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The CIO of MGH discusses health information exchange challenges

It is well known in the health IT world that health information exchange challenges abound. The CIO of MGH discusses the challenges he has witnessed in Massachusetts.

Although Keith Jennings, CIO at Massachusetts General Hospital, is confident in the organization's decision to move to Epic Corp.'s EHR, he recognizes that "they communicate data very well between other Epic customers but not everyone else has Epic." And this can pose a problem when it comes to sharing data and providing patient care.

Some health IT experts have asserted that a promising answer to the lack of interoperability is health information exchanges. While the idea of a health information exchange may be sound -- healthcare organizations participating in a health information exchange can send and share data seamlessly -- the reality is that health information exchange challenges are many and the exchanges have not lived up to their name. Not only because, as it turns out, health information exchanges themselves are siloing data, but also because certain healthcare organizations that are integral to a patient's care aren't connected and participating in the health information exchange.

At least, that's true with Massachusetts and the statewide health information exchange, the Mass HIway, Jennings said.

"Nursing homes and post-acute facilities [for example], many of them don't even have computer systems, they're not covered under meaningful use, they're not affected that way but that's where patients go, many sick patients," Jennings said. "Your higher cost patients go after they've received acute care and the question is, how do you communicate with the care givers after [the patient has gone to] those institutions? How do they know … what happened to that patient or what [the patients' needs are] coming out of an acute care facility like Mass General? And if they have questions, how do they communicate back with the care teams here?"

Keith JenningsKeith Jennings

Jennings said that while health information exchanges were intended to facilitate the sharing of data between various healthcare organizations, it did not turn out that way. In his opinion, this is mainly because one of the health information exchange challenges is that not everyone that is involved or could be involved in the care of a patient is able to connect to the system and share data.

For example, Jennings explained that although in western Massachusetts there are five local health information exchanges, they don't necessarily reach across the entire state.

Therefore, if a patient is seeing a cardiologist in western Massachusetts, that cardiologist may be able to communicate with Cooley Dickinson, a hospital located in Northampton, Mass., but should that patient go to MGH in Boston, "there's very limited or poor electronic communication between Mass General [and] Cooley [and] that private practice cardiologist who's affiliated with Cooley Dickinson," Jennings said. "That's the piece that we're … missing."

Should that cardiologist's patient go to MGH, that cardiologist will want to know information such as what doctors at MGH did, what medications the patient took, and what procedures were done, Jennings said.

MGH's options for sharing data

Jennings explained that if a healthcare organization isn't hooked up to the state health information exchange then another option for sharing data is to log into MGH's physician gateway website in order to see a patient's documentation, test results, notes, and more.

I don't know that it's clear yet what's the best way because we have a state [health information exchange]. The question is: Why isn't everyone using it?
Keith Jennings, CIO at Massachusetts General Hospital

However, there are a few issues with this method.

"That's somewhat unsatisfying to the clinician," Jennings said. "Granted they can see [the patient's documentation, test results, and notes] but what they really wanted was to get that into their electronic record so that either they can see it when they want or if there's clinical information that could be used for clinical decision support you really want that discrete data in the system as opposed to a document you scanned in. You want the raw data."

Jennings explained that some clinicians also don't want to log in because it means they'd need to keep track of their user name and password.

"If they only send one patient a year to Mass General, then keeping track of a password to the Mass General site … becomes problematic and sometimes they won't, they don't want to do that," Jennings said.

Should the physician not want to log into MGH's physician gateway website, the only other option is to mail or fax them the patient's documents, Jennings said.

Health information exchange challenges: Fixing the system

For Jennings, the answer is unclear when it comes to trying to fix health information exchanges.

"I don't know that it's clear yet what's the best way because we have a state [health information exchange]," Jennings said. "The question is: Why isn't everyone using it?"

However, there is no doubt that health information exchanges are important he said. But it may take the next couple of years or the next decade to figure out how to untangle the health information exchange mess.

One obvious and clear way to fix this problem is to have everyone connect to one health information exchange.

"There are still people sitting on the side lines. They haven't even stepped in," Jennings said. "I think there would be benefit if we could get everybody to dip a toe in the water and over time we'll get the pool at the right temperature."

Have you run into any health information exchange challenges on your state HIE? Let me know; shoot me an email at or find me on Twitter at @Kristen_Lee_34.

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What issues have you encountered with your state HIE?
Mr. Jennings makes some excellent points regarding the state of HIEs and their role in driving interoperability. There are, without question, challenges that still need to be overcome before we can suggest that we have achieved the end goal. That said, I have to take issue with these statements made in the article:

"the reality is that health information exchange challenges are many and the exchanges have not lived up to their nameNot only because, as it turns out, health information exchanges themselves are siloing data, but also because certain healthcare organizations that are integral to a patient's care aren't connected and participating in the health information exchange."

While suggesting that "Health Information Exchanges have not lived up to their name" may be provocative, such a sweeping generalization is hardly "the reality". Mr. Jennings accurately frames his experience with patient data exchange in the context of the state of Massachusetts. That's because at this stage of development, most health information exchange activity is state specific (there are SEVERAL competing initiatives underway right now to develop a national system of health data sharing). Making any sort of apples to apples comparison is extremely difficult because the organizational structures of HIEs, and the regulatory environments in which they operate varies widely from state to state. Some states have one centralized state-sponsored echange, while others have a "network of networks" made up of multiple private HIE companies. To have a conversation with one individual in Massachusetts or Arizona and apply their local challenges on the entire industry is, in my opinion, an inaccurate oversimplification of a complex issue. 

Is competitive data blocking a challenge that inhibits successful health data exchange? Certainly. But just last week, the Executive Director of Great Lakes Health Connect (Michigan's leading Health Information Exchange) made the case for your readers as to why HIEs are NOT data blocking. Simply stated, as contractually obligated Business Associates of their participating provider organizations, HIEs can't data outside of their contractual commitments, because they do not own it. HIE's are granted access to data by their participating providers in order to facilitate communication among all those contributing to the network. 

Lastly, it is true that there are significant portions of the healthcare delivery ecosystem that have still to be connected and engaged in active data sharing. The struggle as illustrated in Mr. Jennings' example is real. My response is that Rome wasn't built in a day. The healthcare system as it exists took decades to build, and is extraordinarily complex. By comparison, electronic Health Information Exchange as a concept has been around fewer than 10 years, and is evolving at an incredibly fast rate. It is unrealistic to expect that we can simply flip a switch and have a fully functional perfect working model. Health information exchange IS however making impressive and encouraging strides forward every day, and will play an integral role in ushering in a new era for healthcare delivery that is patient focused, high quality, and value driven.

For glimpses into this future, I recommend you explore the efforts underway in Michigan, Delaware, Colorado, and Indiana just to name a few. I think that you will see that claims of HIEs not living up to their name have been greatly exaggerated.