Information and Management Systems Symposium, held in Orlando in February. Keynote speakers addressed the issue in a session titled, “Innovation Drives Value in HIE.”
“There should be a free and easy exchange of [personal health] information,” said Brian Patrick Kennedy, health reform advocate and Rhode Island state representative, “because if you need to in and see a doctor, and another doctor has previously seen you about something else, that information should all be together in that medical record so that you don’t have to have another procedure, for example, or another test…” Patrick delivered the keynote remarks that opened the symposium along with Dr. Michael Hankins.
“One of the key benefits of the whole health information exchange is that the portability of that record, that brings along all the information that’s in that record, so that when you go to see a doctor or a specialist…all of that information is gathered together.”
Included in that clinical data is information useful to every participant in the delivery of healthcare: the patient, clinicians, specialists, hospitals, suppliers, pharmacies, and health insurance companies.
HIE standards, useful as they are, nonetheless present a huge challenge to many participants in integrated healthcare, due to the rapidity with which they are evolving. Each year, HIMSS reports on industry uptake of the revised standards – and, each year, many entities in the healthcare delivery system remain behind.
An example of this is the Stage 2 Meaningful Use Rules, which represent a major step forward in secure information exchange between healthcare delivery participants, including common implementation specifications for electronic information exchange, rules for formatting structured data, coding for procedures, medications, lab results, diagnoses, and other clinical data, various status codes, care plans, and medical diagnostic data. (The Meaningful Use adoption deadline is July 1.)
But implementing the standard is easier said than done. Stage 2 requires providers to complete two years of participation in comformity to the standard; but enough participants are lagging behind in implementation that Stage 2, which commenced over a year ago, has been extended into 2016.
According to the US Department of Health and Human Services, barriers to implementation include restrictions imposed upon providers who do not meet the required security standards; lack of reliable source data from government organizations feeding data into the system; and the failure of some providers and participants to meet eligibility requirements for participation.
But one of the biggest shortfalls, according to a survey of CIOs in health information management, is that HIE standards have outpaced the evolution of computerized provider order entry systems. The initial point of entry for medical records, the computer systems in the offices of doctors and specialists, do not measure up to the standards now in place among other participants in healthcare delivery.
“Policymakers and other stakeholders should consider strategies that maintain the critical elements of Meaningful Use,” the survey read, “while adequately supporting hospitals that desire to become Meaningful Use [compliant] but are impeded by specific technological, cultural and organizational adoption and use challenges.”
With the Meaningful Use adoption deadline looming, many organizations are scrambling to complete technological upgrades in order to come into compliance; many will succeed, some will not. But the impetus – the advancement of industry initiatives accommodating healthcare reform in general and the Affordable Care Act in particular – is strong, and the technological inertia is undeniable. HIE has assumed a unique and prominent stature among B2B integration initiatives.
The evolution of health information standards is greatly increasing interoperability, and in upcoming phases of its evolution will enable new models of care delivery. Despite the growing pains, HIE is providing a positive demonstration of the complexity and high standards that integrated partnership can accommodate.