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The recent rise in EHR adoption and participation in the Medicare and Medicaid EHR Incentive Programs has spurred an increase in the exchange of health information. Several health systems across the nation have supported private and/or state-based HIEs to exchange patient continuity of care records.
Motivated by an underwhelming level of HIE activity, ONC released its Shared Nationwide Interoperability Roadmap in January. The document outlines the ONC's strategy to boost interoperability over the next 10 years, including new regulations and policy updates to secure a greater chance of success. The document is a framework in which true nationwide health IT interoperability can be achieved. It also addresses some of the following predicted barriers the healthcare industry will be faced with on its journey:
Standardization of electronic health records: To achieve true interoperability, healthcare entities such as hospitals, HIEs and other care facilities must be able to adopt and use a common data standard, regardless of what EHR or other health IT systems they deploy. As a result of meaningful use criteria, all certified EHR applications could support the Consolidated-Clinical Document Architecture, or C-CDA.
The ONC has indicated that it is looking to encourage wider adoption of a newer standard. CDA Release 2.0 contains far more meaningful health information content and will further enhance the value of the data being transmitted. However, switching to a new standard would be time-consuming because it would force software vendors to upgrade and test all current systems against the new standard.
Overall costs of integrations and system readiness: Many organizations see that the expenses of participating in an information exchange go beyond the cost of systems integration. Many EHR products will require the purchase of upgrades to function with a new interoperability standard. Additional systems training and changes to the workflows of the IT department and other employees may also prove costly. The ONC has signaled that it will likely offer future incentive programs to help providers offset the costs of meeting interoperability standards.
Limited federal and state policies: Eligible hospitals and professionals that are meaningful users of EHRs have avoided reimbursement reductions from Medicare and Medicaid. In doing so, they have also met some of the baseline requirements for interoperability. However, there are still policy gaps. There needs to be much clearer set of requirements to make a more serious push for nationwide interoperability.
Lack of trust in public HIE plans: While it is accepted that long-term HIE adoption hinges on the sharing of meaningful health data, the best way to approach this is unknown. The majority of independent physicians don't have faith in public HIEs, with 94% of them waiting on healthcare payers to play a major role in funding HIE development. That was among the findings of a recent survey on health information exchange done by Black Book Market Research.
Interoperability would cause more security concerns
As more physicians link to HIEs, it will create another area of vulnerability for patients' health information. Policymakers will have to make note of data breach and cyberattack patterns and adjust regulations to keep HIE participants protected from such threats.
The ONC has put its spotlight on interoperability. The release of the Shared Nationwide Interoperability Roadmap and a new round of HIE funding announced by HHS and the ONC signal that 2015 and beyond will be focused on improving the secure sharing of healthcare information.
About the author:
Reda Chouffani is vice president of development at Biz Technology Solutions Inc., which provides software design, development and deployment services for the healthcare industry. Let us know what you think about the story; email firstname.lastname@example.org or contact @SearchHealthIT on Twitter.
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