Feds outline plans for electronic exchange of patient information

U.S. has given out $5 billion in EHR incentive payments to 76,000 healthcare providers

The U.S. government expects to provide both money and standards guidance to encourage healthcare providers to deploy and use health information exchanges (HIE) in a manner similar to the way electronic prescription technology was deployed and adopted.

During a webinar Wednesday, Claudia Williams, director of the State HIE Program at the U.S. Office of the National Coordinator (ONC) for Health Information Technology, said the public process to establish standards for HIEs will begin "very soon" after the comment period ends for Phase 2 rules for meaningful use of electronic health records (EHRs). That comment period ends May 7.

The ONC will first publish a request for information, followed by a notice of proposed rule-making and then a final rule.

Williams said the government does not intend to set up HIEs or restrict them to one type -- whether national, state, regional, public or private. The government's role will be to establish the vocabulary and the code sets to ensure information contained in electronic health record (EHR) systems can be exchanged no matter which network platform is used.

"A national health information network is a set of standards, services and policies that allow information to flow across the Internet in a safe and secure way. We also do not expect there will be one solution, or one architecture or a one-size-fits-all [approach]. We think multiple approaches will sit side by side," Williams said.

The government will use both grant incentives and penalties to encourage providers to exchange information in a certified way. Williams called the HIE program "voluntary" but with a validation process. Criteria will focus on data transport, querying, provider directories, privacy and security expectations, and business practices of every validated entity.

Williams said some state HIE grantees, like Texas, are offering vouchers to healthcare providers to purchase exchange services today.

HIEs will allow physicians to exchange patient treatment data, prescriptions and radiological images such as X-rays, with other medical facilities. Standardizing data transfer protocols will allow that information to be exchanged with non-affiliated facilities. For example, a specialist from a cancer treatment center could share test results with a patient's primary care physician in a different hospital network or different part of the country.

With regard to helping to build state-level HIEs, the ONC will focus on standards for electronic prescriptions, the exchange of patient care summaries, lab test results, public health statistics reporting, and overall patient engagement in healthcare.

Williams said the ONC recognizes that "every state is different, so there cannot be a cookie-cutter approach."

"You'll see a wide variety strategies ... depending on what's already in place in a state. We're focusing our efforts on the certification part of it. It's not that we want to be the builder. What we want to do is have the standards, the policy and the services that we're enabling through our regulations and through our standards work," she said. Williams explained that the government will also be consulting with the private sector to establish the "building block" needed to create cheap yet effective exchanges.

"We think of exchange and interoperability as a journey and not a destination. We're not going to be done this year. We're not going to be done next year, but we're going to be continually evolving," Williams said. "We're going to be moving quickly into a world where care coordination and care management [are] across [a network] that's distributed."

$5 billion in incentive payments

Through the end of March, almost $5 billion had been paid out as incentives to 76,000 healthcare providers for deploying EHR systems, the ONC's Health IT policy committee reported on Wednesday. The payments are made to providers who meet the first of three stages of so-called "meaningful use" of EHRs, and were reimbursed for a portion of the cost of implementing them.

"Not a single hospital has been rejected. All have succeeded in getting their payments," Williams said. "We've seen tremendous progress across the board in health IT adoption."

One of the most prominent aspects of Stage 2 of meaningful use, which is undergoing a six-month comment period, is the requirement for healthcare providers to be able to share patient medical data with one another through HIEs.

However, three quarters of the time, primary care providers don't get simple discharge information from hospitals on their patients, said Williams, citing the latest survey figures from 2010.

"Only 20% of hospitals are exchanging clinical records electronically in 2010," Williams said. "A lot of information is not getting to its desired destination quickly enough or accurately enough. We're in a world where a lot of patient-information sharing still occurs on paper."

Williams pointed to the approach the government took to promulgating electronic systems for prescribing medications as a model for the push to deploy patient data exchanges. E-prescription technology was adopted quickly in 2009 and 2010 because the government not only offered both penalties and incentives to insurance payers and healthcare providers, but also standardized a method for deploying the technology, Williams said.

E-prescribing tools were used by 58% of all physicians in 2011, up from 10% in 2010. In 2011, 570 million prescriptions were routed electronically, according to a national progress report from e-prescription giant Surescripts.

"I think what we're looking to do is put in place the same building blocks of motivation, of standards, of incentives, and of professional expectation that have really driven such a rapid increase in e-prescribing," William said.

The ONC expects that HIE adoption will climb quickly this year with the more rigorous requirements in Stage 2 of meaningful use. Standards for information exchange will also spur adoption by driving down the cost of exchanging data between healthcare facilities. Williams said laws spurring insurance payment reform, which will focus on the quality of care and its outcome and not the amount of care provided, should also help spur HIE adoption.

"Our goal is to have information follow patients wherever and whenever they seek care and support better care coordination," she said.

The HIE marketplace is a cornucopia of services, both public and private.

Health exchanges growing

The federal government has already poured millions of dollars into creating regional and state level HIEs that act as engines for providers to exchange patient information. The federal government is also in the process of developing a Nationwide Health Information Network, which it hopes will make it possible for a patient's health information to travel anywhere the patient goes.

Private vendors, such as Verizon, have also created cloud-based patient health information exchanges.

Yet the health information exchange market is still nascent.

Hospitals and private practices will likely focus on creating private regional HIEs (RHIO) that will provide standards-based connections among organizations in a particular region, as promoted by Integrating the Healthcare Enterprise (IHE) and Health Level Seven International (HL7).

HL7 and IHE are global nonprofit organizations involved in developing standards for the interoperability of healthcare information technology. The term HL7 is also used to describe those standards based on the Open Systems Interconnection (OSI) model. IHE promotes HL7 and standards such as Digital Imaging and Communications in Medicine (DICOM), which is focused on enabling providers to share digital images.

Williams said the federal government recognizes that there won't be a single model for deploying HIEs, although it wants a single standard for exchanging the data so that all HIEs can speak the same language. The existence of different protocols for data exchange is making HIEs expensive to deploy, she said.

"Exchange volume is relatively low, and the cost of exchanges is often higher than we would like," Williams said. "[But] we're seeing that 70% of hospitals say they plan to invest in HIE services this year."

Lucas Mearian covers storage, disaster recovery and business continuity, financial services infrastructure and health care IT for Computerworld. Follow Lucas on Twitter at @lucasmearian, or subscribe to Lucas's RSS feed . His email address is lmearian@computerworld.com.

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