Innovation is not what Health Information exchanges are focusing on right. The reason is that there is enough work pending to be done on improving deployment rates performance and usability. The Stages 2 and 3 implementation of the Meaningful Use program have HIEs as a major component. Its adoption although in higher single digits now has been steady. In the process there have been multiple instances of vendors exiting from the market and more expected to follow suit. Overall, their impact on better care co-ordination and interoperability has started becoming evident. A governance framework has been setup by the Office of the National Coordinator for Health IT to provide a guiding model for HIE governance. According to the framework, there are four principles of paramount importance which should pervade all governance models. These principles in reality are not binding in any form and are expected to act as guidance. The four tenets include:
- Trust: on matter involving patient privacy, meaningful choice and data management
- Business: Transparency in operations and finances
- Technical: Use standards to implement principles and further interoperability
- Organizational: Identify the best approaches to achieve the means
Reports done by surveys have indicated that HIEs have achieved commendable progress in areas like portal access, orders and results, and clinician messaging. The aim is to try and achieve a state where information related to a patient can flow electronically across organizations, vendors and geographic boundaries. A national information exchange governance forum has been also created to make it possible for the best practices followed across regional HIEs to be shared. This is not only going to help the members but also a go a long way is assuring privacy and security of electronic exchange.
Some of the areas in where HIEs are falling short of expectations include notifications and alerts, queries across networks and clinical alignment. Other issues of concern include the variability of technical standards and policies related to who should have access to patient information. All these are acting as major hurdles which need to be overcome. The stakeholders are looking up to ONC to find solutions to these issues. One of the suggestions put forth is to define the baseline standards and modify them when the market by and large moves to it. But all future standards and related certifications have to be such so has to enable complete interoperability. For e.g. an EHR which receives data should be able to use right away. This will also require a synergized effort directed towards making key stakeholders IT literate with in quick time. They will need to be aware of all the relevant technical standards and protocols related to data exchange. ONC on its part has acknowledged the concerns of the stakeholders and is constantly taking feedback from vendors, providers and others involved enabling them to suggest solutions. That matters are in a state of flux and that solutions will have to evolve with time is understood by all.
Given how things stand today, HIEs are more or less to be looked upon as startup businesses. People who currently are and will be part of the workforce will need to have a set of diverse skills. They will be expected to learn and deliver as various models start taking shape. From governance to policies to technical infrastructure, everything is expected to evolve into something tangible and reliable in the future so as to ensure long-term sustainability. All the neo care concepts which are being promoted like patient-centered medical home and population health management depend heavily on information exchange. Also, with the widespread use of electronic health records, HIE will end up a “necessary tool“ for providing affordable and high quality care. In fact many leaders in the Health IT have recommended that the best way to further HIE adoption could be by showing its value to healthcare reforms rather than pushing it as a regulatory step.
Healthcare software testing can be an eye-opener in this case as well. The feedback collated from user acceptance testing can also help provide insights into the needs of the patients and users of the systems. If there is a regular mechanism to test and record the feedback, that would also help HIEs.