Think it's tough being in the business of providing patient care? Try running a state health information exchange. While 2013 might be the watershed year for statewide HIEs that the Office of the National Coordinator for Health IT and their administration brethren hope it will be, difficult challenges stand it their way:
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- Sustainability: Where's the money to operate state health information exchanges (HIEs) going to come from once the federal government mostly curtails its grant funding in early 2014? Some HIE pioneers -- such as Micky Tripathi, founding president and CEO of the Massachusetts eHealth Collaborative -- are already predicting most state HIEs won't survive as Tennessee dissolved its state HIE and California handed off its HIE to a group at UC Davis earlier this year. Those are some of the worst-case scenarios, however. Most other state HIEs at least appear to be healthier.
- EHR penetration: While electronic health record (EHR) adoption among U.S. hospitals and ambulatory facilities continues to rise, according to stats from the Centers for Disease Control and Prevention, just more than half were connected as of last summer. A lot of the time HIEs can't receive data from or serve data to -- or collect fees for serving -- physicians mired in paper. Although that too is changing. Some HIEs are experimenting with service offerings in which they act as digital on-ramps for paper-bound providers.
- Rumors of lax security: Even when they are using EHRs, more than one-third of providers told the Ponemon Institute in a recent survey that they will not be joining their state HIE because of security, read: HIPAA compliance, risks.
We have to make sure that trust is not breached.
CEO, Ohio Health Information Partnership
Report author Larry Ponemon dismissed those risks mostly as "scuttlebutt." Dan Paoletti, CEO of Ohio Health Information Partnership (OHIP) -- the organization leading Ohio's state HIE, which comprises several public and private regional HIEs -- said his organization strives to neutralize those fears with potential HIE participants by leading off discussions outlining OHIP's policy and technical safeguards protecting patient data.
He understands how those fears exist. "This is so new. The trust is so fragile among people sharing information," Paoletti said. "We have to make sure that trust is not breached. If you have a security issue, that's right off the bat going to kill you."
Paoletti is sanguine about his state HIE's future; he feels its sustainability model -- make the hospitals pay the lion's share but make everyone pay at least a little -- is working now. OHIP is prepared for the end of federal funds in February 2014. About half of Ohio's hospitals will be contracted to participate by the end of 2013 or soon after, and by the end of June 2014 OHIP expects to have 100 or 138 facilities under its umbrella. The HIE currently enables the exchange of lab data, CCDs for hospital stays, care alerts and radiology data mainly from hospitals and specialists to primary care physicians, long-term care facilities and behavioral health practitioners.
OHIP's biggest puzzle to solve is standardizing patient care, labs and other data from hospitals and specialists, and disseminating it back to primary care physicians. Not the simplest task in a state where the health IT "haves" and "have-nots" contrast to the extreme, including facilities serving Amish populations with hitching posts in front -- and they're not there for decoration. Needless to say, not everyone has an Internet connection, let alone the latest and greatest EHR system.
Stages 2 and 3 of meaningful use, Paoletti said, will help HIEs, too, with more features mandated in EHR systems such as the federal direct messaging initiative and rules mandating radiologists, for example, push reports to patients quickly. If state HIEs can just hang on through 2013, the next couple years could be the tipping point for adoption and sustainability.